1
|
Ishikawa Y, Saito R, Murakami K, Fujio A, Miyazawa K, Sasaki K, Matsumura M, Mitsugashira H, Degawa K, Kobayashi Y, Muto R, Tokodai K, Furukawa T, Unno M, Kamei T. Small Intestinal Adenocarcinoma Arising at the Anastomotic Site after Kasai Operation for Biliary Atresia: A Case Report and Literature Review. TOHOKU J EXP MED 2023; 261:267-272. [PMID: 37766552 DOI: 10.1620/tjem.2023.j080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Biliary atresia is an obliterative cholangiopathy of unknown etiology. Hepatic portoenterostomy, in which obliterated extrahepatic bile ducts are resected and bile flow is restored, known as Kasai operation, is performed within 3 months after birth. While this operation enhances long-term survival of patients, the occurrence of primary malignant hepatic tumors has been increasing. We report a case of small intestinal adenocarcinoma arising at the anastomotic site after Kasai operation. A 49-year-old man, who underwent Kasai operation for biliary atresia when he was 2 months old, experienced rapidly progressive jaundice and liver dysfunction. Deceased-donor liver transplantation was performed for liver failure. Macroscopically, there was a white-yellow tumor located at the anastomotic site of hepatic portoenterostomy of the resected liver. Pathological examination revealed a well-differentiated adenocarcinoma with some Paneth cells in the neoplastic lesion. Immunohistochemically, the tumor cells were negative for cytokeratin 7 (CK7) but positive for cytokeratin 20 (CK20) and a homeobox domain-containing transcription factor (CDX2). Mucin expression in tumor cells was negative for mucin 1 (MUC1) and mucin 6 (MUC6) and positive for mucin 2 (MUC2) and mucin 5AC (MUC5AC). The pathological diagnosis was small intestinal adenocarcinoma originating from the jejunum. The patient was discharged 48 days after the operation. The patient had not experienced recurrence at 10 months after the operation. This is the first report of small intestinal adenocarcinoma arising at the anastomotic site after Kasai operation for biliary atresia. Special care should be taken for the patients after Kasai operation with acute progressive jaundice and liver dysfunction because there is a possibility of malignancy in their native liver.
Collapse
Affiliation(s)
- Yuki Ishikawa
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Ryusuke Saito
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Keigo Murakami
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine
| | - Atsushi Fujio
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Koji Miyazawa
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Kengo Sasaki
- Department of Surgery, Tohoku University Graduate School of Medicine
| | | | | | - Kazuki Degawa
- Department of Surgery, Tohoku University Graduate School of Medicine
| | | | - Ryo Muto
- Department of Surgery, National Hospital Organization Mito Medical Center
| | - Kazuaki Tokodai
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine
| |
Collapse
|
2
|
Asai A, Wu JF, Wang KS, Yamataka A, Nio M, Su DJ, Short C, Tsuboi K, Ochi T, Sasaki H, Okubo R, Yodoshi T, Konishi K, Rogers ME, Tiao GM. The Outcome of Patients With Cystic Biliary Atresia With Intact Proximal Hepatic Ducts Following Hepatic-Cyst-Jejunostomy. J Pediatr Gastroenterol Nutr 2022; 75:131-137. [PMID: 35653389 DOI: 10.1097/mpg.0000000000003485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To determine the outcomes of patients with cystic biliary atresia by correlating the anatomy of the hepatic ducts with the choice of biliary reconstruction surgery. BACKGROUND The Kasai hepatoportoenterostomy (Kasai) is the initial surgical procedure offered to most patients with biliary atresia. In contrast, a hepatic-cyst-jejunostomy has been reported to be effective in patients with the cystic form of biliary atresia. METHODS AND RESULTS We performed an international multicenter retrospective review. Two hundred eighty-seven patients were included, and 33 cases of cystic biliary atresia were identified. Outcomes were the serum total bilirubin level 3 months post-surgery and native liver survival at 2 years of age and were compared between cases who received the Kasai versus hepatic-cyst-jejunostomy in correlation to the anatomy of proximal hepatic ducts. The patients were categorized into 3 anatomical groups: patent intact hepatic ducts (n = 10), patent hypoplastic hepatic ducts (n = 13), and obliterated hepatic ducts (n = 10). All 10 patients with patent intact hepatic duct group underwent hepatic-cyst-jejunostomy, and 9 experienced bile drainage and native liver survival. Among the 13 patients with hypoplastic hepatic ducts, 11 underwent the Kasai procedure, and 9 had bile drainage, whereas 2 underwent hepatic-cyst-jejunostomy, and one survived with the native liver. All of the patients with obliterated hepatic ducts underwent the Kasai procedure; 5 established biliary drainage and survived with the native liver. Of 5 who did not drain, 3 underwent liver transplantation. CONCLUSIONS In patients with cystic biliary atresia, the subset with a connection between cyst and intrahepatic bile ducts via intact proximal hepatic ducts had favorable clinical outcomes following hepatic-cyst-jejunostomy.
Collapse
Affiliation(s)
- Akihiro Asai
- From the Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- the College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Jia-Feng Wu
- the Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Kasper S Wang
- the Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
- the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Atsuyuki Yamataka
- the Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masaki Nio
- the Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Da-Jyun Su
- the Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Celia Short
- the Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Koichi Tsuboi
- the Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takanori Ochi
- the Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideyuki Sasaki
- the Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryuji Okubo
- the Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshifumi Yodoshi
- From the Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kenichiro Konishi
- From the Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Michael E Rogers
- From the Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- the College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Gregory M Tiao
- the Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| |
Collapse
|