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Seo DW. A prospective randomized trial of Teflon versus polyethylene stents for distal malignant biliary obstruction. Gastrointest Endosc 2000; 51:633-5. [PMID: 10896487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Le Borgne J, Partensky C, Glemain P, Dupas B, de Kerviller B. Pancreaticoduodenectomy for metastatic ampullary and pancreatic tumors. HEPATO-GASTROENTEROLOGY 2000; 47:540-4. [PMID: 10791233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND/AIMS To report the clinical presentation, diagnosis and results of aggressive surgical management in patients with metastatic ampullary and pancreatic tumors. METHODOLOGY Twelve patients underwent pancreaticoduodenectomy for ampullary or pancreatic metastases from January 1, 1987, to June 30, 1998, in 2 institutions. The primary cancer was renal cell carcinoma (n = 5), melanoma (n = 2), venous leiomyosarcoma (n = 1), carcinoid tumor (n = 1), colon carcinoma (n = 1), breast carcinoma (n = 1) and small-cell lung carcinoma (n = 1). The mean interval between primary treatment and metachronous pancreatic metastasis was 88 months. In 3 cases, pancreatic metastases were synchronous with the primary tumor. The main symptoms were jaundice (n = 8) and upper gastrointestinal tract bleeding (n = 2). The principal investigations were computed tomography scan (n = 9), arteriography (n = 7), duodenoscopy (n = 6) and fine-needle aspiration (n = 4). A correct preoperative diagnosis was made for 8 patients. RESULTS In all cases, the pancreatic tumor was resected with intention to cure or provide useful palliation, using pancreaticoduodenectomy for isolated tumors (n = 11) or total pancreatectomy for multiple lesions (n = 1). Three out of 12 patents had positive lymph nodes, and the resection margin was free of disease in all cases. There was no postoperative mortality. Survival after pancreaticoduodenectomy averaged 26 months. Overall survival of patients undergoing pancreaticoduodenectomy was 35% at 2 years and 17% at 5 years. One patient is still alive more than 10 years after pancreaticoduodenectomy. CONCLUSIONS Pancreaticoduodenectomy can be performed safely, representing a suitable option for resection in patients with symptomatic or late isolated pancreatic metastases in the absence of widely metastatic disease. The best indications are solitary metastases from renal cell carcinoma, sarcoma and neuroendocrine tumors. However, there is no evidence of survival benefit after pancreaticoduodenectomy for synchronous tumors or metachronous tumors from melanoma or colon carcinoma.
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Stein M, Dong PR, McGahan JP, Link DP. Renal cell carcinoma metastatic to the biliary system--effective palliation with biliary stenting, tumour embolization and intraluminal brachytherapy: case report. Can Assoc Radiol J 1999; 50:317-20. [PMID: 10555506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
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Caballero-Mendoza E, Gallo-Reynoso S, Arista-Nasr J, Angeles-Angeles A. Obstructive jaundice as the first clinical manifestation of a metastatic malignant melanoma in the ampulla of vater. J Clin Gastroenterol 1999; 29:188-9. [PMID: 10478883 DOI: 10.1097/00004836-199909000-00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The authors report a patient with obstructive jaundice as the first clinical manifestation of a primary malignant melanoma metastatic in the ampulla of Vater. After the histologic diagnosis of the metastases was made, the primary tumor was located in the skin of the back. Obstruction jaundice secondary to ampullary obstruction due to metastatic melanoma has only been reported twice, and in neither case was jaundice the first symptom of the disease.
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Scotiniotis I, Ginsberg GG. Endoscopic clip-assisted biliary cannulation: externalization and fixation of the major papilla from within a duodenal diverticulum using the endoscopic clip fixing device. Gastrointest Endosc 1999; 50:431-6. [PMID: 10462673 DOI: 10.1053/ge.1999.v50.97369] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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31
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Meyers MO, Frey DJ, Levine EA. Pancreaticoduodenectomy for melanoma metastatic to the duodenum: a case report and review of the literature. Am Surg 1998; 64:1174-6. [PMID: 9843339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Although melanoma accounts for fewer than 5 per cent of cutaneous malignancies, it is responsible for more than 75 per cent of skin cancer deaths. Metastasis generally proceeds from regional lymph nodes to visceral organs, with the lungs, liver, brain, and bowel being most commonly affected. Herein, we report a case of malignant melanoma metastatic to the ampulla of Vater treated with a pancreaticoduodenectomy.
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Janzen RM, Ramj AS, Flint JD, Scudamore CH, Yoshida EM. Obscure gastrointestinal bleeding from an ampullary tumour in a patient with a remote history of renal cell carcinoma: a diagnostic conundrum. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 1998; 12:75-8. [PMID: 9544417 DOI: 10.1155/1998/429832] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Metastasis of renal cell carcinoma to the ampulla of Vater is a rare occurrence. The outlined case, which presented as an upper gastrointestinal bleed, is only the eighth such reported case in the English-language literature. This case is the longest reported time interval between surgical nephrectomy to presentation with ampullary metastasis at 17.5 years. The ampullary source of bleeding in this case was initially obscure and missed by conventional gastroscopy. Diagnosis was made with a side-viewing endoscope, emphasizing the usefulness of this instrument in the investigation of active bleeding from a small bowel source.
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Titus AS, Baron TH, Listinsky CM, Vickers SM. Solitary breast metastasis to the ampulla and distal common bile duct. Am Surg 1997; 63:512-5. [PMID: 9168764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The indications for pancreaticoduodenectomy have continued to expand over the past 10 to 15 years. This is in large part due to improved diagnostic studies, endoscopic retrograde cholangiopancreaticogram and computed tomography, and decreases in hospital perioperative morbidity and mortality. One third of breast cancer patients will develop metastatic disease usually to the liver, lung, or bone (World J Surg 1994;18:98-111). However, the presentation of painless jaundice due to a single metastatic lesion to the distal common bile duct from ductal adenocarcinoma of the breast is extremely rare. In this case report and review of the literature, we discuss the indications and emerging evidence that pancreaticoduodenectomies can now be performed for localized metastatic disease.
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34
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Sans M, Llach J, Bordas JM, Andreu V, Campo A, Castells A, Mondelo E, Terés J, Rodés J. Metastatic malignant melanoma of the papilla of Vater: an unusual case of obstructive cholestasis treated with biliary prostheses. Endoscopy 1996; 28:791-2. [PMID: 9007447 DOI: 10.1055/s-2007-1005618] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Miyagishima T, Ohnishi S, Chuma M, Kishimoto A, Kumagai K, Ishizuka J, Kobayashi T, Kamiya K, Fujimoto N, Kamiyama T, Ogasawara K, Hata Y, Takahashi T. Intraluminal tumor of the common bile duct as a metastasis of renal cell carcinoma. Intern Med 1996; 35:720-3. [PMID: 8915699 DOI: 10.2169/internalmedicine.35.720] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A 57-year-old woman was admitted for evaluation of liver dysfunction. A physical examination revealed jaundice and a left abdominal mass, which was diagnosed as being a large renal tumor. Cholangiography showed a smooth filling defect 1 cm in diameter at the common bile duct. Left nephrectomy, and resection of the common bile duct were performed. The pathological diagnosis was metastasis of the common bile duct wall resulting from renal cell carcinoma. Metastatic common bile duct tumors are extremely rare. However, it is important to consider that this is one of the causes of obstructive jaundice.
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Silva R, Paiva ME, Santos CC. Obstructive jaundice caused by ampullary metastases of an endometrioid adenocarcinoma. Gastrointest Endosc 1996; 44:195-7. [PMID: 8858330 DOI: 10.1016/s0016-5107(96)70142-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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37
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Longwitz D, Schulz HG, Bosse A. [Malignant melanoma of the gallbladder]. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 1996; 17:195-198. [PMID: 8999521 DOI: 10.1055/s-2007-1003180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A 75 year woman developed a primary malignant melanoma of the gallbladder. The patient presented with abdominal pain in the upper right quadrant typically seen in acute cholecystitis. Neither intravesical concretions nor cholestasis was seen. Ultrasound demonstrated hyperechogenic intraluminal "school of fish" reflections, which are typical for metastatic melanoma to the gallbladder. Intravesical fluid collection was not present. The tumor did not expand past the wall of the gallbladder. The main sonographic features are hyperdense intraluminal strands of tumor and the lack of fluid. Computed tomography showed solid intraluminal masses with hypodensive and partially hyperdensive reticular structure.
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38
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Hakami F, Hannoun L. [Intraluminal metastasis of the common bile duct from renal carcinoma]. Prog Urol 1996; 6:436-8. [PMID: 8763702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Leslie KA, Tsao JI, Rossi RL, Braasch JW. Metastatic renal cell carcinoma to ampulla of Vater: an unusual lesion amenable to surgical resection. Surgery 1996; 119:349-51. [PMID: 8619191 DOI: 10.1016/s0039-6060(96)80122-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Nakeeb A, Lillemoe KD, Cameron JL. The role of pancreaticoduodenectomy for locally recurrent or metastatic carcinoma to the periampullary region. J Am Coll Surg 1995; 180:188-92. [PMID: 7850053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The efficacy of operative resection of metastatic lesions to the liver, lung, and brain is well established. However, the appropriate management of metastatic or locally recurrent malignancies to the periampullary region is less well established. STUDY DESIGN A retrospective review of The Johns Hopkins Hospital experience with pancreaticoduodenectomy for metastatic or locally recurrent periampullary lesions was performed. RESULTS From 1988 to 1993, 27 patients with a past history of malignancy underwent pancreaticoduodenectomy. In six patients (22 percent), the lesion was determined to be from a metastasis or a local recurrence, and in 21 patients (78 percent), the lesion was a new primary. Patients with metastatic or locally recurrent lesions were younger (51.3 compared to 67.1 years of age) and presented with a shorter interval from their initial neoplasm (33 compared to 120 months). Of the six patients undergoing pancreaticoduodenectomy for a metastatic or locally recurrent lesion, three patients are alive an average of 38 months and three patients died an average of 11 months postoperatively. This compares favorably with the survival rate of the new primary group in which 12 patients are alive a mean of 22 months and nine patients died a mean of 14 months postoperatively. CONCLUSIONS These results suggest that patients with metastatic or locally recurrent lesions in the periampullary region from a previously treated neoplasm should be considered candidates for pancreaticoduodenectomy.
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Hardwigsen J, Berthet B, Le Treut YP. [Intraductal biliary metastasis: metastasis of a metastasis?]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 1995; 19:134-5. [PMID: 7720980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
Cholangiocarcinoma is an infrequent complication of inflammatory bowel disease. Although increasing numbers of cholangiocarcinomas are being reported in association with ulcerative colitis, the occurrence of this disease in patients with Crohn's disease is rare. To understand this complication better, we have reported the case of a patient with Crohn's disease in whom cholangiocarcinoma subsequently developed and reviewed the literature.
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Jones WF, Harford W, Goldschmiedt M. Removal of plastic biliary stents placed through metal stent. Gastrointest Endosc 1993; 39:601. [PMID: 7689995 DOI: 10.1016/s0016-5107(93)70195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Thompson JF, Mathur MN, Coates AS. Common bile duct obstruction due to intraluminal metastatic melanoma. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1993; 63:502-4. [PMID: 8498925 DOI: 10.1111/j.1445-2197.1993.tb00438.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Although metastatic melanoma is renowned for its propensity to spread to a wide range of sites, symptomatic metastases within the biliary tree are very rare. A patient with a past history of melanoma who presented with obstructive jaundice and in whom computerized tomography (CT) scanning revealed a spherical filling defect 1 cm in diameter at the lower end of the common bile duct is reported. The obstructing lesion was thought likely to be a gallstone. However, on surgical exploration it was found to be a polypoid melanoma metastasis, freely mobile within the lumen of the lower duct but attached to its wall by a thin stalk. There was no evidence of metastatic melanoma elsewhere in the abdomen. The tumour was removed without difficulty, completely relieving the obstructive jaundice. The patient remains well 14 months later, with no evidence of recurrent visceral melanoma.
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Asbun HJ, Rossi RL, Munson JL. Local resection for ampullary tumors. Is there a place for it? ARCHIVES OF SURGERY (CHICAGO, ILL. : 1960) 1993; 128:515-20. [PMID: 8098205 DOI: 10.1001/archsurg.1993.01420170045006] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Two of 14 patients with adenomas were without disease 25 and 43 months after ampullary resection. Two patients with an initial diagnosis of malignant neoplasm had no recurrence at 75 and 40 months; one underwent pancreatoduodenectomy at 8 months because of recurrence. Six of nine patients with initial diagnoses of villous adenoma were without disease at 1, 2, 16, 23, 46, and 51 months; three underwent conversion to pancreatoduodenectomy because of invasive carcinoma. Frozen-section studies revealed adenocarcinoma in two patients with villous adenoma but failed to show invasion in one patient. One patient with villous adenoma was mistakenly thought to have carcinoma based on results of frozen-section studies. Local ampullary resection is valuable in treating benign and selected premalignant and malignant ampullary lesions. The threshold for conversion to pancreatoduodenectomy should be low unless ampullectomy is performed with palliative intent.
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Abstract
Metastatic cancer of the prostate, presenting with carcinomatous obstruction of the common bile duct as a cause of jaundice and abnormal liver function tests is very unusual. The literature suggests an association between abnormal liver function tests and poor survivability in those patients with liver parenchymal metastases. This case illustrates that patients with abnormal liver function tests on the basis of extrahepatic ductal obstruction may have a better prognosis than those with hepatic disease.
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Kauffmann P, Le Bouedec G, Fondrinier E, Dauplat J. Intracholedocal metastatic thrombus of renal adenocarcinoma. JOURNAL DE CHIRURGIE 1992; 129:215-7. [PMID: 1527194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The authors report about the intraoperative discovery of a metastatic thrombus in the common bile duct, produced by a right renal adenocarcinoma metastasized in the Vth segment of the liver. As far as the treatment is concerned, in addition to nephrectomy, the use of a simple device allowed intraluminal irradiation with radioiridium. Although this approach is palliative, it resulted from the desire to maintain the patency of the common bile duct by controlling tumor proliferation within the duct. The pathogenesis of this proliferation is discussed. In our opinion, the favorable outcome after 18 months confirms the merits of this therapeutic attitude, which can be used for such tumoral extensions.
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Komorowski RA, Beggs BK, Geenan JE, Venu RP. Assessment of ampulla of Vater pathology. An endoscopic approach. Am J Surg Pathol 1991; 15:1188-96. [PMID: 1746684 DOI: 10.1097/00000478-199112000-00010] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
One hundred eighty-nine endoscopic biopsies of the papilla of Vater were obtained from 125 patients during a 10-year period. Chronic inflammation was the most common histologic change identified. Of the 44 patients with papillary neoplasia, 42 were diagnosed by endoscopic biopsy. Sixteen of the 18 patients with invasive carcinoma were diagnosed by biopsy. Follow-up biopsies in patients endoscopically managed demonstrated recurrent tumors in 6 of 11 patients. With advances in instrumentation and techniques, pathologists can expect to see increasing numbers of ampullary biopsies. When multiple biopsy fragments are obtained and step sectioned, the diagnostic reliability of endoscopic biopsies in patients with tumors and carcinoma is greater than 90%. The morphologic spectrum of papillary lesions is similar to that seen in the colon with some significant exceptions. Tumor morphology varied considerably from area to area. Variations were seen in the basic architecture (villous-tubular), grade of dysplasia, presence of malignancy, and invasion from fragment to fragment, and in some cases from microscopic field to field. Another notable difference between the ampulla and colon is the rich mucosal lymphatic network of the ampullary region. Thus, any carcinoma invading the lamina propria was diagnosed as invasive carcinoma.
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Bolkier M, Ginesin Y, Moskovitz B, Munichor M, Levin DR. Obstructive jaundice caused by metastatic renal cell carcinoma. Eur Urol 1991; 19:87-8. [PMID: 2007425 DOI: 10.1159/000473588] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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