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BARTOŠKA P, PALUCH Z. Treatment of Crohn's disease. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.22.04819-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Song J, Li Y, Bowlus CL, Yang G, Leung PSC, Gershwin ME. Cholangiocarcinoma in Patients with Primary Sclerosing Cholangitis (PSC): a Comprehensive Review. Clin Rev Allergy Immunol 2020; 58:134-149. [PMID: 31463807 DOI: 10.1007/s12016-019-08764-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cholangiocarcinoma (CCA) is the most common malignancy in patients with primary sclerosing cholangitis (PSC) and carries a high rate of mortality. Although the pathogenesis of CCA in PSC is largely unknown, inflammation-driven carcinogenesis concomitant with various genetic and epigenetic abnormalities are underlying factors. The majority of CCA cases develop from a dominant stricture (DS), which is defined as a stricture with a diameter < 1.5 mm in the common bile duct or < 1.0 mm in the hepatic duct. In PSC patients presenting with an abrupt aggravation of jaundice, pain, fatigue, pruritus, weight loss, or worsening liver biochemistries, CCA should be suspected and evaluated utilizing a variety of diagnostic modalities. However, early recognition of CCA in PSC remains a major challenge. Importantly, 30-50% of CCA in PSC patients are observed within the first year following the diagnosis of PSC followed by an annual incidence ranging from 0.5 to 1.5 per 100 persons, which is nearly 10 to 1000 times higher than that in the general population. Cumulative 5-year, 10-year, and lifetime incidences are 7%, 8-11%, and 9-20%, respectively. When PSC-associated CCA is diagnosed, most tumors are unresectable, and no effective medications are available. Given the poor therapeutic outcome, the surveillance and management of PSC patients who are at an increased risk of developing CCA are of importance. Such patients include older males with large-duct PSC and possibly concurrent ulcerative colitis. Thus, more attention should be paid to patients with these clinical features, in particular within the first year after PSC diagnosis. In contrast, CCA is less frequently observed in pediatric or female PSC patients or in those with small-duct PSC or concurrent Crohn's disease. Recently, new biomarkers such as antibodies to glycoprotein 2 have been found to be associated with an increased risk of developing CCA in PSC. Herein, we review the literature on the pathogenesis, incidence, clinical features, and risk factors, with a focus on various diagnostic modalities of PSC-associated CCA.
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Affiliation(s)
- Junmin Song
- Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China.,Division of Rheumatology, Allergy and Clinical Immunology, University of California, 451 Health Science Drive, Suite 6510, Davis, CA, 95616, USA
| | - Yang Li
- Department of Intensive Care Unit (ICU), Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, People's Republic of China
| | - Christopher L Bowlus
- Division of Gastroenterology and Hepatology, University of California, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
| | - GuoXiang Yang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, 451 Health Science Drive, Suite 6510, Davis, CA, 95616, USA
| | - Patrick S C Leung
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, 451 Health Science Drive, Suite 6510, Davis, CA, 95616, USA.
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, 451 Health Science Drive, Suite 6510, Davis, CA, 95616, USA.
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Boyd S, Vannas M, Jokelainen K, Isoniemi H, Mäkisalo H, Färkkilä MA, Arola J. Suspicious brush cytology is an indication for liver transplantation evaluation in primary sclerosing cholangitis. World J Gastroenterol 2017; 23:6147-6154. [PMID: 28970730 PMCID: PMC5597506 DOI: 10.3748/wjg.v23.i33.6147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/16/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate markers for high-grade dysplasia for the optimal timing of liver transplantation in patients with primary sclerosing cholangitis (PSC).
METHODS Earlier data support a dysplasia-carcinoma sequence, even low- to high-grade dysplasia, in PSC-associated cholangiocarcinoma (CCA). Surveillance using endoscopic retrograde cholangiography (ERC) and brush cytology aims to detect cases of biliary dysplasia, and liver transplantation is an option in cases with suspicion of malignancy in brushing. This study investigated markers to identify patients with high-grade biliary dysplasia for optimal timing in early liver transplantation. Patients undergoing surveillance using ERC and brush cytology during 2008-2014 and who were diagnosed with biliary dysplasia in explanted liver or CCA until February 2016 were included in the study. Demographic data, cholangiography findings, laboratory values, cytological morphology and DNA ploidy were analysed.
RESULTS Thirty PSC patients had biliary neoplasia in the explanted liver during the study period. Sixteen of these patients had low-grade dysplasia, 10 patients had high-grade dysplasia, and 4 patients had CCA. Fifteen PSC patients diagnosed with CCA were not transplanted. Patients with low-grade dysplasia were younger. Alkaline phosphatase or carcinoembryonic antigen values did not differ between groups during surveillance, but carbohydrate antigen 19-9 was higher in CCA patients. No difference in PSC duration, ERC scores, suspicious cytology, or ploidy analysis was found between groups. No difference was observed between fibrosis stage in explanted livers. Low- and high-grade dysplasia could not be differentiated before liver transplantation based on liver enzymes, tumour markers, ERC scores, brush cytology or DNA ploidy.
CONCLUSION Repeated suspicion of neoplasia in brush cytology should be an indication for evaluations of liver transplantation prior to the development of CCA.
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Affiliation(s)
- Sonja Boyd
- Department of Pathology, University of Helsinki and Helsinki University Hospital, HUSLAB, 00029 Helsinki, Finland
| | - Marko Vannas
- Transplantation and Liver Surgery Clinic, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland
| | - Kalle Jokelainen
- Clinic of Gastroenterology, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland
| | - Helena Isoniemi
- Transplantation and Liver Surgery Clinic, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland
| | - Heikki Mäkisalo
- Transplantation and Liver Surgery Clinic, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland
| | - Martti A Färkkilä
- Clinic of Gastroenterology, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland
| | - Johanna Arola
- Department of Pathology, University of Helsinki and Helsinki University Hospital, HUSLAB, 00029 Helsinki, Finland
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Boyd S, Mustonen H, Tenca A, Jokelainen K, Arola J, Färkkilä MA. Surveillance of primary sclerosing cholangitis with ERC and brush cytology: risk factors for cholangiocarcinoma. Scand J Gastroenterol 2017; 52:242-249. [PMID: 27806633 DOI: 10.1080/00365521.2016.1250281] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease leading to bile duct strictures and fibrosis, and predisposing to cholangiocarcinoma (CCA). Biliary dysplasia is a known precursor of CCA. In our unit, PSC patients undergo regular surveillance with ERC and brush cytology (BC), and liver transplantation is an option in case with biliary dysplasia. We evaluated the risk factors for biliary dysplasia and CCA based on ERC imaging, BC and liver function tests. PATIENTS AND METHODS Seven hundred and eighty-eight ERCs were performed with BC for 447 PSC patients. ERC images were evaluated using the modified Amsterdam score, neutrophilic inflammation was assessed in BC, and liver function tests were collected. Ploidy analysis with DNA flow cytometry was performed in cases with advanced PSC or previous suspicious BC/aneuploidy. The endpoint was either a benign disease course (follow-up for ≥2.4 years after the latest ERC), benign histology, biliary dysplasia or CCA. RESULTS Benign disease course was seen in 424/447 (including 23 cases with biliary dysplasia), and CCA in 17 (3.8%) patients. Gallbladder carcinoma/carcinoma in situ was diagnosed in three patients. Advanced ERC findings, male gender, suspicious BC, aneuploidy in flow cytometry, inflammation, and elevation of ALP, bilirubin, ALT, AST, GGT, CEA and CA19-9 represented significant risk factors for CCA in univariate analysis. CONCLUSIONS PSC patients with advanced bile duct disease and elevated liver enzymes, CEA or CA19-9, inflammation or suspicious BC are most likely to develop CCA. These patients may benefit from surveillance with BC if early liver transplantation is possible.
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Affiliation(s)
- Sonja Boyd
- a Department of Pathology , University of Helsinki, and Helsinki University Hospital , Helsinki , Finland
| | - Harri Mustonen
- b University of Helsinki and Department of Surgery, Helsinki University Hospital , Helsinki , Finland
| | - Andrea Tenca
- c University of Helsinki and Clinic of Gastroenterology, Helsinki University Hospital , Helsinki , Finland
| | - Kalle Jokelainen
- c University of Helsinki and Clinic of Gastroenterology, Helsinki University Hospital , Helsinki , Finland
| | - Johanna Arola
- a Department of Pathology , University of Helsinki, and Helsinki University Hospital , Helsinki , Finland
| | - Martti A Färkkilä
- c University of Helsinki and Clinic of Gastroenterology, Helsinki University Hospital , Helsinki , Finland
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Razumilava N, Gores GJ. Vigilancia del colangiocarcinoma en pacientes con colangitis esclerosante primaria: ¿es efectiva y está justificada? Clin Liver Dis (Hoboken) 2016; 8:S20-S24. [PMID: 31041091 PMCID: PMC6490230 DOI: 10.1002/cld.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/02/2016] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Gregory J. Gores
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMN, EE. UU
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Razumilava N, Gores GJ. Surveillance for Cholangiocarcinoma in Patients with Primary Sclerosing Cholangitis: Effective and Justified? Clin Liver Dis (Hoboken) 2016; 8:43-47. [PMID: 27822365 PMCID: PMC5096651 DOI: 10.1002/cld.567] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
| | - Gregory J. Gores
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMN
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Trilianos P, Agnihotri A, Ucbilek E, Gurakar A. Greater Biosynthetic Liver Dysfunction in Primary Sclerosing Cholangitis Suggests Co-existent or Impending Cholangiocarcinoma. J Clin Transl Hepatol 2016; 4:1-4. [PMID: 27047765 PMCID: PMC4807136 DOI: 10.14218/jcth.2015.00048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/29/2016] [Accepted: 01/20/2016] [Indexed: 12/18/2022] Open
Abstract
Background and Aim : Patients with primary sclerosing cholangitis (PSC) who develop cholangiocarcinoma (CCA) have a median survival of less than 6 months. In half of cases, PSC and CCA will be diagnosed either concurrently or within a year of one another. The aim of the present study is to demonstrate that the degree of biochemical liver dysfunction is associated with concomitant or impending CCA. Methods : We did a chart review of patients diagnosed with PSC and CCA up to 18 months from presentation ("CCA" group) as well as patients with PSC that underwent transplantation with no sign of CCA in their explanted liver ("nCCA" group). Along with demographic data and follow-up length, we recorded their presenting liver function tests, including alanine and aspartate aminotransferases (ALT, AST), total bilirubin (TBil), alkaline phosphatase (ALP), international normalization ratio (INR), and serum Ca 19-9 levels. Differences between mean values of the two groups were analyzed with a student's t-test. Results : Twenty-four patients were included. The "CCA" group consisted of eight patients, and the "non-CCA" group had 16 patients. There was no significant difference between the two groups in their presenting values of ALT, ALP, or serum Ca 19-9. However, the "CCA" group had significantly higher levels of AST, TBil, and INR. Conclusion : Patients with PSC and concurrent or impending CCA appear to exhibit significantly greater biochemical liver dysfunction than those who do not develop CCA. Therefore, newly-diagnosed PSC patients presenting with these findings may warrant more rigorous evaluation.
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Affiliation(s)
- Panagiotis Trilianos
- Department of Gastroenterology & Hepatology, Section of Transplant Hepatology, The Johns Hopkins School of Medicine, Baltimore MD, USA
- Department of Medicine, MetroWest Medical Center, Framingham, MA, USA
- Correspondence to: Panagiotis Trilianos, Dept. of Medicine, MetroWest Medical Center, 115 Lincoln Str., 2 Floor, Framingham, MA 01701, USA. Tel: 508-596-2856, Fax: 508-872-4794, E-mail:
| | - Abhishek Agnihotri
- Department of Gastroenterology & Hepatology, Section of Transplant Hepatology, The Johns Hopkins School of Medicine, Baltimore MD, USA
| | - Enver Ucbilek
- Department of Gastroenterology & Hepatology, Section of Transplant Hepatology, The Johns Hopkins School of Medicine, Baltimore MD, USA
| | - Ahmet Gurakar
- Department of Gastroenterology & Hepatology, Section of Transplant Hepatology, The Johns Hopkins School of Medicine, Baltimore MD, USA
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Gao ZJ, Wang FS. Current diagnosis and treatment of primary intrahepatic cholangiocarcinoma. Shijie Huaren Xiaohua Zazhi 2015; 23:4939-4945. [DOI: 10.11569/wcjd.v23.i31.4939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Primary intrahepatic cholangiocarcinoma (ICC) is a rare malignancy arising from intrahepatic biliary epithelial cells and is also defined as cholangiohepatoma. It is the second most common primary liver malignancy after hepatocellular carcinoma. Epidemiologic research shows that the incidence rate of ICC has increased in recent years. Till now, surgical resection remains the only effective treatment to cure the disease, but single-center large-sample clinical trials are still limited. Early diagnosis of ICC is difficult due to the lack of specific clinical manifestations. The rate of resection is low, while the mortality is high and the prognosis is poor. With the development of medical imaging and pathological diagnosis technology, the early diagnosis and overall survival rates are increasing. Comprehensive therapy including non-surgical treatment plays a more and more important role in improving the prognosis. The aim of this study is to review the advances in the diagnosis and treatment of ICC in recent years.
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