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Wu C, Yang JF, Zhang Q, Liu W, Liao K, Hu B. Successful cholangioscopic electrocoagulation for biliary papillomatosis: Report covering six cases (with video). GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 44:546-551. [PMID: 33617929 DOI: 10.1016/j.gastrohep.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/29/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biliary papillomatosis is a rare type of papillomatosis. Depending on the location of the disease, radical surgical resection or liver transplants are the treatment of choice. These radical surgical options may be unrealistic in patients who are not surgical candidates or who are unwilling to consider surgery. AIMS To evaluate the effectiveness of endoscopic electrocoagulation for the biliary papillomatosis. METHODS In this case series, we report six patients with unresectable biliary papillomatosis who underwent cholangioscopic electrocoagulation using needle knife and their clinic follow up information. RESULTS After patients received cholangioscopy with electrocoagulation of the residual biliary papilloma, the daily T-tube drainage volume increased to 200-400ml with improvement in the drainage content and significant relief of clinical symptoms, such as jaundice and abdominal pain. CONCLUSION This method of using electrocoagulation to directly target and destroy tumor tissue is a safe and effective alternative for those with unresectable disease, and this method has shown to enhance T-tube drainage volume and improve patients' overall clinical symptoms.
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Affiliation(s)
- Chuncheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Juliana F Yang
- Department of Internal Medicine, Division of Digestive and Liver Diseases, The Vanderbilt University Medical Center, Nashville, TN, USA
| | - Qiongying Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Wei Liu
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Ke Liao
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, China.
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Fan F, Xu DP, Xiong ZX, Li HJ, Xin HB, Zhao H, Zhang JW. Clinical significance of intrapancreatic choledochal cyst excision in surgical management of type I choledochal cyst. J Int Med Res 2018; 46:1221-1229. [PMID: 29322850 PMCID: PMC5972235 DOI: 10.1177/0300060517728598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/07/2017] [Indexed: 01/29/2023] Open
Abstract
Objective To investigate the effectiveness of intrapancreatic choledochal cyst excision in treating type I choledochal cyst, and increase understanding of the need for thorough surgical management of the disease. Methods Primary and secondary (including multiple) surgical cases, treated between 2005 and 2015, were retrospectively analysed, and follow-up data of post-treatment effectiveness to date were reviewed. Differences in curative effects were compared between whole and partial excision of the choledochal cyst. Results Out of 350 cases, patients with whole excision of the choledochal cyst ( n = 272) experienced no associated symptoms in the long-term (3/272 [1.1%] experienced stomach ache or fever). Patients with partial resection of the choledochal cyst ( n = 78) developed associated symptoms, including new cyst, calculus of the bile duct (51/78 [65.4%]), and carcinogenesis (11/78 [14.1%]) in the residual intrapancreatic biliary duct. Post-treatment clinical manifestations were significantly different between patients with partial resection versus whole excision of the choledochal cyst ( P<0.05). Conclusion Surgical re-excision should be considered in patients with a residual intrapancreatic portion of the choledochal cyst due to prior incomplete surgery, regardless of clinical symptoms.
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Affiliation(s)
- Fei Fan
- Department of Special Treatment II, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Da-Peng Xu
- Department of General Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Zheng-Xiang Xiong
- Department of Special Treatment II, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Hai-Jia Li
- Department of General Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Hai-Bei Xin
- Department of General Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Huan Zhao
- Department of General Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Jin-Wei Zhang
- Department of General Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
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Subramony R, Kittisarapong N, Barata I, Nelson M. Choledochal Cyst Mimicking Gallbladder with Stones in a Six-Year-Old with Right-sided Abdominal Pain. West J Emerg Med 2015; 16:568-71. [PMID: 26265970 PMCID: PMC4530916 DOI: 10.5811/westjem.2015.4.25407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/28/2015] [Accepted: 04/15/2015] [Indexed: 02/07/2023] Open
Abstract
Choledochal cysts are rare but serious bile duct abnormalities are found in young children, usually during the first year of life.1 They require urgent surgical intervention due to the risk of developing cholangiocarcinoma.2 Clinicians should consider this diagnosis and perform a point-of-care ultrasound (POCUS) when a child presents to the emergency department (ED) with findings of jaundice, abdominal pain, and the presence of an abdominal mass. We present the case of a six-year-old child presenting only with abdominal pain upon arrival to our ED and was ultimately diagnosed by POCUS to have a choledochal cyst.
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Affiliation(s)
- Rachna Subramony
- University of Massachusetts, Department of Emergency Medicine, Boston, Massachusetts
| | - Nat Kittisarapong
- Northshore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Isabel Barata
- Northshore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Matthew Nelson
- Northshore University Hospital, Department of Emergency Medicine, Manhasset, New York
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Nishant K, Singh VK, Sharma BK. Rare event of biliary papillomatosis arising in a choledochal cyst. BMJ Case Rep 2014; 2014:bcr-2014-204680. [PMID: 24990847 DOI: 10.1136/bcr-2014-204680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 31-year-old man presented with features of recurrent cholangitis for 7 months. Examination revealed icterus and a palpable 10×8 cm lump in the right hypochondrium extending into the epigastrium. Total and direct bilirubin was raised (8.4, 6.7 mg/dL). Alkaline phosphatase (468 U/L) was raised but other liver enzymes were normal. Ultrasound of the abdomen showed dilated intrahepatic biliary radicals (IHBRs) and common hepatic duct (CHD) with a significant intrahepatic portion. Contrast-enhanced CT scan of the abdomen showed similar findings. MR cholangiopancreatography demonstrated diffusely dilated IHBRs and choledochal cyst involving the CHD. The common bile duct was mildly dilated without any filling defect. Tumour markers (carcinoembryonic antigen and cancer antigen 19-9) were normal. The patient underwent complete excision of the extrahepatic biliary system including choledochal cyst and Roux-en-Y hepaticojejunostomy. Opening up the bile duct showed very thick gelatinous material and multiple pedunculated papillary type structures arising from the wall of the choledochal cyst.
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Affiliation(s)
- Kumar Nishant
- Department of Surgery, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | - Varun Kumar Singh
- Department of Surgery, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | - Barun Kumar Sharma
- Department of Radiodiagnosis, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
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Cerwenka H. Bile duct cyst in adults: Interventional treatment, resection, or transplantation? World J Gastroenterol 2013; 19:5207-5211. [PMID: 23983423 PMCID: PMC3752554 DOI: 10.3748/wjg.v19.i32.5207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/02/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
Cystic dilatations of the bile ducts may be found along the extrahepatic biliary tree, within the liver, or in both of these locations simultaneously. Presentation in adults is often associated with complications. The therapeutic possibilities have changed considerably over the last few decades. If possible, complete resection of the cyst(s) can cure the symptoms and avoid the risk of malignancy. According to the type of bile duct cyst, surgical procedures include the Roux-en-Y hepaticojejunostomy and variable types of hepatic resection. However, the diffuse forms of Todani type V cysts (Caroli disease and Caroli syndrome) in particular remain a therapeutic problem, and liver transplantation has become an important option. The mainstay of interventional treatment for Todani type III bile duct cysts is via endoscopic retrograde cholangiopancreatography. The diagnostic term “bile duct cyst” comprises quite different pathological and clinical entities. Interventional therapy, hepatic resection, and liver transplantation all have their place in the treatment of this heterogeneous disease group. They should not be seen as competitive treatment modalities, but as complementary options. Each patient should receive individualized treatment after all of the clinical findings have been considered by an interdisciplinary team.
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Matthaei H, Wu J, Dal Molin M, Debeljak M, Lingohr P, Katabi N, Klimstra DS, Adsay NV, Eshleman JR, Schulick RD, Kinzler KW, Vogelstein B, Hruban RH, Maitra A. GNAS codon 201 mutations are uncommon in intraductal papillary neoplasms of the bile duct. HPB (Oxford) 2012; 14:677-83. [PMID: 22954004 PMCID: PMC3461374 DOI: 10.1111/j.1477-2574.2012.00504.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Activating point mutations of GNAS at codon 201 have been detected in approximately two thirds of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Intraductal papillary neoplasms of the bile ducts (IPNBs) morphologically resemble pancreatic IPMNs. This study sought to assess the mutational status of GNAS at codon 201 in IPNBs. METHODS Thirty-four patients were included. DNA from microdissected IPNBs was subjected to a polymerase chain reaction and ligation method for the detection of GNAS mutations at codon 201 and of KRAS mutations at codon 12. Mutational status was compared with clinical and pathologic data. RESULTS The IPNBs had a median diameter of 3.5 cm and were located intrahepatically (n= 6), extrahepatically (n= 13), both intra- and extrahepatically (n= 4) or in the gallbladder (intracystic papillary neoplasms, n= 11). Most exhibited pancreatobiliary differentiation (n= 20), high-grade dysplasia (n= 26) and an associated adenocarcinoma (n= 20). Analysis of GNAS codon 201 identified only one mutant sample in a multifocal intestinal subtype intrahepatic IPNB with high-grade dysplasia. Six lesions harboured a KRAS codon 12 mutation. CONCLUSIONS GNAS codon 201 mutations are uncommon in IPNBs, by contrast with pancreatic IPMNs. More comprehensive molecular profiling is needed to uncover the pathways involved in IPNB development.
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Affiliation(s)
- Hanno Matthaei
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of MedicineBaltimore, MD, USA,Department of Surgery, University of BonnBonn, Germany
| | - Jian Wu
- Ludwig Center for Cancer Genetics, Johns Hopkins University School of MedicineBaltimore, MD, USA,State Key Laboratory of Cancer Biology, Cell Engineering Research Center & Department of Cell Biology, The Fourth Military Medical UniversityXi'an, China
| | - Marco Dal Molin
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Marija Debeljak
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | | | - Nora Katabi
- Department of Pathology, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
| | - David S Klimstra
- Department of Pathology, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
| | - N Volkan Adsay
- Department of Pathology, Emory University School of MedicineAtlanta, GA, USA
| | - James R Eshleman
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of MedicineBaltimore, MD, USA,Department of Oncology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Richard D Schulick
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of MedicineBaltimore, MD, USA,Department of Surgery, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Kenneth W Kinzler
- Ludwig Center for Cancer Genetics, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Bert Vogelstein
- Ludwig Center for Cancer Genetics, Johns Hopkins University School of MedicineBaltimore, MD, USA,Department of Oncology, Howard Hughes Medical Institute, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Ralph H Hruban
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of MedicineBaltimore, MD, USA,Department of Oncology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Anirban Maitra
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of MedicineBaltimore, MD, USA,Department of Oncology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of MedicineBaltimore, MD, USA
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Abstract
Choledochal cysts are cystic dilation of extrahepatic duct, intrahepatic duct, or both that may result in significant morbidity and mortality, unless identified early and managed appropriately. The incidence is common in Asian population compared with western counterpart with more than two third of the cases in Asia being reported from Japan. The traditional anatomic classification system is under debate with more focus on etiopathogenesis and other aspects of choledochal cysts. Even though categorized under the same roof, choledochal cysts vary with respect to their natural course, complications, and management. In this review, with the available literature on choledochal cysts, we discuss different views about the etiopathogenesis along with the natural course, complications, diagnosis, and surgical approach for choledochal cysts, which also explains why the traditional classification is questioned by some authors.
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Affiliation(s)
- Mahendra S. Bhavsar
- Department of Surgical Gastroenterology, Smt. NHL Municipal Medical College, Ahmedabad, India
| | - Hasmukh B. Vora
- Department of Surgical Gastroenterology, Smt. NHL Municipal Medical College, Ahmedabad, India
| | - Venugopal H. Giriyappa
- Department of Surgical Gastroenterology, Smt. NHL Municipal Medical College, Ahmedabad, India,Address for correspondence: Dr. Venugopal H. Giriyappa, B-33, Doctors Quarters, V.S. Hospital Campus, Ellisbridge, Ahmedabad, Gujarat – 380 006, India. E-mail:
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Abstract
Biliary papillomatosis is a rare disease that occurs more commonly in elderly males. The usual presentation of this disease is obstructive jaundice or recurrent cholangitis. Characterized by multiple papillary adenomas involving extensive areas of the biliary tree, biliary papillomatosis has a high recurrence rate and a significant risk of malignant transformation. Here, we will review the pathogenesis, clinical features, diagnosis and therapy of biliary papillmatosis.
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Vassiliou I, Kairi-Vassilatou E, Marinis A, Theodosopoulos T, Arkadopoulos N, Smyrniotis V. Malignant potential of intrahepatic biliary papillomatosis: a case report and review of the literature. World J Surg Oncol 2006; 4:71. [PMID: 17026772 PMCID: PMC1618388 DOI: 10.1186/1477-7819-4-71] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 10/07/2006] [Indexed: 01/24/2023] Open
Abstract
Background Biliary papillomatosis (BP) is a rare disease entity with a strong malignant potential. It is characterized by multiple papillary adenomas involving both the intrahepatic and extrahepatic biliary tree. BP was considered in the past to be a disease with low malignant potential. However, a current review of the English literature revealed a high rate of malignant occurrence of approximately 41% and histological analysis along with the expression pattern of mucin core proteins (MUC) and mucin carbohydrate antigens suggests that BP is a borderline or low grade malignant neoplasm with a high malignant potential. Case presentation A 68 year-old male patient was referred to our hospital due to the presence of sudden right upper quadrant abdominal pain, nausea and dark urine. Imaging workup demonstrated dilatation of the left hepatic duct without the presence of a space-occupying lesion. A left hepatectomy and cholecystectomy were carried out and histological analysis revealed a moderately to poorly differentiated carcinoma of the left hepatic duct in the background of biliary papillomatosis. Postoperative course was uneventful. Unfortunately, two years after initial diagnosis the patient rapidly deteriorated and died from multiple pulmonary secondary deposits. Conclusion BP should not be considered to be a benign disease. The clinical behavior, the high recurrence rate and the even higher malignant transformation occurrence, as well as the presence of carcinogenetic indicators (K-ras mutation, overexpression of p53, MUC and Tn antigens) strongly support that BP is a low-grade neoplasm with high malignant potential.
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Affiliation(s)
- Ioannis Vassiliou
- 2Department of Surgery, Areteion University Hospital, Athens Medical School, Athens, Greece
| | - Evi Kairi-Vassilatou
- Department of Pathology, Areteion University Hospital, Athens Medical School, Athens, Greece
| | - Athanasios Marinis
- 2Department of Surgery, Areteion University Hospital, Athens Medical School, Athens, Greece
| | | | - Nikolaos Arkadopoulos
- 2Department of Surgery, Areteion University Hospital, Athens Medical School, Athens, Greece
| | - Vassilios Smyrniotis
- 2Department of Surgery, Areteion University Hospital, Athens Medical School, Athens, Greece
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