51
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Okazumi S, Yamamoto H, Enomoto K, Isono K, Ryu M. [Evaluation of oxygen metabolism, blood flow and blood volume of liver cancers using 15O and positron emission tomography]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 1991; 49:1868-72. [PMID: 1664894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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52
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Okada S, Okazaki N, Haniya K, Kurita S, Tsuchiya Y, Ohto M. [Ultrasonography in the early diagnosis of cholangiocarcinoma]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 1991; 49:1789-93. [PMID: 1664881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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53
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Yoshikawa J, Matsui O, Takashima T. [Angiography in the early diagnosis of cholangiocarcinoma]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 1991; 49:1794-8. [PMID: 1664882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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54
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Nagaoka T, Ohkawa S, Ito Y, Tamai S, Tarao K, Sugimasa Y, Takemiya S, Okamoto T, Kameda Y, Yamaguchi M. [A case of minute cholangiocellular carcinoma which was found in the follow-up periods of liver cirrhosis and was indistinguishable from hepatocellular carcinoma on hepatic angiography]. NIHON SHOKAKIBYO GAKKAI ZASSHI = THE JAPANESE JOURNAL OF GASTRO-ENTEROLOGY 1991; 88:1369-74. [PMID: 1653864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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55
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Granov AM, Tarazov PG, Ryzhkov VK, Noskov AA, Polysalov VN, Derkach VI, Dmitrieva IA, Gapchenko EM. [Embolization of the hepatic artery in the treatment of malignant tumors of the liver]. Khirurgiia (Mosk) 1991:80-6. [PMID: 1648150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The results of therapeutic hepatic artery embolization (HAE) in 25 patients with malignant unresectable tumors of the liver are discussed. The proximal segments of the hepatic artery were occluded by metal spirals. Thrombosis of the portal vein was accepted as an absolute contraindication for HAE, and a tumor involving more than 50% of the volume of the liver and chronic hepatic insufficiency were considered relative contraindications. After the intervention signs of subjective improvement were noted in 73.9% and signs of objective improvement in 65.2% of cases. The mortality after HAE was 4.2%. The obtained results are evidence of the efficacy of proximal HAE as a method for the treatment of inoperable malignant tumors of the liver.
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56
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Lawrence TS, Dworzanin LM, Walker-Andrews SC, Andrews JC, Ten Haken RK, Wollner IS, Lichter AS, Ensminger WD. Treatment of cancers involving the liver and porta hepatis with external beam irradiation and intraarterial hepatic fluorodeoxyuridine. Int J Radiat Oncol Biol Phys 1991; 20:555-61. [PMID: 1847363 DOI: 10.1016/0360-3016(91)90069-g] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A Phase I/II clinical trial was designed for patients with malignancies of the liver and porta hepatis. This protocol employed three concepts: a) boost treatment to gross tumor within the liver for selected patients, determined by the dose-volume histogram (DVH) of the normal liver that would be irradiated by boost treatment; b) concurrent use of intraarterial hepatic 5-fluorodeoxyuridine (FdUrd) as a radiosensitizer; and c) hyperfractionation (1.5 Gy fractions given bid greater than 4 hr apart). This report describes the results of treatment of the first 33 patients entered onto this study, with a minimum follow-up of 1 year. Twenty patients received only whole liver irradiation (33 Gy). Thirteen patients were treated with whole liver irradiation (30 Gy) plus a 15 Gy (6 patients) or 30 Gy (7 patients) boost (total 45 Gy and 60 Gy to the tumor, respectively). Forty-eight percent of the evaluable patients (14/29) had an objective response, based on CT scan. The median duration of response was 8 months. The chief toxicities were fatigue, nausea, gastritis, and diarrhea, which were less than or equal to grade 2 in severity. Two patients developed mild radiation hepatitis which was treated successfully with diuretics. These data suggest that the treatment of intrahepatic malignancies can be guided by the concept of DVH analysis of the normal liver to allow the safe administration of doses of radiation that are potentially tumoricidal and are well above those that would be predicted to be tolerable for the whole liver.
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57
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Wetter LA, Ring EJ, Pellegrini CA, Way LW. Differential diagnosis of sclerosing cholangiocarcinomas of the common hepatic duct (Klatskin tumors). Am J Surg 1991; 161:57-62; discussion 62-3. [PMID: 1846276 DOI: 10.1016/0002-9610(91)90361-g] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although it is recognized that some other lesion may be the cause, a presumptive diagnosis of Klatskin tumor is usually made when a focal stenotic lesion of the common hepatic duct is seen on a cholangiogram of a jaundiced patient. Biopsy is so often nondiagnostic that decisions about therapy are usually made on the basis of the imaging tests and lack of evidence for some other disease. Because the accuracy and consequences of this strategy have never been tested, we contrasted the preoperative diagnosis of Klatskin tumor with the final diagnosis in 98 consecutive patients treated from 1985 to 1990. Preoperative investigations included ultrasound and computed tomographic scans, percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, and angiography. Sclerosing cholangiocarcinomas of the bile duct were correctly diagnosed in 68 cases. The final diagnosis was other than a sclerosing adenocarcinoma in 30 (31%) cases. There were 5 papillary bile duct carcinomas, 12 gallbladder carcinomas invading the bile duct, 5 metastatic tumors to the bile duct, 2 cases of Mirizzi syndrome, 3 granulomas, and 3 cases of idiopathic benign focal stenosis. Patients with papillary adenocarcinomas had an extensive filling defect of the duct, which was often thought to be unresectable. However, four of these five lesions could be completely excised, and the tumor was confined to the duct wall in all four. The outcome of surgical treatment of the other eight patients with benign lesions was good in most cases. These findings demonstrate the pitfalls of assuming that a focal stenosis of the hepatic duct represents a sclerosing adenocarcinoma. The diagnosis is much less specific than is generally thought, so there is considerable opportunity for mismanaging such patients.
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58
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Uttaravichien T, Buddhisawasdi V. Experience of non-jaundiced cholangiocarcinoma. HEPATO-GASTROENTEROLOGY 1990; 37:608-11. [PMID: 1963169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In an endemic areas of the NE region of Thailand the "liver mass" of non-jaundiced cholangiocarcinoma is another major form of clinical presentation in 14%. Between December 1983 and December 1984, twenty-nine cases of such a presentation were studied. All cases were submitted to exploration and primary tumor removal whenever possible, regardless of the severity of the pathology. The results of this palliative surgical procedure in this non-jaundiced presentation are far better as compared with the jaundiced cholangiocarcinoma, both in terms of quality of life and survival time. Among the twenty-nine cases, 14 died during the first postoperative year, 5 during the second, and 5 during the third, the remaining 5 surviving the third year and still alive and well at the end of the fifth year, in December 1988. Specific tumor markers for early detection are needed to improve surgical results.
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59
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Tartar VM, Balfe DM. Lymphoma in the wall of the bile ducts: radiologic imaging. GASTROINTESTINAL RADIOLOGY 1990; 15:53-7. [PMID: 2153595 DOI: 10.1007/bf01888735] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Extranodal lymphoma is not uncommon; however, lymphomatous involvement of the wall of the bile duct is rare, with only a few case reports available. Three cases were imaged with computed tomography (CT) and direct cholangiography at our institution. In one, Hodgkin disease recurred in the duct wall, producing a radiographic pattern indistinguishable from sclerosing cholangitis. In another, central sclerosis on cholangiography was associated with a separate liver mass identified by CT. This presentation of non-Hodgkin lymphoma mimicked cholangiocarcinoma. The third patient had multifocal, diffuse histiocytic lymphoma arising in the gallbladder and cystic duct, as well as in the kidneys and pancreas. Although the condition is unusual, the diagnosis of lymphoma in the bile duct wall should be considered, particularly when the cholangiographic picture of diffuse central sclerosis is associated with little or no observable mass on CT.
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60
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Nunnerley HB, Karani JB. Interventional radiology of the biliary tract. Intraductal radiation. Radiol Clin North Am 1990; 28:1237-40. [PMID: 2173016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
One palliative method of treating patients with a high duct cholangiocarcinoma is the use of 192Ir wire. This is placed through the tumor, which has been previously intubated, and delivers a high local dose of radiation. The mean survival time in 30 patients treated with intraductal radiation was 16.8 months, an improvement compared to surgical bypass or endoscopic and radiologic drainage procedures.
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61
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Kokubo T, Itai Y, Nagao T. Intrahepatic cholangiocarcinoma with cystic formation. RADIATION MEDICINE 1990; 8:219-21. [PMID: 1965556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We present a case of intrahepatic cystic cholangiocarcinoma with unusual radiologic appearance. Computed tomography, ultrasonography, and magnetic resonance imaging showed a cystic mass with thick wall, that mimicked liver abscess, and cystic or necrotic metastasis. The fluid in the cyst was not mucinous and was negative bacteriologically. Histologic examination showed cholangiocarcinoma with large cavities resulting from necrosis.
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62
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Murphy JR, Shay SS, Moses FM, Braxton J, Jaques DP, Wong RK. Suture granuloma masquerading as malignancy of the biliary tract. Dig Dis Sci 1990; 35:1176-9. [PMID: 2167828 DOI: 10.1007/bf01537593] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Eighteen years after having a duodenal leiomyosarcoma resected, a patient presented with weight loss, pruritus, and abdominal pain. ERCP was consistent with a cholangiocarcinoma with proximal hepatic duct stricture and nonfilling of the cystic duct. CAT scan revealed no extrinsic masses compressing the gallbladder or biliary tract. At surgical exploration, the patient was found to have a suture granuloma with surrounding fibrosis within the common bile duct. There was no evidence of malignancy.
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63
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Elkins DB, Haswell-Elkins MR, Mairiang E, Mairiang P, Sithithaworn P, Kaewkes S, Bhudhisawasdi V, Uttaravichien T. A high frequency of hepatobiliary disease and suspected cholangiocarcinoma associated with heavy Opisthorchis viverrini infection in a small community in north-east Thailand. Trans R Soc Trop Med Hyg 1990; 84:715-9. [PMID: 2177578 DOI: 10.1016/0035-9203(90)90159-c] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A group of 87 adults from a small village in north-east Thailand was chosen to undergo ultrasound investigation based on their intensity of infection with the liver fluke, Opisthorchis viverrini, or clinical status (history of jaundice, current hepatomegaly). From this group, 8 cases of suspected early cholangiocarcinoma were found, and the diagnostic features of 6 of the 8 were confirmed by computerized tomography scan and endoscopic retrograde cholangiopancreatography. In addition, several cases of mild gall-bladder disease, chronic cholecystitis, cholelithiasis and parenchymal liver disease were detected. A highly significant positive relationship between the intensity of liver fluke worm burden and the severity of biliary tract disease within individuals is reported. These results indicate that Opisthorchis is associated with moderate to severe hepatobiliary disease in a considerable proportion of infected individuals.
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64
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Takayasu K, Ikeya S, Mukai K, Muramatsu Y, Makuuchi M, Hasegawa H. CT of hilar cholangiocarcinoma: late contrast enhancement in six patients. AJR Am J Roentgenol 1990; 154:1203-6. [PMID: 2159688 DOI: 10.2214/ajr.154.6.2159688] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hilar cholangiocarcinoma usually appears on CT scans as a low-density or isodense mass that abruptly obstructs converging dilated bile ducts. In four of six patients with histopathologically proved hilar cholangiocarcinoma who had late enhanced CT 8-15 min after dynamic CT, the lesion was seen as a high-density mass instead of the low-density lesion seen earlier on unenhanced and dynamic CT scans. The other two patients had ring enhancement with evidence of a thickened wall of the bile duct both on early and late enhanced CT scans. In the first four patients, carcinoma invaded the neighboring hepatic parenchyma and produced a mass, whereas in the last two, carcinoma was localized in the wall of the bile duct. Histopathologically, all lesions consisted of adenocarcinoma associated with a dense fibrotic tissue. As late enhanced CT shows hilar cholangiocarcinoma as a high-density mass, the exact location of the tumor and its relation to neighboring vessels can be determined, especially in relatively small tumors, and differentiation from sclerosing cholangitis is possible.
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65
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Winslet MC, Bramhall S, Neoptolemos JP, Harding LK, Hesslewood SR. Diffuse increase in renal uptake of technetium 99m methylene diphosphonate in association with disseminated cholangiocarcinoma. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1990; 17:372-3. [PMID: 1962748 DOI: 10.1007/bf01268030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 48-year-old woman presented with disseminated cholangiocarcinoma and diffuse joint pain. A technetium 99m methylene diphosphonate bone scan revealed no bony abnormality, but intense bilateral renal uptake was seen. There was temporary renal impairment following imaging, but the cause of this is uncertain. An association between cholangiocarcinoma and 'hot kidneys' on bone imaging scanning has not been previously reported.
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66
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Moreira VF, Meroño E, San Román AL, Pérez F, Erdozain JC, Sánchez-Ruano JJ, Bárcena R. [Is endoscopic retrograde cholangiopancreatography useful in the diagnosis of cholangiocarcinoma?]. Rev Clin Esp 1990; 186:430-5. [PMID: 2174180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We have been interested in demonstrating the usefulness of the reverse endoscopic cholangiopancreatography, a technique already accepted in extrahepatic biliary pathology and the cholangiocarcinoma diagnosis. First of all we reviewed those cases diagnosed as cholangiocarcinoma using the REC and we found that only in 14 (60.9%) of a total of 23 cases the diagnosis was confirmed by surgery, resulting in a false positive ratio of 39.1%. In the second analysis of 22 patients who underwent surgery and whose surgical diagnosis was cholangiocarcinoma, we confirmed a correct presurgery diagnosis by REC in 14 (63.6%) with a false negative ratio of 36.3% which could be reduced to 26.3% after excluding the technically incorrect explorations or those in which only the pancreatic ductus was visualized. We conclude that cholangiocarcinoma diagnosis by REC has a high false positive or negative ratio, thus, treatment, specially non surgical, of a possibly malignant stenosis or obstruction of the bile duct can not only be based on choleangiopatic findings.
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67
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Tompkins RK, Saunders K, Roslyn JJ, Longmire WP. Changing patterns in diagnosis and management of bile duct cancer. Ann Surg 1990; 211:614-20; discussion 620-1. [PMID: 1692678 PMCID: PMC1358236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An analysis of 186 patients treated for bile duct cancer at UCLA Medical Center from November 1954 to December 1988 demonstrated improvements in several areas of diagnosis and management. Comparison of 96 patients treated between 1954 and 1978 (group 1) with 90 patients treated between 1978 and 1988 (group 2) showed earlier diagnosis and treatment in group 2 (2.1 months from onset of symptoms) than in group 1 (4.9 months; p less than 0.05) and this was correlated with increased use of ultrasonography, computed tomographic (CT) scans, transhepatic cholangiography, and endoscopic retrograde cholangiopancreatography. Operative mortality rates were lower in group 2 (4%) than in group 1 (12%) and the difference was most marked in patients with upper-third lesions, where resections in group 1 had a 23% operative mortality rate but group 2 resected patients had zero mortality (p less than 0.001). A program of operative staging and selection of patients for resection or palliative procedures has resulted in better operative risks with no deterioration in survival.
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68
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Zwicker C, Langer M, Astinet F, Langer R, Urich V, Felix R. [Differentiation of malignant liver tumors using rapid dynamic CT]. ROFO-FORTSCHR RONTG 1990; 152:293-302. [PMID: 2157252 DOI: 10.1055/s-2008-1046871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this prospective study 39 patients with malignant liver tumours were examined by rapid CT. CT was performed before contrast, as dynamic CT, with and without table movement and, in some patients, images were obtained four hours after contrast injection. Time/density curves of hepato-cellular carcinomas (nine cases) showed more rapid and more intense enhancement of the tumour than of the liver parenchyma, whereas tumours of biliary origin (ten cases) showed a slower and less marked enhancement than surrounding tissue. In addition, it was possible to differentiate hypovascular metastases (18 cases) and hypervascular lesions by means of the time-density curve. Best diagnostic information was obtained by dynamic bolus CT. This method without table movement is best for differentiating focal lesions, whereas dynamic CT with table movement shows the extent and number of tumour lesions.
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69
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Ishizaki Y, Itoh T, Shibayama K, Takami M, Shimada K, Nomura Y, Shimomura K, Idezuki Y, Terano A. [A case of cholangiocarcinoma who showed mimicking appearance of primary sclerosing cholangitis on the cholangiography]. NIHON SHOKAKIBYO GAKKAI ZASSHI = THE JAPANESE JOURNAL OF GASTRO-ENTEROLOGY 1989; 86:2606-10. [PMID: 2557470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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70
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Leitha T, Stümpflen A, Gebauer A, Amann G, Dudczak R. "False positive" immunoscintigraphic diagnosis of liver abscesses in a patient with a necrotic liver tumour. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1989; 15:673-5. [PMID: 2553415 DOI: 10.1007/bf00251683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The following report describes the scintigraphic findings in a patient who underwent immunoscintigraphy with anti granulocyte Mab because of septic fever. Focal tracer accumulation in the liver corresponding with hypoechoic and hypodense areas documented by sonography and computed tomography was believed to represent liver abscesses, yet surgery and autopsy revealed a large necrotic cholangiocellular liver carcinoma. The possible mechanisms, which had led to the false positive immunoscintigraphic image are discussed and we conclude that a necrotic neoplasm has to be a major differential diagnosis in any case of positive liver uptake in an anti granulocyte scan.
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71
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Abstract
The authors studied the computed tomographic (CT) images obtained in 56 patients with pathologically proved biliary cancer and 75 patients with no evidence of biliary disease, attempting to define the normal anatomy of the lymphatic system draining the bile ducts and the prevalence of extrahepatic spread of primary biliary cancer into these retroperitoneal planes. Of 20 patients with gallbladder cancer, 14 (70%) had proved adenopathy and nine (45%) had peritoneal spread at presentation, and another three later developed carcinomatosis. Of 22 patients with proximal cholangiocarcinoma, 16 (73%) had nodal involvement at presentation, four later developed adenopathy, and five had peritoneal dissemination. Distal or diffuse cholangiocarcinomas were less associated with metastatic nodes or peritoneal spread. For all biliary cancers, the nodes most commonly involved were the node of the foramen of Winslow, the superior pancreatoduodenal node, and the posterior pancreatoduodenal chain. Extrahepatic tumor spread produced proximal intestinal obstruction in 13 patients (23%). CT reliably demonstrates lymphatic or other extrahepatic spread of biliary cancers, which may have an important bearing on management decisions.
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72
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Sasaki F, Kido C, Sato Y, Tateno H. Roentgenologic appearance of a thorotrast-induced small cholangiocarcinoma in a case of thorotrastosis. An autopsy case of massive gastrointestinal bleeding of esophageal varices. NIHON IGAKU HOSHASEN GAKKAI ZASSHI. NIPPON ACTA RADIOLOGICA 1989; 49:568-73. [PMID: 2552400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A small cholangiocarcinoma was detected at autopsy in a patient with thorotrastosis who died from the rupture of esophageal varices at the esophagogastric junction. Prior to the advent of recent diagnostic imaging technique, a correct antemortem diagnosis could only be obtained from tumor markers. However, the tendency for the opacity of the liver to decrease slowly with time and develop uneven trabeculation suggests that small tumors may be difficult to detect against such a non-homogeneous background.
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73
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Takayasu K, Muramatsu Y, Moriyama N, Makuuchi M, Yamazaki S, Kishi K, Yoshino M. Hepatocellular and cholangiocellular carcinoma, double cancer of the liver: report of two cases resected synchronously and metachronously. Am J Gastroenterol 1989; 84:544-7. [PMID: 2541608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Double primary liver cancer, i.e., hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC), was detected by ultrasound (US) during the follow-up of chronic liver disease, and was safely resected in two patients, one synchronously and the other metachronously. On admission, laboratory data were normal except for slightly abnormal liver function tests. One patient (case 1) had a 5.1-cm white firm CCC with several small daughter lesions around it which was enhanced late in computed tomography, and a 2.1-cm well-circumscribed HCC with a pseudocapsule; the two were situated very close to one another in the right posterior segment of the liver. Another patient (case 2) had a small 1.5-cm CCC in the anterior superior area, and 6 yr after the first resection, alpha-fetoprotein gradually increased and a 4-cm HCC was detected anew and resected; the preoperative diagnosis made by US and ethiadol-computed tomography was correct. The histopathological diagnosis of the noncancerous portion was chronic active hepatitis in both cases. However, it changed to precirrhosis in case 2 during the follow-up.
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MESH Headings
- Adenoma, Bile Duct/diagnostic imaging
- Adenoma, Bile Duct/pathology
- Adenoma, Bile Duct/surgery
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/surgery
- Humans
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Male
- Middle Aged
- Neoplasms, Multiple Primary/diagnostic imaging
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Tomography, X-Ray Computed
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74
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Itai Y, Ohtomo K, Kokubo T, Yoshida H, Minami M, Kawauchi N, Okada Y. Diagnosis of coexistent hepatic tumors of different kinds: a challenge from CT and MR imaging. RADIATION MEDICINE 1989; 7:143-9. [PMID: 2555846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Three cases of multiple, different liver tumors in the same patient were examined with CT and MR imaging. Two patients with coexistent hepatocellular carcinoma and cavernous hemangioma were correctly diagnosed by the following characteristic findings on dynamic CT and/or MR images; spreading and markedly prolonged enhancement in cavernous hemangioma, and the presence of capsule and/or transient diffuse enhancement in hepatocellular carcinoma. The third case of hepatocellular carcinoma and cholangiocarcinoma showed typical findings of hepatocellular carcinoma in one tumor and unusual complex enhancement in the other. CT and MR imaging may enable correct diagnosis to be made even in patients with multiple liver tumors of different kinds.
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MESH Headings
- Adenoma, Bile Duct/diagnosis
- Adenoma, Bile Duct/diagnostic imaging
- Bile Duct Neoplasms/diagnosis
- Bile Duct Neoplasms/diagnostic imaging
- Bile Ducts, Intrahepatic
- Carcinoma, Hepatocellular/diagnosis
- Carcinoma, Hepatocellular/diagnostic imaging
- Hemangioma, Cavernous/diagnosis
- Hemangioma, Cavernous/diagnostic imaging
- Humans
- Liver Neoplasms/diagnosis
- Liver Neoplasms/diagnostic imaging
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/diagnostic imaging
- Tomography, X-Ray Computed
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75
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Oyamada H, Yamazaki S, Makuuchi M, Hasegawa H. Clinical significance of 99mTc-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) in the diagnosis of intrahepatic masses. RADIOISOTOPES 1989; 38:244-51. [PMID: 2546192 DOI: 10.3769/radioisotopes.38.5_244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hepatobiliary scintigraphy with 99mTc-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) was carried out on 48 patients with intrahepatic masses, 44 with hepatocellular carcinoma and one each of hepatocellular adenoma, focal nodular hyperplasia, cholangiocellular carcinoma, and adenoid cystic carcinoma. Scans were performed twice, early scan (30 min post i.v.) and delayed scan (2.5 h post i.v.), and the delayed scan was used for assessing the accumulation of 99mTc-PMT in the intrahepatic masses. In the hepatocellular carcinoma group, based on individual patients, 17 out of 44 (38.6%) showed accumulation of 99mTc-PMT in various degrees; and based on individual masses, accumulation was noted in 21 out of 55 masses (38.2%). However, only the cases which had not received transarterial infusion of anti-cancer drugs (TAI) and/or blocking agents (TAE) were taken into consideration, 9 out of 18 patients (50%) and 12 out of 25 masses (48.0%) were found capable of picking up 99mTc-PMT. A case of hepatocellular adenoma showed a strong accumulation of 99mTc-PMT in the mass which was depicted as a defect on the 99mTc-colloid scan and did not show a significant accumulation of 67Ga. In a case of focal nodular hyperplasia, there were two space-occupying lesions (SOLs), one of which showed a clear-cut defect on the 99mTc-colloid scan and the other which showed only a distorted uptake pattern. However, both masses were strongly positive with 99mTc-PMT. 99mTc-PMT scintigraphy is useful in connection with 99mTc-colloid scan and sometimes with 67Ga-citrate in the diagnosis of intrahepatic masses originating from hepatocytes.
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