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Tidwell J, Wu GY. Heritable Chronic Cholestatic Liver Diseases: A Review. J Clin Transl Hepatol 2024; 12:726-738. [PMID: 39130622 PMCID: PMC11310751 DOI: 10.14218/jcth.2024.00119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/14/2024] [Accepted: 05/28/2024] [Indexed: 08/13/2024] Open
Abstract
Chronic cholestasis due to heritable causes is usually diagnosed in childhood. However, many cases can present and survive into adulthood. The time course varies considerably depending on the underlying etiology. Laboratory data usually reveal elevated conjugated hyperbilirubinemia, alkaline phosphatase, and gamma-glutamyl transpeptidase. Patients may be asymptomatic; however, when present, the typical symptoms are pruritus, jaundice, fatigue, and alcoholic stools. The diagnostic methods and management required depend on the underlying etiology. The development of genome-wide associated studies has allowed the identification of specific genetic mutations related to the pathophysiology of cholestatic liver diseases. The aim of this review was to highlight the genetics, clinical pathophysiology, presentation, diagnosis, and treatment of heritable etiologies of chronic cholestatic liver disease.
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Affiliation(s)
- Jasmine Tidwell
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
- Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
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2
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Guo Y, Li S, Zhu Z, Cai W, Zheng H, Yin D, Zhang S. Liver Transplantation for Diffuse Form of Caroli Disease with Chronic Hepatitis B: A Case Report. Transplant Proc 2024; 56:1161-1164. [PMID: 38816291 DOI: 10.1016/j.transproceed.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/10/2024] [Indexed: 06/01/2024]
Abstract
Caroli disease (CD) is a congenital disease of the intrahepatic biliary system, which manifests as cystic dilatation of the intrahepatic bile ducts. The disease has a low incidence and atypical clinical manifestations; therefore, it can be easily misdiagnosed. Hepatitis B infection is a viral infection that affects liver cells, leading to degeneration, necrosis, and regeneration of the cells and formation of false lobules, and ultimately nodular cirrhosis, which can lead to liver dysfunction and liver failure. Herein, we report a case of decompensated liver cirrhosis because of a diffuse form of CD, which was misdiagnosed because of long-term hepatitis B virus (HBV) infection. Finally, orthotopic liver transplantation (OLT) was performed, and the patient was cured. We believe that this congenital factor combined with HBV infection accelerated cirrhosis progression in this patient. This transplant was carried out in accordance with the Helsinki Congress and the Declaration of Istanbul.
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Affiliation(s)
- Yafei Guo
- Department of Hepatobiliary Surgery and Organ Transplantation Center, The First Affiliated Hospital of of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Shilan Li
- Department of Pathology, the First Affiliated Hospital of University of Science and Technology of China, He Fei, Anhui, China
| | - Zebin Zhu
- Department of Hepatobiliary Surgery and Organ Transplantation Center, The First Affiliated Hospital of of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wei Cai
- Department of Hepatobiliary Surgery and Organ Transplantation Center, The First Affiliated Hospital of of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Hao Zheng
- Department of Hepatobiliary Surgery and Organ Transplantation Center, The First Affiliated Hospital of of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Dalong Yin
- Department of Hepatobiliary Surgery and Organ Transplantation Center, The First Affiliated Hospital of of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Shugeng Zhang
- Department of Hepatobiliary Surgery and Organ Transplantation Center, The First Affiliated Hospital of of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
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3
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Gambaccini D, Sciumè GD, Ruggiero L, Natali V, Tapete G, Bolognesi V, Marciano E. Suspected stenosis in Caroli syndrome: when cholangioscopy can be the game changer. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:281-282. [PMID: 38887730 PMCID: PMC11180349 DOI: 10.1016/j.vgie.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Video 1Cholangioscopy performed during ERCP.
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Affiliation(s)
| | | | - Luigi Ruggiero
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi (SA), Italy
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Rathi KM, Pingat P, Bansode P, Dongare S. Caroli's Disease Associated with Autosomal Dominant Polycystic Kidney Disease with Acute Pancreatitis: A Case Report. Middle East J Dig Dis 2023; 15:289-292. [PMID: 38523883 PMCID: PMC10955986 DOI: 10.34172/mejdd.2023.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/07/2023] [Indexed: 03/26/2024] Open
Abstract
A rare congenital hepatobiliary disorder called Caroli's disease is characterized by multifocal segmental dilatation of intrahepatic bile ducts that can affect the entire liver or only specific areas of it. Coexisting conditions with Caroli's disease include autosomal dominant polycystic kidney disease (ADPKD) and autosomal recessive polycystic kidney disease (ARPKD). ADPKD results in the development of cysts, which are tiny fluid-filled sacs, in the kidneys. Caroli's disease is considered a rare disorder, affecting a small number of individuals worldwide. The symptoms of Caroli's disease can vary from person to person and it also may overlap with other liver and biliary disorders. As a result, it may be challenging to diagnose and manage the condition due to limited awareness and expertise. Increased awareness, research, and specialized medical care are crucial in improving outcomes for individuals affected by this rare disorder. This study involves the case of a 60- year-old woman presented with abdominal pain, fever, weight loss, and jaundice. Her imaging test endoscopic retrograde cholangiopancreatography (ERCP) signifies Caroli's disease with pancreatic duct (PD) calculi and management involves supportive care with antibiotics. Antibiotics were prescribed to prevent or treat infections such as cholangitis and nutritional supplement was recommended in managing Caroli's disease. The patient underwent pancreatic stent placement and was discharged with regular follow-up. So, this case highlights the clinical and diagnostic aspects to improve disease understanding and the progression of Caroli's illness along with ADPKD.
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Affiliation(s)
- Karishma M Rathi
- Department of Pharmacy Practice at Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research Pimpri, Pune, India
| | - Priyanka Pingat
- Department of Pharmacy Practice at Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research Pimpri, Pune, India
| | - Prachi Bansode
- Department of Pharmacy Practice at Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research Pimpri, Pune, India
| | - Shaili Dongare
- Department of Pharmacy Practice at Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research Pimpri, Pune, India
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Möller K, Braden B, Culver EL, Jenssen C, Zadeh ES, Alhyari A, Görg C, Ignee A, Hocke M, Dong Y, Sun S, Faiss S, Dietrich CF. Secondary sclerosing cholangitis and IgG4-sclerosing cholangitis - A review of cholangiographic and ultrasound imaging. Endosc Ultrasound 2023; 12:181-199. [PMID: 36588352 PMCID: PMC10237613 DOI: 10.4103/eus-d-22-00208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
Sclerosing cholangitis (SC) represents a spectrum of chronic progressive cholestatic diseases of the intrahepatic and/or extrahepatic biliary system characterized by patchy inflammation, fibrosis, and stricturing. Primary and secondary SC must be distinguished given the different treatment modalities, risks of malignancy, and progression to portal hypertension, cirrhosis, and hepatic failure. This review focuses on secondary SC and the pathogenic mechanisms, risk factors, clinical presentation, and novel imaging modalities that help to distinguish between these conditions. We explore the detailed use of cholangiography and ultrasound imaging techniques.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Emma L. Culver
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland GmbH, Strausberg, Wriezen, Germany
- Brandenburg Institute of Clinical Medicine at Medical University Brandenburg, Neuruppin, Germany
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Amjad Alhyari
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - André Ignee
- Department of Internal Medicine – Gastroenterology and Rheumatology; Klinikum Wuerzburg Mitte, Wuerzburg, Germany
| | - Michael Hocke
- Medical Department II, Helios Klinikum Meiningen, Meiningen, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Siegbert Faiss
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Christoph F. Dietrich
- Department of Internal Medicine (DAIM), Hirslanden Private Hospital, Beau Site, Salem und Permanence, Bern, Switzerland
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Role of Cholangioscopy in a Patient With Hepatolithiasis and Caroli Disease. ACG Case Rep J 2023; 9:e00935. [PMID: 36628373 PMCID: PMC9820776 DOI: 10.14309/crj.0000000000000935] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/14/2022] [Indexed: 01/07/2023] Open
Abstract
Caroli disease is an infrequent congenital pathology that is part of the spectrum of fibrocystic diseases, characterized mainly by malformation of bile ducts. These patients often have stones and cholangitis, which respond poorly to conventional endoscopic retrograde cholangiopancreatography. To date, there is little evidence on the usefulness of cholangioscopy in this disease, so we describe the experience of performing cholangioscopy in a patient with hepatolithiasis and Caroli disease.
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Ludwig DR, Anderson MA, Itani M, Sharbidre KG, Lalwani N, Paspulati RM. Secondary sclerosing cholangitis: mimics of primary sclerosing cholangitis. Abdom Radiol (NY) 2023; 48:151-165. [PMID: 35585354 PMCID: PMC9116710 DOI: 10.1007/s00261-022-03551-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 01/21/2023]
Abstract
Sclerosing cholangitis is a chronic cholestatic disease characterized by stricturing, beading, and obliterative fibrosis of the bile ducts. Sclerosing cholangitis is considered primary (PSC) if no underlying etiology is identified or secondary (SSC) if related to another identifiable cause. In this article, we will review the clinical features, pathogenesis, diagnosis, and imaging findings of PSC and SSC, with an emphasis on features that may aid in the distinction of these entities. We will also discuss various etiologies of SSC including recurrent pyogenic cholangitis, other infectious etiologies, ischemic damage, toxic insults, and immunologic, congenital, and miscellaneous causes, highlighting the unique imaging findings and clinical context of each diagnosis.
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Affiliation(s)
- Daniel R. Ludwig
- grid.4367.60000 0001 2355 7002Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63110 USA
| | - Mark A. Anderson
- grid.38142.3c000000041936754XDepartment of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Malak Itani
- grid.4367.60000 0001 2355 7002Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63110 USA
| | - Kedar G. Sharbidre
- grid.265892.20000000106344187Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL USA
| | - Neeraj Lalwani
- grid.224260.00000 0004 0458 8737Department of Radiology, Virginia Commonwealth University, Richmond, VA USA
| | - Raj M. Paspulati
- grid.67105.350000 0001 2164 3847Department of Radiology, Case Western Reserve University, Cleveland, OH USA
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Birgin E, Reissfelder C, Rahbari NN. Roboter-assistierte Hemihepatektomie links mittels Glissonean pedicle approach bei Caroli Syndrom. Zentralbl Chir 2022; 148:129-132. [PMID: 36104087 DOI: 10.1055/a-1923-4341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Zusammenfassung
Zielsetzung Das Caroli-Syndrom ist eine seltene Gallenwegserkrankung, die durch eine nicht obstruktive Dilatation der intrahepatischen Gallenwege, Leberfibrose und ein erhöhtes
Risiko für ein cholangiozelluläres Karzinom charakterisiert ist. Eine Leberresektion ist beim lokalen Befund die Therapie der Wahl und wird in der Literatur zunehmend minimalinvasiv
durchgeführt. Allerdings wurde in der Literatur bisher eine roboterassistierte Leberresektion beim Caroli-Syndrom nicht beschrieben. Indikation Eine 72-jährige asiatische Patientin
wurde mit einer multifokalen zystischen Dilatation der Lebersegmente II, III und IV unserer Klinik vorgestellt. Bis auf eine konventionelle Appendektomie waren keine weiteren Voroperationen
und Vorerkrankungen, insbesondere keine kongenitalen Zysten, bekannt. Die Leberfunktionsparameter waren unauffällig und die Echinokokkus-Serologie fiel negativ aus. Die MRT-Schnittbildgebung
zeigte eine reguläre Gallenwegsanatomie der rechten Leber. Eine roboterassistierte Hemihepatektomie links mit dem Da Vinci Xi-System wurde geplant. Methode Die roboterassistierte
Hemihepatektomie links wurde in einer Französischlagerung durchgeführt. Zunächst erfolgte eine Adhäsiolyse und Cholezystektomie. Eine aberrante Leberarterie aus der A. gastrica sinistra
wurde mithilfe von Clips abgesetzt. Nach Senkung der hilären Platte wurde der linke Pedikel en bloc mittels Glissonean Pedicle Approach umfahren und mit einer Bulldog-Klemme ausgeklemmt.
Eine ischämische Demarkationslinie zur rechten Leber zeichnete sich auf der Leberoberfläche ab. Die Parenchymdissektion wurde mittels bipolarer Pinzette durchgeführt. Ein Pringle-Manöver
wurde nicht angewendet. Der linke Pedikel und die linke Lebervene wurden mit einem robotischen Linearstapler abgesetzt und die mittlere Lebervene erhalten. Die regelrechte Perfusion der
Restleber inkl. Segment I wurde mittels intravenöser Indocyaningrünapplikation (ICG) in einer Dosierung von 0,2 mg/kg Körpergewicht bestätigt. Das Resektat wurde in einen Bergebeutel
verbracht und über einen Pfannenstiel-Schnitt geborgen. Die OP-Zeit betrug 239 min mit einem Gesamtblutverlust von 100 ml. Die Patientin wurde am 5. postoperativen Tag entlassen. Der
histologische Befund bestätigte ein Caroli-Syndrom. In der 6-Monats-Verlaufskontrolle hatte die Patientin eine regelrechte Leberfunktion ohne Zeichen einer rezidivierenden Erkrankung.
Schlussfolgerung Eine Hemihepatektomie links ist in der Glissonean-Pedicle-Approach-Technik sicher roboterassistiert durchführbar und ein geeignetes Verfahren für die Therapie des
Caroli-Syndroms.
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Affiliation(s)
- Emrullah Birgin
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | | | - Nuh N. Rahbari
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
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Priadko K, Niosi M, Vitale LM, De Sio C, Romano M, De Sio I. “Starry liver” - Von Meyenburg complex clinical case presentation and differential diagnosis discussion: A case report. World J Hepatol 2022; 14:1520-1527. [PMID: 36158921 PMCID: PMC9376765 DOI: 10.4254/wjh.v14.i7.1520] [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] [Received: 04/04/2022] [Revised: 05/29/2022] [Accepted: 06/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Von Meyenburg complex (VMC) (i.e., biliary hamartoma) is a rare congenital disorder characterized by multiple dilated cystic bile ducts, without clear trends in sex or age predominance. Due to the low number of published cases and the lack of recognized guidelines, the management of such patients remains a clinical challenge.
CASE SUMMARY We present a case of symptomatic VMC that was diagnosed after imaging and histopathological examinations. Considering the patient’s condition, a conservative treatment strategy was chosen. Instrumental, laboratory, and clinical follow-up demonstrated the stable condition of the patient receiving conservative treatment.
CONCLUSION VMC is a potentially non-life threatening condition, but its recognition is crucial for the management of patients.
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Affiliation(s)
- Kateryna Priadko
- Department of Precision Medicine and Hepato-Gastroenterology Unit, University Hospital and Università degli Studi della Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Marco Niosi
- Department of Precision Medicine and Hepato-Gastroenterology Unit, University Hospital and Università degli Studi della Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Luigi Maria Vitale
- Department of Precision Medicine and Hepato-Gastroenterology Unit, University Hospital and Università degli Studi della Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Chiara De Sio
- Internal Medicine Unit, Camilliani Hospital, Casoria 80026, Italy
| | - Marco Romano
- Department of Precision Medicine and Hepato-Gastroenterology Unit, University Hospital and Università degli Studi della Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Ilario De Sio
- Department of Precision Medicine and Hepato-Gastroenterology Unit, University Hospital and Università degli Studi della Campania Luigi Vanvitelli, Naples 80138, Italy
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Giacobbe C, Di Dato F, Palma D, Amitrano M, Iorio R, Fortunato G. Rare variants in PKHD1 associated with Caroli syndrome: Two case reports. Mol Genet Genomic Med 2022; 10:e1998. [PMID: 35715958 PMCID: PMC9356553 DOI: 10.1002/mgg3.1998] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/31/2022] [Accepted: 05/13/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Caroli disease (CD, OMIM #600643) is a rare autosomal recessive disorder characterized by polycystic segmental dilatation of the intrahepatic bile ducts and extreme variability in age of onset and clinical manifestations. When congenital hepatic fibrosis is associated with the polycystic dilatation of the biliary tract, the condition is referred as Caroli syndrome. The disease is thought to be caused by pathogenic variants in the PKHD1 gene (OMIM *606702). METHOD We report the clinical, biochemical, and molecular characterization of three patients with a clinical suspicion of CS belonging to two different families. The genetic screening was performed using a target custom panel and sequencing was performed on Illumina platform. RESULTS Genetic analysis revealed the presence of rare variants in the PKHD1 gene of the analyzed patients. In the first case, and his younger sister, two pathogenic variants (c.2702A>C and c.4870C>T) were found to be associated with a hepatic phenotype at clinical onset, followed by renal disease probably age-related; while in the second case, one pathogenic variant (c.5879C>G) and a complex allele with uncertain clinical significance [c.3407A>G; c.8345G>C; c.8606C>A] were found to be associated with a severe hepatic phenotype. CONCLUSION The identification of the genetic causes of the disease and their relationship with the clinical phenotype could have a favorable impact on clinical management and complication prevention.
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Affiliation(s)
- Carola Giacobbe
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Fabiola Di Dato
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Daniela Palma
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Michele Amitrano
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Raffaele Iorio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Giuliana Fortunato
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
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Fabris L, Milani C, Fiorotto R, Mariotti V, Kaffe E, Seller B, Sonzogni A, Strazzabosco M, Cadamuro M. Dysregulation of the Scribble/YAP/β-catenin axis sustains the fibroinflammatory response in a PKHD1 -/- mouse model of congenital hepatic fibrosis. FASEB J 2022; 36:e22364. [PMID: 35593740 PMCID: PMC9150862 DOI: 10.1096/fj.202101924r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/25/2022] [Accepted: 05/10/2022] [Indexed: 11/11/2022]
Abstract
Congenital hepatic fibrosis (CHF), a genetic cholangiopathy characterized by fibropolycystic changes in the biliary tree, is caused by mutations in the PKHD1 gene, leading to defective fibrocystin (FPC), changes in planar cell polarity (PCP) and increased β-catenin-dependent chemokine secretion. In this study, we aimed at understanding the role of Scribble (a protein involved in PCP), Yes-associated protein (YAP), and β-catenin in the regulation of the fibroinflammatory phenotype of FPC-defective cholangiocytes. Immunohistochemistry showed that compared with wild type (WT) mice, in FPC-defective (Pkhd1del4/del4 ) mice nuclear expression of YAP/TAZ in cystic cholangiocytes, significantly increased and correlated with connective tissue growth factor (CTGF) expression and pericystic fibrosis, while Scribble expression on biliary cyst cells was markedly decreased. Cholangiocytes isolated from WT mice showed intense Scribble immunoreactivity at the membrane, but minimal nuclear expression of YAP, which conversely increased, together with CTGF, after small interfering RNA (siRNA) silencing of Scribble. In FPC-defective cholangiocytes, inhibition of YAP nuclear import reduced β-catenin nuclear expression, and CTGF, integrin β6, CXCL1, and CXCL10 mRNA levels, whereas inhibition of β-catenin signaling did not affect nuclear translocation of YAP. Notably, siRNA silencing of Scribble and YAP in WT cholangiocytes mimics the fibroinflammatory changes of FPC-defective cholangiocytes. Conditional deletion of β-catenin in Pkhd1del4/del4 mice reduced cyst growth, inflammation and fibrosis, without affecting YAP nuclear expression. In conclusion, the defective anchor of Scribble to the membrane facilitates the nuclear translocation of YAP and β-catenin with gain of a fibroinflammatory phenotype. The Scribble/YAP/β-catenin axis is a critical factor in the sequence of events linking the genetic defect to fibrocystic trait of cholangiocytes in CHF.
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Affiliation(s)
- Luca Fabris
- Department of Molecular Medicine (DMM), University of Padova, Padova, Italy
- International Center for Digestive Health (ICDH), University of Milan-Bicocca, Milan, Italy
- Liver Center, Department of Internal Medicine, Yale University, New Haven (CT), US
| | - Chiara Milani
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Romina Fiorotto
- Liver Center, Department of Internal Medicine, Yale University, New Haven (CT), US
| | - Valeria Mariotti
- Department of Molecular Medicine (DMM), University of Padova, Padova, Italy
- Liver Center, Department of Internal Medicine, Yale University, New Haven (CT), US
| | - Eleanna Kaffe
- Liver Center, Department of Internal Medicine, Yale University, New Haven (CT), US
| | - Barbara Seller
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Aurelio Sonzogni
- Department of Pathology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mario Strazzabosco
- Liver Center, Department of Internal Medicine, Yale University, New Haven (CT), US
- Corresponding authors: Mario Strazzabosco, MD, PhD, Department of Internal Medicine, Yale University School of Medicine, Cedar Street 333 Room LMP1080, New Haven, CT 06517, USA. Phone: +1‐203‐785‐5110, , Massimiliano Cadamuro, PhD, Department of Molecular Medicine, University of Padova, Gabelli Street 63, Padova, 35121, Italy. Phone: +39-049-827-6113,
| | - Massimiliano Cadamuro
- Department of Molecular Medicine (DMM), University of Padova, Padova, Italy
- International Center for Digestive Health (ICDH), University of Milan-Bicocca, Milan, Italy
- Corresponding authors: Mario Strazzabosco, MD, PhD, Department of Internal Medicine, Yale University School of Medicine, Cedar Street 333 Room LMP1080, New Haven, CT 06517, USA. Phone: +1‐203‐785‐5110, , Massimiliano Cadamuro, PhD, Department of Molecular Medicine, University of Padova, Gabelli Street 63, Padova, 35121, Italy. Phone: +39-049-827-6113,
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12
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Sun J, Wang S, Chen B. Childhood-onset Caroli's disease as a cause of recurrent fever: A case report. Front Pediatr 2022; 10:903285. [PMID: 35989996 PMCID: PMC9386290 DOI: 10.3389/fped.2022.903285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Caroli's disease is a rare congenital bile duct malformation characterized by intrahepatic bile duct dilatation. This kind of situation is seldom encountered in clinical work. We report such a case who presented to our emergency department with recurrent fever as initial symptom. According to the clinical manifestation and imaging examination, a 13-year-old boy was diagnosed with suppurative cholangitis and sepsis caused by Caroli's disease. The symptoms were got relieved after antibiotic therapy upgraded from cephalosporins to carbapenems. After 5 months of follow-up, he did not have fever, abdominal pain or any other discomfort. We believe the present report is of medical significance since it serves as a reminder that Caroli's disease may have atypical presentations and be masked by non-specific clinical findings. The report hopes to enlighten our pediatric colleagues by providing more knowledge on such rare congenital disease.
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Affiliation(s)
- Jing Sun
- Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei, China
| | - Sheng Wang
- Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei, China
| | - Biquan Chen
- Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei, China
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13
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Nari GA, Lopez A, Joseph A, Lopez F, DE-Elias ME, Romero L. CONGENITAL CYSTIC DILATATIONS OF THE BILE DUCTS: ATTEMPT FOR MODIFICATION IN CLASSIFICATION. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1573. [PMID: 34008714 PMCID: PMC8121055 DOI: 10.1590/0102-672020190004e1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Gustavo Adrian Nari
- Hospital Tránsito Cáceres de Allende, Cirugía General, Córdoba, Cordoba, Argentina
| | - Alesio Lopez
- Hospital Tránsito Cáceres de Allende, Cirugía General, Córdoba, Cordoba, Argentina
| | - Angel Joseph
- Hospital Tránsito Cáceres de Allende, Cirugía General, Córdoba, Cordoba, Argentina
| | - Flavia Lopez
- Hospital Tránsito Cáceres de Allende, Cirugía General, Córdoba, Cordoba, Argentina
| | | | - Lorna Romero
- Hospital Tránsito Cáceres de Allende, Cirugía General, Córdoba, Cordoba, Argentina
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14
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Wabitsch S, Schoening W, Bellingrath JS, Brenzing C, Arnold A, Fehrenbach U, Schmelzle M, Pratschke J. Laparoscopic liver resection in Caroli disease: A single-centre case series. J Minim Access Surg 2021; 17:63-68. [PMID: 33353891 PMCID: PMC7945652 DOI: 10.4103/jmas.jmas_177_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Liver resection is the treatment of choice for patients with localised Caroli disease. While liver resection was traditionally performed as open procedure, this case series aims to evaluate the safety and efficacy of minimally invasive, laparoscopic liver surgery in these patients. Methods: A systematic review of electronic case files of patients seen between April 2015 and December 2017 at the Department of Surgery, Charité University Hospital Berlin, was conducted. Patients with Caroli disease in whom laparoscopic liver resection had been performed were identified and analysed in this single-centre case series. Results: Seven patients who underwent laparoscopic liver surgery for Caroli syndrome were identified and presented with a median age of 49 (range = 44–66) years, of which four (57%) were female. Preoperatively, six patients were classified as the American Society of Anaesthesiologists (ASA) 2 and one patient as ASA 3. Two operations were performed as single-incision laparoscopic surgery, whereas the others were done as multi-incision laparoscopic surgery. One patient required a conversion to an open procedure. The length of operation varied between patients, ranging from 128 to 758 min (median = 355). The length of stay in the intensive care unit ranged from 0 to 2 days. Two patients presented with post-operative complications (Clavien–Dindo Grade ≥3a), whereas no patient died. In histopathological analysis, all patients demonstrated characteristic findings of Caroli disease and no cholangiocarcinoma was found. Conclusion: These results indicate that minimally invasive, laparoscopic liver surgery is a safe and efficacious treatment option for patients with Caroli disease who require liver resection.
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Affiliation(s)
- Simon Wabitsch
- Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Wenzel Schoening
- Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Julia-Sophia Bellingrath
- Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Christian Brenzing
- Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Alexander Arnold
- Department of Pathology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
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15
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Abstract
Fibropolycystic liver disorders (FLD) arise from abnormal development of the ductal plate and are classified according to the size of the affected hepatobiliary duct. Congenital hepatic fibrosis (CHF) has small duct involvement characterized by a variable degree of periportal fibrosis and hyperplasia without affecting the liver’s architecture. Caroli’s disease (CD) is a rare autosomal recessive disorder with a prevalence of one case per 1,000,000 people and is characterized by cystic dilation of large intrahepatic ducts. When the disease presents with congenital hepatic fibrosis, it is referred to as Caroli’s syndrome (CS). Patients are usually diagnosed around the age of 20 with episodes of cholangitis, portal hypertension or hepatomegaly. We present the case of a two-year-old male with a previous history of autosomal recessive polycystic kidney disease (ARPKD) who presented to the emergency room with variceal bleeding secondary to portal hypertension. The physical examination showed an acutely ill-looking boy, with evident paleness and distended abdomen. Past medical history was negative for previous gastrointestinal bleeding or episodes of cholangitis. An upper gastrointestinal endoscopy was performed, showing esophageal varices secondary to portal hypertension. Imaging studies revealed hepatosplenomegaly, alterations in liver echogenicity, and dilated saccular bile ducts affecting both liver lobes without observing any apparent obstruction, highly suggestive of CD. A liver biopsy revealed nodular liver tissue with marked fibrosis between nodules, which confirmed the presence of CHF. Both kidneys were increased in size, hyperechoic and with loss of corticomedullary differentiation. FLD commonly present with coexisting hepatobiliary and renal alterations. Therefore, starting at the time of initial diagnosis, all patients with ARPKD should be evaluated to detect liver abnormalities due to the high association. Despite the rarity of CS, especially in early childhood, the association between ARPKD and FLD is well documented. So if this clinical presentation arises, CS should be suspected.
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Affiliation(s)
- Elsa Acevedo
- General Medicine, National Autonomous University of Honduras, Tegucigalpa, HND
| | - Stephanie S Laínez
- General Medicine, National Autonomous University of Honduras, Tegucigalpa, HND
| | | | - Daniel Vivar
- General Medicine, National Autonomous University of Honduras, Tegucigalpa, HND
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16
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Fahrner R, Dennler SGC, Inderbitzin D. Risk of malignancy in Caroli disease and syndrome: A systematic review. World J Gastroenterol 2020; 26:4718-4728. [PMID: 32884228 PMCID: PMC7445861 DOI: 10.3748/wjg.v26.i31.4718] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/15/2020] [Accepted: 08/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Congenital intrahepatic bile duct dilatation without fibrosis is called Caroli disease (CD), and is called Caroli syndrome (CS) when it has fibrotic and cirrhotic liver morphology. The development of intrahepatic carcinoma is described in both conditions, but the reported incidence varies extensively. Potential risk factors for the malignant transformation were not described. Furthermore, conservative or surgical treatment is performed depending on the extent of cystic malformation, hepatic dysfunction and structural hepatic changes, but little is known about which treatment should be offered to patients with CD or CS and cancer.
AIM To further investigate the malignant transformation in these conditions.
METHODS A systematic review of the current literature until January 2019 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A search using Medline (PubMed) was performed using a combination of Medical Subject Headings terms “caroli disease”, “caroli syndrome”, “tumor”, “malignant”, and “cholangiocarcinoma”. Only human studies published in English were used for this systematic review. The following parameters were extracted from each article: year of publication, type of study, number of patients, incidence of malignant tumor, duration of symptoms, age, sex, diagnostics, identification of tumor, surgical therapy, survival and tumor recurrence.
RESULTS Twelve retrospective studies reporting the courses of 561 patients (53% females) were included in this systematic review. With a mean age of 41.6 years old (range 23 to 56 years old), patients were younger than other populations undergoing liver surgery. Depending on the size of the study population the incidence of cholangiocarcinoma varied from 2.7% to 37.5% with an overall incidence of 6.6%. There were only few detailed reports about preoperative diagnostic work-up, but a multimodal work-up including ultrasound of the liver, computed tomography, magnetic resonance imaging and endoscopic retrograde cholangiopancreatography was used in most studies. Disease duration was variable with up to several years. Most patients had episodes of cholangitis, sepsis, fever or abdominal pain. Tumor detection was an incidental finding of the surgical specimen in most cases because it is currently often impossible to detect tumor manifestation during preoperative diagnostics. Liver resection or liver transplantation was performed depending on the extent of the biliary pathology and additional alterations of the liver structure or function. No postoperative adjuvant chemotherapy was reported, but chemotherapy was administered in selected cases of tumor recurrence. Overall survival rates after one year were low at 36% and a high recurrence rate of up to 75% during the observation period.
CONCLUSION Only few retrospective studies reported a low tumor incidence. Despite the high rate of mortality and tumor recurrence, definite surgical treatment should be offered as soon as possible.
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Affiliation(s)
- René Fahrner
- Department of Surgery, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Sandra GC Dennler
- Department of Surgery, University Hospital Dresden, Dresden 01307, Germany
| | - Daniel Inderbitzin
- Department of Surgery, Bürgerspital Solothurn, Solothurn 4500, Switzerland
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17
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Li QQ, Guo XZ, Li HY, Qi XS. Portal hypertension in a patient with biliary hamartomas: A case report. World J Clin Cases 2020; 8:1745-1751. [PMID: 32420308 PMCID: PMC7211530 DOI: 10.12998/wjcc.v8.i9.1745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/26/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Biliary hamartomas (BH) are a rare benign disease caused by malformation of the intrahepatic bile ducts. BH are occasionally diagnosed, but often lack obvious clinical symptoms. They are usually diagnosed by biopsy and imaging tests in clinical practice. Few studies have reported the association of BH with portal hypertension.
CASE SUMMARY A 40-year-old man was repeatedly admitted to our hospital due to hematochezia. The source of bleeding was considered to be gastroesophageal varices and portal hypertensive gastropathy by endoscopy. He had no history of hepatitis virus infection, alcohol abuse, drug-induced liver injury, or autoimmune liver disease. He underwent magnetic resonance imaging, which showed rounded, irregular, low-signal-T1 and high-signal-T2 lesions diffusely distributed on the liver, that were not communicated with the biliary system on magnetic resonance cholangiopancreatography. According to the imaging examination, the patient was considered to have a diagnosis of BH with portal hypertension.
CONCLUSION Based on the present case report, BH may be a potential etiology of portal hypertension.
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Affiliation(s)
- Qian-Qian Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Xiao-Zhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Hong-Yu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Xing-Shun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
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18
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Cadamuro M, Girardi N, Gores GJ, Strazzabosco M, Fabris L. The Emerging Role of Macrophages in Chronic Cholangiopathies Featuring Biliary Fibrosis: An Attractive Therapeutic Target for Orphan Diseases. Front Med (Lausanne) 2020; 7:115. [PMID: 32373615 PMCID: PMC7186419 DOI: 10.3389/fmed.2020.00115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/12/2020] [Indexed: 12/16/2022] Open
Abstract
Cholangiopathies are a heterogeneous group of chronic liver diseases caused by different types of injury targeting the biliary epithelium, such as genetic defects and immune-mediated attacks. Notably, most cholangiopathies are orphan, thereby representing one of the major gaps in knowledge of the modern hepatology. A typical hallmark of disease progression in cholangiopathies is portal scarring, and thus development of effective therapeutic approaches would aim to hinder cellular and molecular mechanisms underpinning biliary fibrogenesis. Recent lines of evidence indicate that macrophages, rather than more conventional cell effectors of liver fibrosis such as hepatic stellate cells and portal fibroblasts, are actively involved in the earliest stages of biliary fibrogenesis by exchanging a multitude of cues with cholangiocytes, which promote their recruitment from the circulating compartment owing to a senescent or an immature epithelial phenotype. Two cholangiopathies, namely primary sclerosing cholangitis and congenital hepatic fibrosis, are paradigmatic of this mechanism. This review summarizes current understandings of the cytokine and extracellular vesicles-mediated communications between cholangiocytes and macrophages typically occurring in the two cholangiopathies to unveil potential novel targets for the treatment of biliary fibrosis.
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Affiliation(s)
| | - Noemi Girardi
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology and the Mayo Clinic Center for Cell Signaling in Gastroenterology, Mayo Clinic, Rochester, NY, United States
| | - Mario Strazzabosco
- Liver Center, Department of Medicine, Yale University, New Haven, CT, United States
| | - Luca Fabris
- Department of Molecular Medicine, University of Padua, Padua, Italy.,Liver Center, Department of Medicine, Yale University, New Haven, CT, United States
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19
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A rare missense variant in APC interrupts splicing and causes AFAP in two Danish families. Hered Cancer Clin Pract 2020; 18:8. [PMID: 32292534 PMCID: PMC7140378 DOI: 10.1186/s13053-020-00140-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/11/2020] [Indexed: 11/30/2022] Open
Abstract
Background We report the first case of a missense variant in the APC gene that interrupts splicing by creating a new cryptic acceptor site. The variant, c.289G>A, p.(Gly97Arg), is located in exon 3, and qualitative and semi-quantitative RNA splicing analysis reveal that the variant results in skipping of the last 70 nucleotides of the exon, which leads to the introduction of a frameshift and a premature stop codon. Case presentation The variant was detected in two, apparently unrelated, Danish families with an accumulation of colorectal cancers, colonic adenomas and other cancers. The families both have an attenuated familial adenomatous polyposis phenotype, which is consistent with the association of pathogenic variants in the 5′ end of the gene. One variant-carrier also had Caroli Disease and a Caroli Disease associated hepatic mucinous cystadenocarcinoma. This is the first description of a person with both Caroli Disease and a pathogenic APC variant, and although the APC variant is not known to be connected to the development of the hepatic malformations in Caroli Disease, it remains unclear whether the variant could have contributed to the carcinogenesis of the liver tumour. Conclusions Based on functional and co-segregation data we classify the APC c.289G>A, p.(Gly97Arg) variant as pathogenic (class 5). Our findings emphasize the importance of a functional evaluation of missense variants although located far from the exon-intron boundaries.
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20
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Wambura C, Sharma M, Surani S. Revisiting Caroli Syndrome in a Tanzanian Patient. Cureus 2020; 12:e6661. [PMID: 32089970 PMCID: PMC7021243 DOI: 10.7759/cureus.6661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 11/28/2022] Open
Abstract
Caroli disease and Caroli syndrome are two rare congenital diseases of the intrahepatic bile ducts. Caroli syndrome is characterized by the saccular dilatation of intrahepatic bile ducts associated with congenital hepatic fibrosis. It is rarely diagnosed in childhood. We hereby describe a case of Caroli syndrome in a young Tanzanian female who had abdominal pain and distension since childhood. Her history suggested the presence of portal hypertension possibly from congenital hepatic fibrosis. The diagnosis was reached based on ultrasound, computed tomography (CT) scan of the abdomen, and magnetic resonance cholangiopancreatography (MRCP).
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Affiliation(s)
- Casmir Wambura
- Internal Medicine, The Aga Khan University, Dar es Salaam, TZA
| | - Munish Sharma
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Salim Surani
- Internal Medicine, Texas A&M Health Science Center, Bryan, USA
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21
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Menon S, Holt A. Large-duct cholangiopathies: aetiology, diagnosis and treatment. Frontline Gastroenterol 2019; 10:284-291. [PMID: 31288256 PMCID: PMC6583582 DOI: 10.1136/flgastro-2018-101098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/06/2018] [Accepted: 12/09/2018] [Indexed: 02/04/2023] Open
Abstract
Cholangiopathies describe a group of conditions affecting the intrahepatic and extrahepatic biliary tree. Impairment to bile flow and chronic cholestasis cause biliary inflammation, which leads to more permanent damage such as destruction of the small bile ducts (ductopaenia) and biliary cirrhosis. Most cholangiopathies are progressive and cause end-stage liver disease unless the physical obstruction to biliary flow can be reversed. This review considers large-duct cholangiopathies, such as primary sclerosing cholangitis, ischaemic cholangiopathy, portal biliopathy, recurrent pyogenic cholangitis and Caroli disease.
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Affiliation(s)
- Shyam Menon
- Department of Hepatology and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Andrew Holt
- Department of Hepatology and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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22
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Friedmacher F, Ford KE, Davenport M. Choledochal malformations: global research, scientific advances and key controversies. Pediatr Surg Int 2019; 35:273-282. [PMID: 30406431 DOI: 10.1007/s00383-018-4392-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 02/07/2023]
Abstract
Choledochal malformations (CMs) represent a spectrum of relatively rare and complex congenital anomalies, characterized by abnormal dilatation of the biliary tract in the absence of any acute obstruction. Today, almost 20% of CMs can be detected in-utero using maternal ultrasonography. Formal scientometric analysis was used to identify where modern CM research is taking place and perhaps where our attention should be directed in the future. Thus, this article offers a comprehensive review of recent scientific advances relating to CMs including the current understanding of etiology and classification, whilst also discussing key controversies such as risk of malignant transformation and the role of newer modalities of surgical treatment. Although laparoscopic excision of CMs and biliary reconstruction is nowadays feasible and safe, care should be taken before dispensing with standard open techniques, which have minimal complication rates and proven long-term benefit.
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Affiliation(s)
- Florian Friedmacher
- Department of Pediatric Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK. .,Department of Pediatric Surgery, The Royal London Hospital, London, UK.
| | - Kathryn E Ford
- Department of Pediatric Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.,Department of Pediatric Surgery, Oxford University Hospitals, Oxford, UK
| | - Mark Davenport
- Department of Pediatric Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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23
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Abstract
We report the case of a 41-year-old man on conservative treatment for more than 20 years for chronic renal insufficiency, chronic hepatitis and recurrent cholangitis. Following lengthy and extensive diagnostics, the differential diagnosis included primary sclerosing cholangitis and Caroli’s disease (CD). To solve the diagnostic challenge, next generation sequencing (NGS) was performed to distinguish between the disorders possibly present in the patient. The diagnosis of CD became evident after two rare known pathogenic mutations were detected in the poly-ductin 1 (PKHD1) gene, c.370C>T (p.Arg124Ter) and c.4870C>T (p.Arg1624Trp). In this case, NGS was instrumental in solving the diagnostic challenge, allowing differentiation among the proposed genetic and non-genetic ethiologies.
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24
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Fahrner R, Dennler SGC, Dondorf F, Ardelt M, Rauchfuss F, Settmacher U. Liver resection and transplantation in Caroli disease and syndrome. J Visc Surg 2018; 156:91-95. [PMID: 29929811 DOI: 10.1016/j.jviscsurg.2018.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Caroli disease (CD) is a congenital dilatation of the intrahepatic bile ducts. In combination with liver fibrosis or cirrhosis, it is called Caroli syndrome (CS). Infectious complications and intrahepatic cholangiocarcinoma are secondary problems. The aim of this study was to analyse the clinical pattern and outcome in patients with CD/CS who underwent liver surgery. METHODS Between January 2004 and December 2016, 21 patients with CD/CS were treated with liver resection or transplantation (LTX) and post-operative data of patients with CD/CS were retrospectively analysed in a database. RESULTS Two patients underwent LTX, and 19 patients underwent liver resection due to CD/CS. During follow-up, one patient developed lung cancer nine years after LTX. Patients resected due to CD/CS were predominantly females (74%) with an overall low incidence of co-morbidities. The median post-operative Clavien-Dindo score was 1 (range: 0-3). There was no death during a median follow-up period of over five years. In four patients, cholangiocarcinoma was confirmed. Tumor recurrence was seen in three patients, and was treated with chemotherapy or repeated liver resection. CONCLUSIONS LTX and liver resections due to CD/CS are rare and associated with an acceptable post-operative morbidity and low mortality. Surgical treatment should be performed as early as possible to avoid recurrent episodes of cholangitis or carcinogenesis.
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Affiliation(s)
- R Fahrner
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - S G C Dennler
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - F Dondorf
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - M Ardelt
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - F Rauchfuss
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - U Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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25
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Pitchaimuthu M, Duxbury M. Cystic lesions of the liver-A review. Curr Probl Surg 2017; 54:514-542. [PMID: 29173653 DOI: 10.1067/j.cpsurg.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; Department of HPB and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Mark Duxbury
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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26
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Bali M, Pezzullo M, Pace E, Morone M. Benign biliary diseases. Eur J Radiol 2017; 93:217-228. [DOI: 10.1016/j.ejrad.2017.05.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 02/07/2023]
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27
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Hwang MJ, Kim TN. Diffuse-Type Caroli Disease with Characteristic Central Dot Sign Complicated by Multiple Intrahepatic and Common Bile Duct Stones. Clin Endosc 2017. [PMID: 28633199 PMCID: PMC5565043 DOI: 10.5946/ce.2016.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Caroli disease (CD) is a rare congenital malformation of the liver characterized by non-obstructive, segmental, cystic dilatation of the intrahepatic bile ducts (IHDs). The clinical course is usually asymptomatic for the first 5–20 years, and symptoms may seldom occur throughout the patient’s life. Bile stagnation leads to recurrent episodes of cholangitis, stone formation, or liver abscesses, and biliary cirrhosis usually occurs years later. Here we report on a 42-year-old man diagnosed with diffuse-type CD with a characteristic central dot sign, who had multiple intrahepatic and common bile duct (CBD) stones. CBD stones were treated successfully with endoscopic retrograde cholangiopancreatography (ERCP).
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Affiliation(s)
- Moon Joo Hwang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Tae Nyeun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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28
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Affiliation(s)
- Min Hye Jang
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Lutz H, Trautwein C, Tischendorf JW. Primary sclerosing cholangitis: diagnosis and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 110:867-74. [PMID: 24529302 DOI: 10.3238/arztebl.2013.0867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/28/2013] [Accepted: 10/28/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease that involves progressive destruction of the bile ducts. Its prevalence is 4 to 16 cases per 100,000 persons. Its incidence has risen over the last 20 years, with a more than 35% increase in the last 10 years alone. PSC tends to arise in patients with chronic inflammatory bowel diseases. It is associated with an increased risk of various types of cancer (13%-14%), most prominently cholangiocellular carcinoma (CCC). METHOD This review is based on a selective search in PubMed for original articles, meta-analyses, and review articles about PSC that appeared from January 1980 to May 2013. RESULTS The diagnosis is generally established with a bile duct imaging study--typically, magnetic resonance cholangiopancreaticography (MRCP): this test is more than 80% sensitive and more than 90% specific for the diagnosis of PSC. The time from diagnosis to death or liver transplantation is 12 to 18 years, and the risk that a patient with PSC will die of cancer is 40% to 58%. Options for drug treatment are limited. Randomized, controlled trials have not shown any improvement of outcomes from the administration of ursodeoxycholic acid (UDCA). Interventional endoscopy is used to treat dominant stenoses and cholangitis, even though this method of treatment is supported only by low-level evidence. Liver transplantation results in a 10-year survival rate above 80%. CONCLUSION There is no causally directed treatment for PSC. Early diagnosis, complication management, and the evaluation of an optimally timed liver transplantation are the main determinants of outcome.
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Affiliation(s)
- Holger Lutz
- Department of Gastroenterology, Metabolic Diseases and Intensive Care Medicine, Internal Medicine III, University Hospital Aachen
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30
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Wang ZX, Li YG, Wang RL, Li YW, Li ZY, Wang LF, Yang HY, Zhu Y, Wang Y, Bai YF, He TT, Zhang XF, Xiao XH. Clinical classification of Caroli's disease: an analysis of 30 patients. HPB (Oxford) 2015; 17:278-83. [PMID: 25327281 PMCID: PMC4333791 DOI: 10.1111/hpb.12330] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/17/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Caroli's disease (CD) is a rare congenital disorder. The early diagnosis of the disease and differentiation of types I and II are of extreme importance to patient survival. This study was designed to review and discuss observations in 30 patients with CD and to clarify the clinical characteristics of the disease. METHODS The demographic and clinical features, laboratory indicators, imaging findings and pathology results for 30 patients with CD were reviewed retrospectively. RESULTS Caroli's disease can occur at any age. The average age of onset in the study cohort was 24 years. Patients who presented with symptoms before the age of 40 years were more likely to develop type II CD. Approximately one-third of patients presented without positive signs at original diagnosis and most of these patients were found to have type I CD on pathology. Anaemia, leucopoenia and thrombocytopoenia were more frequent in patients with type II than type I CD. Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) examinations were most useful in diagnosing CD. CONCLUSIONS No typical symptoms, signs or laboratory indicators are able to distinguish CD from other conditions. Both MRCP and CT were most valuable in diagnosis. The two types of CD may be differentiated by age of onset and routine blood tests.
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Affiliation(s)
- Zhong-Xia Wang
- Department of Graduate School, 301 HospitalBeijing, China
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Yong-Gang Li
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Rui-Lin Wang
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Yong-Wu Li
- Imaging Centre, 302 HospitalBeijing, China
| | - Zhi-Yan Li
- Imaging Centre, 302 HospitalBeijing, China
| | - Li-Fu Wang
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Hui-Ying Yang
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Yun Zhu
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Yao Wang
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Yun-Feng Bai
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Ting-Ting He
- Integrative Medical Centre, 302 HospitalBeijing, China
| | | | - Xiao-He Xiao
- Department of Graduate School, 301 HospitalBeijing, China
- Integrative Medical Centre, 302 HospitalBeijing, China
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31
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Rock N, McLin V. Liver involvement in children with ciliopathies. Clin Res Hepatol Gastroenterol 2014; 38:407-14. [PMID: 24953524 DOI: 10.1016/j.clinre.2014.04.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/26/2014] [Accepted: 04/11/2014] [Indexed: 02/04/2023]
Abstract
Abnormalities in primary cilia lead to diseases called ciliopathies. Multiple organ involvement is the norm since primary cilia are present in most cells. When cholangiocyte cilia are abnormal, ductal plate malformation ensues leading to such conditions as congenital hepatic fibrosis, Caroli disease or syndrome, or other fibrocystic disease.
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Affiliation(s)
- N Rock
- Swiss Center for Liver Disease in Children, Department of Pediatrics, University Hospitals of Geneva, 5, rue Willy-Donze, 1205 Geneva, Switzerland.
| | - V McLin
- Swiss Center for Liver Disease in Children, Department of Pediatrics, University Hospitals of Geneva, 5, rue Willy-Donze, 1205 Geneva, Switzerland
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32
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Monolobar Caroli’s disease with renal cysts: Case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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33
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Mittal D, Mandelia A, Bajpai M, Pandey RK, Dash NR. Unilobar Caroli's disease and its management in an 8-year-old girl. J Indian Assoc Pediatr Surg 2013; 18:90-1. [PMID: 23798816 PMCID: PMC3687156 DOI: 10.4103/0971-9261.109365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A case of unilobar Caroli's disease in an 8-year-old girl treated with left hepatectomy is reported here.
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Affiliation(s)
- Deepak Mittal
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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34
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Song JS, Noh SJ, Cho BH, Moon WS. Multicystic biliary hamartoma of the liver. KOREAN JOURNAL OF PATHOLOGY 2013; 47:275-8. [PMID: 23837021 PMCID: PMC3701824 DOI: 10.4132/koreanjpathol.2013.47.3.275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/11/2012] [Accepted: 06/12/2012] [Indexed: 12/23/2022]
Abstract
Multicystic biliary hamartoma (MCBH) is a very rare hamartomatous cystic nodule of the liver, which has recently been described as a new entity of a hepatic nodular lesion. We report a unique case of MCBH with a review of the literatures. A hepatic multicystic mass of segment 3 was detected in a 52-year-old male by abdominal computed tomography, and resection of this lesion was performed. Macroscopic examination revealed a 2.7×2.0 cm nodular mass with a multicystic honeycomb cut surface. Histologically, this lesion consisted of multiple dilated cystic ducts lined by biliary type epithelial cells, periductal glands and connective tissue, which included small amounts of hepatic parenchyma and blood vessels. Recognition of this unusual lesion is essential to avoid confusion with other cystic tumors of the liver, and to learn more about its natural history and response to treatment.
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Affiliation(s)
- Ji Soo Song
- Department of Radiology, Research Institute of Clinical Medicine and Research Institute for Endocrine Sciences, Chonbuk National University Medical School, Jeonju, Korea
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35
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Garcea G, Rajesh A, Dennison AR. Surgical management of cystic lesions in the liver. ANZ J Surg 2013; 83:516-22. [PMID: 23316726 DOI: 10.1111/ans.12049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Liver cysts are common, occurring in up to 5% of the population. For many types of cysts, a variety of different treatment options exist and the preferred management is unclear. METHODS A PubMed and Medline literature review was undertaken and articles pertaining to the diagnosis and management of cystic lesions within the liver were retrieved. RESULTS Therapy for symptomatic cysts may incorporate aspiration with sclerotherapy or de-roofing. Polycystic liver disease presents a unique management problem because of the high morbidity and mortality rates from intervention and high rates of recurrence. Careful patient counselling and assessment of symptom index is essential before embarking on any treatment. New medical treatments may ameliorate symptoms. Acquired cystic lesions in the liver require a thorough work-up to fully characterize the abnormality and direct appropriate treatment. Hydatid cysts are best treated by chemotherapy, followed by some form of surgical intervention (either aspiration and sclerotherapy or surgery). Liver abscesses can be effectively treated by aspiration or drainage. CONCLUSION All patients with cystic lesions in the liver require discussion at multidisciplinary meetings to confirm the diagnosis and determine the most appropriate method of treatment.
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Affiliation(s)
- Giuseppe Garcea
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK.
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36
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Guimarães Filho A, Carneiro Neto LA, Palheta MS, Campos PT, Santos LM, Barroso BGC. Doença de Caroli complicada com abscesso hepático: relato de caso. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000600016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A doença de Caroli é uma má-formação congênita rara caracterizada por dilatações multifocais dos ductos biliares intra-hepáticos que predispõem a colestase e episódios recorrentes de colangite. Descrevemos o caso de um paciente jovem diagnosticado com doença de Caroli, por meio da colangiorressonância, que complicou com abscesso hepático e foi submetido a drenagem cirúrgica.
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37
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Raffray L, Desclaux A, Duffau P, Longy-Boursier M, Dieval C, Mercié P. Fièvre récurrente : penser à la maladie de Caroli. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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38
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Zhang DY, Ji ZF, Shen XZ, Liu HY, Pan BJ, Dong L. Caroli's disease: a report of 14 patients and review of the literature. J Dig Dis 2012; 13:491-5. [PMID: 22908976 DOI: 10.1111/j.1751-2980.2012.00619.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Dan Ying Zhang
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China
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39
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Ozkurt S, Canaz F, Temiz G, Sahin G, Yalcin AU. Unusual renal manifestation of Caroli disease: AA amyloidosis. Ren Fail 2012; 34:930-3. [PMID: 22681158 DOI: 10.3109/0886022x.2012.690923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Congenital hepatic fibrosis is a fairly uncommon disorder and it is usually associated with other fibropolycystic disorders, including renal involvement. Main clinical features are hepatic fibrosis, portal hypertension, and renal cystic disease. There are multifocal saccular dilatations of segmental bile ducts, usually with accompanying calculi formation and recurrent bacterial cholangitis. Renal cystic disorders are common complications of Caroli disease (CD), but renal amyloidosis is fairly uncommon. We present a patient who was diagnosed with CD at the age of 31 years and in whom renal AA amyloidosis developed at the age of 45 years due to recurrent bacterial cholangitis.
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Affiliation(s)
- Sultan Ozkurt
- Department of Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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40
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Abstract
BACKGROUND Liver cysts are common, occurring in up to 5% of the population. For many types of cysts, a variety of different treatment options exist and the preferred management is unclear. METHODS A Pubmed and Medline literature review using key words non-parasitic hepatic cysts, polycystic liver disease, echinococcus, hydatid cysts parasitic cysts, Caroli's disease, cystadenoma; liver abscess, surgery, aspiration and treatment was undertaken and papers pertaining to the diagnosis and management of cystic lesions within the liver were retrieved. RESULTS Asymptomatic simple cysts in the liver require no treatment. Therapy for symptomatic cysts may incorporate aspiration with sclerotherapy or de-roofing. At present, insufficient evidence exists to recommend one over the other. Polycystic liver disease presents a unique management problem because of high morbidity and mortality rates from intervention and high rates of recurrence. Careful patient counselling and assessment of symptom index is essential before embarking on any treatment. New medical treatments may ameliorate symptoms. Acquired cystic lesions in the liver require a thorough work-up to fully characterize the abnormality and direct appropriate treatment. Hydatid cysts are best treated by chemotherapy followed by some form of surgical intervention (either aspiration and sclerotherapy or surgery). Liver abscesses can effectively be treated by aspiration or drainage. With improved antimicrobial efficacy, prolonged treatment with antibiotics may also be considered. CONCLUSION All patients with cystic lesions in the liver require discussion at multi-disciplinary meetings to confirm and the diagnosis and determine the most appropriate method of treatment.
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Affiliation(s)
- Giuseppe Garcea
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK.
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41
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42
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Kim RD, Book L, Haafiz A, Schwartz JJ, Sorensen JB, Gonzalez-Peralta RP. Liver transplantation in a 7-month-old girl with Caroli's disease. J Pediatr Surg 2011; 46:1638-41. [PMID: 21843735 DOI: 10.1016/j.jpedsurg.2011.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 04/07/2011] [Accepted: 04/08/2011] [Indexed: 12/16/2022]
Abstract
Caroli's disease (including Caroli's syndrome) is a rare autosomal recessive disorder of the liver characterized by diffuse cystic dilatation of the intrahepatic bile ducts. The disease may present at any age and is characterized by recurrent episodes of biliary obstruction, cholangitis, hepaticolithiasis, and liver abscesses. Caroli's syndrome is further associated with congenital hepatic fibrosis and portal hypertension. Patients with recurrent complications or cirrhosis may die because of recurrent infection, portal hypertension, liver failure, or cholangiocarcinoma. Liver transplantation is the treatment of choice for these complicated patients. Here we describe the youngest reported patient with Caroli's syndrome treated successfully using liver transplantation and review the recent literature.
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Affiliation(s)
- Robin D Kim
- Department of Surgery, Section of Transplantation and Hepatobiliary Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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43
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Maxien D, Reiser MF, Wirth S. [Upper abdominal pain with recurrent cholangitis and pyelonephritis]. Radiologe 2010; 50:372-6. [PMID: 20174781 DOI: 10.1007/s00117-010-1982-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 38-year-old man presented with pain in the right upper abdomen combined with elevated C-reactive protein (5.37 mg/dl) and creatinine levels (2.0 mg/dl). The medical history revealed recurrent abdominal pain. Duplex sonography showed large intrahepatic cystic structures, partially combined with a ribbon-shaped flow signal inside, as well as multiple cysts in the kidneys. The following MRI identified these findings as dilatated bile ducts surrounding the portal vein branches. This is known as the central dot sign. Overall, this special constellation is indicative of Caroli's disease, a rare congenital cystic dilatation of the intrahepatic bile ducts. The imaging results substantiated the diagnosis, especially in combination with cystic renal disease and recurrent cholangitis. Depending on the grade of liver involvement the treatment is partial hepatectomy or, as in our case transplantation, which also eliminates the risk of associated cholangiocarcinoma.
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Affiliation(s)
- D Maxien
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
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44
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Shorbagi A, Bayraktar Y. Experience of a single center with congenital hepatic fibrosis: A review of the literature. World J Gastroenterol 2010; 16:683-90. [PMID: 20135715 PMCID: PMC2817055 DOI: 10.3748/wjg.v16.i6.683] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [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
Congenital hepatic fibrosis (CHF) is an autosomal recessive inherited malformation defined pathologically by a variable degree of periportal fibrosis and irregularly shaped proliferating bile ducts. It is one of the fibropolycystic diseases, which also include Caroli disease, autosomal dominant polycystic kidney disease, and autosomal recessive polycystic kidney disease. Clinically it is characterized by hepatic fibrosis, portal hypertension, and renal cystic disease. CHF is known to occur in association with a range of both inherited and non-inherited disorders, with multiorgan involvement, as a result of ductal plate malformation. Because of the similarities in the clinical picture, it is necessary to differentiate CHF from idiopathic portal hypertension and early liver cirrhosis, for which a liver biopsy is essential. Radiological tests are important for recognizing involvement of other organ systems. With regards to our experience at Hacettepe University, a total of 26 patients have been diagnosed and followed-up between 1974 and 2009 with a diagnosis of CHF. Presentation with Caroli syndrome was the most common diagnosis, with all such patients presenting with symptoms of recurrent cholangitis and symptoms related to portal hypertension. Although portal fibrosis is known to contribute to the ensuing portal hypertension, it is our belief that portal vein cavernous transformation also plays an important role in its pathogenesis. In all patients with CHF portal vein morphology should be evaluated by all means since portal vein involvement results in more severe and complicated portal hypertension. Other associations include the Joubert and Bardet-Biedl syndromes.
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