Ultrasonography and computed tomography for diagnosis and follow-up of biliary duct rhabdomyosarcomas in children

Percutaneous management of tumoral biliary obstruction in children

BACKGROUND

There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures.

OBJECTIVE

To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children.

MATERIALS AND METHODS

Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis.

RESULTS

All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death.

CONCLUSION

Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children.

Botryoid rhabdomyosarcoma of the biliary tract in children: a unique case report

Rhabdomyosarcoma (RMS) is the most common tumour of the biliary tree in childhood. In children, it is a rare lesion, accounting for about 1% of all RMS. Hepatobiliary botryoid RMS is a disease affecting young children at a median age of about 3 years. In literature, the radiological findings of hepatobiliary RMS have been described in small series and some case reports. In this case report, we present a rare case of RMS of the extrahepatic biliary tree initially diagnosed as a choledochal cyst.

Aggressive surgery is unwarranted for biliary tract rhabdomyosarcoma

BACKGROUND/PURPOSE

Rhabdomyosarcoma (RMS) of the biliary tract is rare, and, in addition to multiagent chemotherapy with or without radiotherapy (RT), some investigators recommend aggressive surgery. To assess the role of surgery, records of all 25 eligible patients with biliary RMS enrolled in IRSG studies I through IV from 1972 to 1998 were reviewed.

METHODS

Treatment included surgery with or without vincristine, dactinomycin, cyclophosphamide, doxorubicin, cisplatin, etoposide, ifosfamide, and with or without RT. Data evaluated included clinical presentation, treatment, complications, and outcome.

RESULTS

Diagnostic imaging identified the primary tumor but failed to identify regional metastases. Despite aggressive surgery, gross total resection at diagnosis was possible in only 6 cases, 2 of which had negative surgical margins. Although only 6 (29%) patients without distant metastases underwent gross total resection, estimated 5-year survival rate was 78% (95% CI 58%, 97%). Infectious complications were common and frequently associated with external biliary drains. Five (20%) died within the first 2 months, 3 of sepsis.

CONCLUSIONS

Surgery is critical for establishing an accurate diagnosis and determining the extent of regional disease. Gross total resection is rarely possible despite aggressive surgery, and outcome is good despite residual disease after surgery. External biliary drains increase the risk of postoperative infectious complications.

[Primary pleomorphic rhabdomyosarcoma of the liver]

Two female adults with primary rhabdomyosarcoma of the liver were operated on in 1981 and 1987 in the Department of Surgery in the University Hospital of Hamburg-Eppendorf (Germany). In both cases a hemihepatectomy was performed. Postoperatively, the younger woman received adjuvant chemotherapy. Both patients are still alive. Both cases are reviewed with reference to the unusual findings in the liver combined with a really short history. In addition, the possibilities opened up by the diagnostic are measures discussed. Contrary to the literature, this rare malignant tumour seems to be curable if it is diagnosed early and treated while confined to the liver.