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McLennan AL, Cockerell CJ, Ren VZ. Sarcoidosis Resembling Angiokeratomas: A Case Report. Cureus 2024; 16:e56322. [PMID: 38628994 PMCID: PMC11020630 DOI: 10.7759/cureus.56322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Sarcoidosis, a multifaceted systemic disorder characterized histologically by the presence of non-caseating granulomas, has a wide array of cutaneous manifestations. We describe a case of a 74-year-old woman with a complex medical history, who presented with asymptomatic hyperpigmented papules on her lower extremities. Histological examination of a punch biopsy specimen showed nodular and angiocentric patterns of granulomatous inflammation consistent with sarcoidosis, and chest radiography demonstrated bilateral hilar opacities, supporting the diagnosis. To our knowledge, this specific cutaneous presentation of sarcoidosis has not been described before, and it can easily be mistaken for other conditions. Therefore, this case underscores the importance of recognizing atypical cutaneous morphologies of sarcoidosis, particularly in patients with complex medical histories, to facilitate accurate diagnosis and timely intervention. We aim to increase awareness among clinicians regarding the diverse manifestations of sarcoidosis, thereby enhancing diagnostic acumen and patient care.
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Affiliation(s)
| | | | - Vicky Z Ren
- Dermatology, Baylor College of Medicine, Houston, USA
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Wei W, Luo R, Chen Z, He J. Mycobacterium porcinum Infection of Hilar and Mediastinal Lymph Nodes: A Case Report and Literature Review. Infect Drug Resist 2023; 16:7305-7311. [PMID: 38023396 PMCID: PMC10676095 DOI: 10.2147/idr.s432987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
In the available reports on clinical medicine, the infection sites of Mycobacterium porcinum include wounds, bone marrow, respiratory tract, and catheters. A 61-year-old woman was admitted to our hospital; her hilar and mediastinal lymph nodes were found to be enlarged during health examination, but there was no specific discomfort. Initially, she had undergone a mediastinal lymph node biopsy and pathology, but the diagnosis was not confirmed. However, 16S rRNA gene sequencing revealed M. porcinum infection of hilar and mediastinal lymph nodes. Subsequently, she was treated with clarithromycin, amikacin, imipenem, and tigecycline. After 2 months, chest computed tomography showed a significant reduction in lymph nodes. M. porcinum infection was considered to be the cause of disease.
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Affiliation(s)
- Wenjie Wei
- Department of Respiratory and Critical Care Medicine, Hunan University of Medicine General Hospital, Huaihua, People’s Republic of China
| | - Renrui Luo
- Department of Respiratory and Critical Care Medicine, Hunan University of Medicine General Hospital, Huaihua, People’s Republic of China
| | - Zhikui Chen
- Department of Respiratory and Critical Care Medicine, Hunan University of Medicine General Hospital, Huaihua, People’s Republic of China
| | - Jianbin He
- Department of Respiratory and Critical Care Medicine, Hunan University of Medicine General Hospital, Huaihua, People’s Republic of China
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Aljohaney A, Bakhsh S, Khayat M. The Contribution of Cell Blocks in the Diagnosis of Mediastinal and Hilar Lymphadenopathy Samples From Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA). Cureus 2023; 15:e39673. [PMID: 37398708 PMCID: PMC10308141 DOI: 10.7759/cureus.39673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 07/04/2023] Open
Abstract
Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic procedure that allows clinicians to stage lung cancer by sampling lymph nodes in the mediastinum. EBUS-TBNA is recommended as a first step prior to mediastinoscopy for lung cancer mediastinal staging. This procedure has greatly aided pulmonologists in diagnosing mediastinal pathologies with substantial progress. In this study, our aim is to analyze how cell blocks affect the diagnostic yield of mediastinal and hilar lymphadenopathy using an EBUS cytology needle. Methods This retrospective study was conducted at King Abdulaziz University Hospital between May 2021 and September 2021. Patients with mediastinal and hilar lymphadenopathy in the absence of known or suspected primary lung cancer were included. The EBUS procedure was performed using a flexible bronchoscope equipped with a working channel suitable for transbronchial needle aspiration under direct ultrasound guidance. Data were recorded using Microsoft Excel and analyzed using Statistical Package for the Social Sciences (SPSS) v. 26.0 (IBM Corp., Armonk, NY). Diagnostic accuracy measures were determined, and a p-value of 0.05 was established as the final threshold for statistical significance. Results The total number of patients in our study was 151. The sensitivity for cytology specimens, histology specimens, and a combined evaluation for the full group of patients was 77.14%, 83.33%, and 87.5%, respectively, with a negative predictive value of 27.22%, 25%, and 21.42%. The diagnostic accuracy for cytology specimens, histology specimens, and a combined evaluation was 71.42%, 76.19%, and 80%, respectively. Conclusion Our study found that the combined examination of specimens for both cytology and histology in the diagnosis of lung cancer, sarcoidosis, and tuberculosis resulted in a higher diagnostic yield compared to cytological assessment alone using EBUS-TBNA.
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Affiliation(s)
- Ahmed Aljohaney
- Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Salwa Bakhsh
- Pathology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Manal Khayat
- Pathology, King Abdulaziz Medical City Jeddah, Jeddah, SAU
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Chen ZK, Li DL, Du JJ, She JX, Meng J, Fan J. Radioactive versus normal stent insertion for malignant hilar obstruction: a meta-analysis. MINIM INVASIV THER 2023; 32:47-55. [PMID: 36622278 DOI: 10.1080/13645706.2022.2164697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE This meta-analysis was designed for examining the relative clinical safety and efficacy of normal stent (NS) and radioactive stent (RS) insertion in malignant hilar obstruction (MHO) patients. MATERIAL AND METHODS Relevant studies published as of March 2022 were identified through searches of the Medline, Embase, Wanfang, and CNKI databases, and the pooled results of these studies were then analyzed. RESULTS Eight studies including 258 and 247 patients that underwent NS and RS insertion, respectively, were incorporated into this meta-analysis. RS insertion was found to be associated with significant improvements in functional successful rate (p = 0.04), Δaspertate aminotransferase (AST, p = 0.0004), Δalanine aminotransferase (ALT, p = 0.002), stent patency (p < 0.00001), stent re-obstruction rate (p = 0.03), and OS (p < 0.00001) outcomes as compared to those associated with NS insertion. No differences in Δtotal bilirubin (TBIL, p = 0.38), cholangeitis rate (p = 0.45), cholecystitis rate (p = 0.84), or hemorrhage rate (p = 0.87) were observed when comparing patients that underwent RS and NS insertion. Substantial publication bias was observed for endpoints of cholecystitis and hemorrhage. CONCLUSIONS These results suggest that relative to NS insertion, RS insertion can effectively prolong stent patency and OS in MHO cases.
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Affiliation(s)
- Zhong-Ke Chen
- Department of Intervention, Affiliated Hospital of Gansu Medical College, Pingliang, China
| | | | - Jun-Jun Du
- Department of Intervention, Affiliated Hospital of Gansu Medical College, Pingliang, China
| | - Jia-Xiang She
- Department of Intervention, Affiliated Hospital of Gansu Medical College, Pingliang, China
| | - Jiao Meng
- Department of Radiology, The First people's Hospital Hua Ting, Pingliang, China
| | - Jing Fan
- Department of Radiology Affiliated Hospital of Gansu Medical College, Pingliang, China
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Safdar NZ, Hakeem AR, Faulkes R, James F, Mason L, Masson S, Powell J, Rowe I, Shetty S, Jones R, Spiers HVM, Halliday N, Baker J, Thorburn D, Prasad R, Parker R. Outcomes After Liver Transplantation With Incidental Cholangiocarcinoma. Transpl Int 2022; 35:10802. [PMID: 36406780 PMCID: PMC9667791 DOI: 10.3389/ti.2022.10802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/18/2022] [Indexed: 12/03/2022]
Abstract
Cholangiocarcinoma (CCA) is currently a contraindication to liver transplantation (LT) in the United Kingdom (UK). Incidental CCA occurs rarely in some patients undergoing LT. We report on retrospective outcomes of patients with incidental CCA from six UK LT centres. Cases were identified from pathology records. Data regarding tumour characteristics and post-transplant survival were collected. CCA was classified by TNM staging and anatomical location. 95 patients who underwent LT between 1988-2020 were identified. Median follow-up after LT was 2.1 years (14 days-18.6 years). Most patients were male (68.4%), median age at LT was 53 (IQR 46-62), and the majority had underlying PSC (61%). Overall median survival after LT was 4.4 years. Survival differed by tumour site: 1-, 3-, and 5-year estimated survival was 82.1%, 68.7%, and 57.1%, respectively, in intrahepatic CCA (n = 40) and 58.5%, 42.6%, and 30.2% in perihilar CCA (n = 42; p = 0.06). 1-, 3-, and 5-year estimated survival was 95.8%, 86.5%, and 80.6%, respectively, in pT1 tumours (28.2% of cohort), and 65.8%, 44.7%, and 31.1%, respectively, in pT2-4 (p = 0.018). Survival after LT for recipients with incidental CCA is inferior compared to usual outcomes for LT in the United Kingdom. LT for earlier stage CCA has similar survival to LT for hepatocellular cancer, and intrahepatic CCAs have better survival compared to perihilar CCAs. These observations may support LT for CCA in selected cases.
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Affiliation(s)
- Nawaz Z. Safdar
- School of Medicine, University of Leeds, Leeds, United Kingdom,Leeds Liver Unit, St James’ University Hospital, Leeds, United Kingdom
| | - Abdul R. Hakeem
- Leeds Liver Unit, St James’ University Hospital, Leeds, United Kingdom
| | | | - Fiona James
- Leeds Liver Unit, St James’ University Hospital, Leeds, United Kingdom
| | - Lisa Mason
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Steven Masson
- Newcastle Upon Tyne Hospitals, Newcastle, United Kingdom
| | - James Powell
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Ian Rowe
- Leeds Liver Unit, St James’ University Hospital, Leeds, United Kingdom
| | - Shishir Shetty
- University Hospitals Birmingham, Birmingham, United Kingdom
| | - Rebecca Jones
- Leeds Liver Unit, St James’ University Hospital, Leeds, United Kingdom
| | - Harry V. M. Spiers
- Roy Calne Transplant Unit, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | | | | | | | - Raj Prasad
- Leeds Liver Unit, St James’ University Hospital, Leeds, United Kingdom
| | - Richard Parker
- Leeds Liver Unit, St James’ University Hospital, Leeds, United Kingdom,*Correspondence: Richard Parker,
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Wang YB, Rong PH, Fu YF, Yuan E. Stent with radioactive strand insertion for inoperable hilar cholangiocarcinoma: comparison of unilateral and bilateral insertion. Scand J Gastroenterol 2021; 56:1473-1479. [PMID: 34428128 DOI: 10.1080/00365521.2021.1968945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the relative clinical efficacy associated with the unilateral and bilateral insertion of a stent with a radioactive strand (RS) for the treatment of inoperable hilar cholangiocarcinoma (HCCA) patients. METHODS From January 2017 to June 2020, consecutive patients diagnosed with inoperable HCCA underwent either unilateral or bilateral stent with RS insertion in our hospital. Outcomes compared between these groups included rates of technical success, clinical success, stent-related complications, stent patency and overall survival (OS). RESULTS Unilateral and bilateral stent with RS insertion procedures were performed in 36 and 30 patients over the study period, respectively, with 100% technical and clinical success rates in both groups. No instances of procedure-related complications were reported. Cholangitis was observed in 7 (19.4%) and 6 (20%) patients in unilateral and bilateral groups (p= .955), respectively, while these groups exhibited respective cholecystitis in 2 (5.5%) and 1 (3.3%) cases, respectively (p=.662), and stent restenosis in 9 (25%) and 7 (23.3%) cases, respectively (p=.661). The median duration of stent patency in the unilateral and bilateral groups was comparable at 208 and 222 d, respectively (p=.889). All patients died over the course of follow-up, with similar median OS rates in the unilateral and bilateral groups of 250 and 246 d, respectively (p=.483). CONCLUSIONS These data indicated that similar inoperable HCCA patient clinical outcomes are achieved following stent with RS insertion regardless of whether it is conducted via a unilateral or bilateral approach.
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Affiliation(s)
- You-Bin Wang
- Department of Interventional Radiology, Xuzhou Cancer Hospital, Xuzhou, PR China
| | - Pan-Hao Rong
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, PR China
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, PR China
| | - En Yuan
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, PR China
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Hrudka J, Prouzová Z, Mydlíková K, Jedličková K, Holešta M, Whitley A, Havlůj L. FOXF1 as an Immunohistochemical Marker of Hilar Cholangiocarcinoma or Metastatic Pancreatic Ductal Adenocarcinoma. Single Institution Experience. Pathol Oncol Res 2021; 27:1609756. [PMID: 34257615 PMCID: PMC8262193 DOI: 10.3389/pore.2021.1609756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/17/2021] [Indexed: 12/28/2022]
Abstract
Cholangiocarcinoma (CCA) is a liver malignancy associated with a poor prognosis. Its main subtypes are peripheral/intrahepatic and hilar/extrahepatic CCA. Several molecular, morphological and clinical similarities between hilar/extrahepatic CCA and pancreatic ductal adenocarcinoma (PDAC) have been described. FOXF1 is a transcription factor which has been described to have prognostic significance in various tumors and it is involved in the development of bile ducts. The aim of this study is to determine occurrence of nuclear expression of FOXF1 in both subtypes of CCA and metastatic PDAC and assess its potential usefulness as a diagnostic marker. Secondary aims were to investigate the use of C-reactive protein (CRP) immunohistochemistry for diagnosing intrahepatic peripheral CCA and the significance of histological features in CCA subtypes. 32 archive specimens of CCA, combined hepatocellular carcinoma-CCA (HCC-CCA) and liver metastasis of PDAC were stained by FOXF1 and CRP immunohistochemistry and evaluated to determine histological pattern. The CCAs were classified radiologically into peripheral/intrahepatic and hilar subtype. Using Fisher exact test, we identified nuclear FOXF1 as a fairly specific (87%) but insensitive (65%) marker of hilar and extrahepatic CCA and metastatic PDAC (p = 0.005). CRP immunohistochemistry was characterized by a high sensitivity and specificity, of 79% and 88%, respectively (p = 0.001). We did not identify any histomorphological features associated with either types of CCA or metastatic PDAC. As a conclusion of novel finding, FOXF1 immunohistochemistry may be regarded as a specific but insensitive marker of hilar/extrahepatic CCA and metastatic PDAC and it may help distinguish them from peripheral CCA.
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Affiliation(s)
- Jan Hrudka
- Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Zuzana Prouzová
- Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Katarína Mydlíková
- Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Kristína Jedličková
- Clinical and Transplant Pathology Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Michal Holešta
- Department of Radiodiagnostics, Charles University, 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Adam Whitley
- Department of General Surgery, Charles University, 3rd Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Lukáš Havlůj
- Department of General Surgery, Charles University, 3rd Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, Prague, Czech Republic
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Cao Q, Sun L, Li ZQ, Xia FF, Zhang JH, Song T. Bilateral stenting for hilar biliary obstruction: a meta-analysis of side-by-side versus stent-in-stent. MINIM INVASIV THER 2021; 31:525-530. [PMID: 33433250 DOI: 10.1080/13645706.2020.1871371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the efficacy of stent-in-stent (SIS) and side-by-side (SBS) bilateral stenting for treating malignant hilar biliary obstruction (MHBO). MATERIAL AND METHODS Relevant studies in Pubmed, Embase, and Cochrane Library were identified through June 2020. This meta-analysis was conducted using RevMan v5.3, using relevant endpoint data relating to clinical and technical success, complications, stent dysfunction, and overall survival (OS) rates extracted from these studies. RESULTS We identified six relevant studies which included 315 MHBO patients treated with either SBS (n = 161) or SIS bilateral (n = 154) stenting. We saw no significant difference between these two groups with respect to clinical success (OR: 1.07; 95% CI: 0.46, 2.49, p = .87), complication (HR: 0.12; 95% CI: -0.04, 0.27, p = .15), stent dysfunction (OR: 0.68; 95% CI: 0.42, 1.10, p = .11), or OS (HR: 0.97; 95% CI: 0.82, 1.16, p = .74). However, the SBS group exhibited significantly lower technical success rates (OR: 6.55; 95% CI: 1.10, 38.83, p = .04). Significant heterogeneity was only detected for the endpoint of complication rates (I2 = 60%). CONCLUSION These results suggest that SIS bilateral stenting yields better rates of technical success than does SBS bilateral stenting in MHBO patients.
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Affiliation(s)
- Qiang Cao
- Department of Radiology, Binzhou People's Hospital, Binzhou, China
| | - Lin Sun
- Department of Radiology, Binzhou People's Hospital, Binzhou, China
| | - Zhi-Qiang Li
- Department of Radiology, Binzhou People's Hospital, Binzhou, China
| | - Feng-Fei Xia
- Department of Interventional Radiology, Binzhou People's Hospital, Binzhou, China
| | - Jian-Hua Zhang
- Department of Interventional Radiology, Fengjie People's Hospital, Chongqing, China
| | - Tao Song
- Department of General Surgery, Xuzhou Central Hospital, Xuzhou, China
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Lee TH, Jang SI, Moon JH, Lee YN, Yang JK, Park JS, Jeong S, Lee DH, Heo NH, Park SH, Lee DK. Endoscopic revision efficacy after clinically successful bilateral metal stenting for advanced malignant hilar obstruction. J Gastroenterol Hepatol 2020; 35:2248-2255. [PMID: 32472962 DOI: 10.1111/jgh.15123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUNDS AND AIM Multiple insertions of self-expandable metal stents (SEMS) for advanced malignant hilar obstruction (MHO) are now considered to be an effective palliative method for adequate drainage of liver volume. However, the efficacy of endoscopic reintervention in technically and clinically successful bilateral SEMS is limited. This study investigated the endoscopic revision efficacy in patients who underwent bilateral SEMS in MHO. METHODS Primary endoscopic revision using plastic or metal stents or an alternative percutaneous approach followed by secondary endoscopic revision was performed in patients who underwent clinically successful deployment of bilateral SEMS. The primary outcome was a technical success. Secondary outcomes were clinical success, adverse events, and patency duration after reintervention. RESULTS A total of 55 patients (83.3%) out of 66 enrolled patients underwent reintervention: primary endoscopic reintervention (n = 47) and secondary endoscopic revision following percutaneous drainage (n = 8). Intended technical success rates of primary and secondary endoscopic reintervention were 93.6% (44/47) and 87.5% (7/8), respectively (P = 0.47). Clinical success rates were 72.3% and 50%, respectively (P = 0.23). Stent malfunction rate after reintervention was 48.9% (23/47) and 37.5% (3/8) (P = 0.70) during follow up, and median cumulative stent patency duration was 119 and 55 days, respectively (log-rank P = 0.68). Stent patent rate after reintervention was not different according to the time interval. In univariate and multivariate analysis for stent patency duration-related factors after reintervention, there were no meaningful factors. CONCLUSION Primary endoscopic reintervention for bilateral SEMS in MHO was feasible technically and clinically. However, there were no statistically meaningful factors for stent patency duration after reintervention.
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Affiliation(s)
- Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Sung Ill Jang
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Ho Moon
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Yun Nah Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Jae Kook Yang
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Jin-Seok Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Seok Jeong
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Don Haeng Lee
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Sang-Heum Park
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Dong Ki Lee
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kawase T, Inoue Y, Matsuo J, Omura A, Seike Y, Uehara K, Sasaki H, Matsuda H. Results of Surgical Repair of Hilar Renal Artery Aneurysm to Preserve Renal Blood Flow. Ann Vasc Dis 2020; 13:281-285. [PMID: 33384731 PMCID: PMC7751073 DOI: 10.3400/avd.oa.20-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Surgical indications and procedures for hilar renal artery aneurysm (HRAA) are controversial in terms of invasiveness and feasibility. Catheter treatment is minimally invasive but leads to renal dysfunction due to renal infarction. This study aims to investigate the results of surgical repair of HRAA. Method: Fourteen patients (58.7±11.6 years old, 7 male) who underwent surgical repair of HRAA were retrospectively reviewed. Nine patients (64%) developed HRAA in the right renal artery, and the mean maximum aneurysmal diameter was 25.9±10.3 mm. HRAA was exposed via the extraperitoneal approach. HRAA was resected completely, and reconstruction of renal arteries was performed by direct closure in two, direct anastomosis in nine, and interposition of saphenous vein graft in three patients. Results: The average operation and renal ischemic times were 186±49 and 35±16 min, respectively. No operative death occurred, and postoperative renal function at the time of discharge had not deteriorated (creatinine, 0.74±0.15 mg/dl). During the follow-up periods (4.7±5.1 years), there was no death, no new introduction of hemodialysis, and no recurrence of renal artery aneurysm. Conclusion: Surgical repair of HRAA remains a valid option because of its operative safety, preservation of renal function, and long-term feasibility and patency.
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Affiliation(s)
- Takumi Kawase
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Jiro Matsuo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Atsushi Omura
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kyokun Uehara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
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Mehrian P, Doroudinia A, Shams M, Alizadeh N. Distribution and Characteristics of Intrathoracic Lymphadenopathy in TB/HIV Co-Infection. Infect Disord Drug Targets 2020; 19:414-420. [PMID: 30324894 DOI: 10.2174/1871526518666181016111142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 07/22/2018] [Accepted: 10/06/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intrathoracic Lymphadenopathy (ITLN) in Human Immunodeficiency Virus (HIV) infected patients may have various etiologies and prognoses. Etiologies of ITLN can be distinguished based on the distribution of enlarged lymph nodes. Sometimes tuberculosis (TB) is the first sign of underlying HIV infection. OBJECTIVES We sought to determine ITLN distribution and associated pulmonary findings in TB/HIV co-infection using Computed Tomography (CT) scan. METHODS In this retrospective, observational, cross-sectional study, chest CT scans of 52 patients with TB/HIV co-infection were assessed for enlarged intrathoracic lymph nodes (>10 mm in short axis diameter), lymphadenopathy (LAP) distribution, calcification, conglomeration, the presence of hypodense center and associated pulmonary abnormalities. LAP distribution was compared in TB/HIV co-infection with isolated TB infection. RESULTS Mediastinal and/or hilar LAP were seen in 53.8% of TB/HIV co-infection patients. In all cases, LAP was multistational. The most frequent stations were right lower paratracheal and subcarinal stations. Lymph node conglomeration, hypodense center and calcification were noted in 25%, 21.4% and 3.5% of patients, respectively. LAP distribution was the same as that in patients with isolated TB infection except for the right hilar, right upper paratracheal and prevascular stations. All patients with mediastinal and/or hilar adenopathy had associated pulmonary abnormalities. CONCLUSION All patients with TB/HIV co-infection and mediastinal and/or hilar adenopathy had associated pulmonary abnormalities. Superior mediastinal lymph nodes were less commonly affected in TB/HIV co-infection than isolated TB.
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Affiliation(s)
- Payam Mehrian
- Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abtin Doroudinia
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Moghadaseh Shams
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Alizadeh
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Staub J, Siddiqui A, Murphy M, Lam R, Parikh M, Pleskow D, Papachristou G, Sharaiha R, Iqbal U, Loren D, Kowalski T, Noor A, Mumtaz T, Yasuda I, Thomas S, Hsaeeb A, Herrick J, Greene T, Adler DG. Unilateral versus bilateral hilar stents for the treatment of cholangiocarcinoma: a multicenter international study. Ann Gastroenterol 2020; 33:202-209. [PMID: 32127742 PMCID: PMC7049245 DOI: 10.20524/aog.2020.0451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023] Open
Abstract
Background Endoscopic placement of hilar stents is an accepted palliative therapy for patients with advanced, unresectable cholangiocarcinoma. However, whether unilateral versus bilateral stent placement provides optimal relief continues to be a subject of debate. The aim of this study was to compare the technical and clinical outcomes in patients with inoperable cholangiocarcinoma who received unilateral or bilateral self-expanding metal stents (SEMS). Methods We conducted a multicenter, international retrospective study of 187 patients with cholangiocarcinoma who received unilateral or bilateral SEMS. Outcomes included, but were not limited to, technical success, clinical success, adverse events, stent occlusion, and survival time. Results were further stratified based on the Bismuth classification. Results Fifty patients received unilateral stents and 137 patients received bilateral stents. All patients achieved technical success. The clinical success rates were 86% for unilateral stents and 82.5% for bilateral stents (P>0.99). Clinical success was not statistically different for either group when stratified by the Bismuth classification (P=0.62 and P=0.72 respectively). There were significantly more adverse events in the bilateral stents group (11.7% vs. 0%, P=0.007). There was no greater risk of stent occlusion when bilateral stents were used (unadjusted P=0.71, adjusted P=0.81). There was a greater risk of death for patients who received bilateral SEMS (hazard ratio 1.78, 95% confidence interval 1.09-2.89; P=0.02). Conclusions Unilateral and bilateral drainage had similar technical and clinical success rates. However, bilateral stents had a higher risk of death and more adverse events. Therefore, unilateral SEMS placement is sufficient for relief of biliary obstruction secondary to cholangiocarcinoma.
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Affiliation(s)
- Judith Staub
- Department of Gastroenterology, University of Utah, Salt Lake City, UT (Judith Staub, Samuel Thomas, Abdul Hsaeeb, Jennifer Herrick, Tom Greene, Douglas G. Adler)
| | - Ali Siddiqui
- Department of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA (Ali Siddiqui, Megan Murphy, Robert Lam, Meet Parikh, David Loren, Thomas Kowalski, Arish Noor)
| | - Megan Murphy
- Department of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA (Ali Siddiqui, Megan Murphy, Robert Lam, Meet Parikh, David Loren, Thomas Kowalski, Arish Noor)
| | - Robert Lam
- Department of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA (Ali Siddiqui, Megan Murphy, Robert Lam, Meet Parikh, David Loren, Thomas Kowalski, Arish Noor)
| | - Meet Parikh
- Department of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA (Ali Siddiqui, Megan Murphy, Robert Lam, Meet Parikh, David Loren, Thomas Kowalski, Arish Noor)
| | - Douglas Pleskow
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA (Douglas Pleskow)
| | - Georgios Papachristou
- Department of Gastroenterology, University of Pittsburgh, Pittsburgh, PA (Georgios Papachristou)
| | - Reem Sharaiha
- Department of Gastroenterology, Weill Cornell Medical College, New York City, NY (Reem Sharaiha)
| | - Usama Iqbal
- Department of Gastroenterology, Drexel University, Philadelphia, PA (Usama Iqbal)
| | - David Loren
- Department of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA (Ali Siddiqui, Megan Murphy, Robert Lam, Meet Parikh, David Loren, Thomas Kowalski, Arish Noor)
| | - Thomas Kowalski
- Department of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA (Ali Siddiqui, Megan Murphy, Robert Lam, Meet Parikh, David Loren, Thomas Kowalski, Arish Noor)
| | - Arish Noor
- Department of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA (Ali Siddiqui, Megan Murphy, Robert Lam, Meet Parikh, David Loren, Thomas Kowalski, Arish Noor)
| | - Tayebah Mumtaz
- Department of Gastroenterology, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania (Tayebah Mumtaz)
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Japan (Ichiro Yasuda)
| | - Samuel Thomas
- Department of Gastroenterology, University of Utah, Salt Lake City, UT (Judith Staub, Samuel Thomas, Abdul Hsaeeb, Jennifer Herrick, Tom Greene, Douglas G. Adler)
| | - Abdul Hsaeeb
- Department of Gastroenterology, University of Utah, Salt Lake City, UT (Judith Staub, Samuel Thomas, Abdul Hsaeeb, Jennifer Herrick, Tom Greene, Douglas G. Adler)
| | - Jennifer Herrick
- Department of Gastroenterology, University of Utah, Salt Lake City, UT (Judith Staub, Samuel Thomas, Abdul Hsaeeb, Jennifer Herrick, Tom Greene, Douglas G. Adler)
| | - Tom Greene
- Department of Gastroenterology, University of Utah, Salt Lake City, UT (Judith Staub, Samuel Thomas, Abdul Hsaeeb, Jennifer Herrick, Tom Greene, Douglas G. Adler)
| | - Douglas G Adler
- Department of Gastroenterology, University of Utah, Salt Lake City, UT (Judith Staub, Samuel Thomas, Abdul Hsaeeb, Jennifer Herrick, Tom Greene, Douglas G. Adler)
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Abstract
Although endoscopic intervention is the mainstay for palliation of malignant biliary obstruction, a percutaneous approach has been preferred, particularly in patients with advanced high-grade hilar malignant biliary obstruction, because of the technical difficulty and risk of complications. However, recently, primary endoscopic palliation using plastic or metal stents has had higher technical and clinical success with fewer adverse events than the percutaneous approach. Endoscopic interventions are being done more and more frequently because of advances in metal stents, accessories, and techniques. However, several concerns, such as optimal stent type, number, and deployment method, remain to be resolved. Therefore, we reviewed the literature in order to identify the optimal biliary stenting strategy for patients with hilar malignant biliary obstruction, focusing on stent type (plastic vs metal), number (unilateral [single] vs bilateral [multiple]), and deployment method (stent-in-stent vs stent-by-stent).
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Affiliation(s)
- Tae Hoon Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Jong Ho Moon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Sang-Heum Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan Hospital, Cheonan, Korea
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14
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Turgeon MK, Maithel SK. Cholangiocarcinoma: a site-specific update on the current state of surgical management and multi-modality therapy. Chin Clin Oncol 2019; 9:4. [PMID: 31500433 DOI: 10.21037/cco.2019.08.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022]
Abstract
Biliary tract cancers (BTC) are rare, heterogeneous malignancies that include cholangiocarcinoma and gallbladder cancer (GBC). Cholangiocarcinoma subtypes differ by anatomic location and molecular profile. Currently, resection with lymphadenectomy is the only curative treatment of locally advanced cholangiocarcinoma. Given the high risk of recurrence, multi-modality therapy spanning surgery, chemotherapy, and radiation therapy should be considered. Current data is discordant and there is limited prospective data to support an optimal treatment regimen, though recent studies have demonstrated the utility of adjuvant chemotherapy and chemoradiation in specific settings and patient populations. There is a potential role for neoadjuvant chemotherapy in patients with resectable disease or chemoradiation in select patients with unresectable, locally advanced disease. Randomized clinical trials are necessary to establish the effectiveness of therapies specific to disease sites, especially with the emerging role of immunotherapy and targeted therapy to actionable mutations.
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Affiliation(s)
- Michael K Turgeon
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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15
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Abstract
Advanced pancreaticobiliary malignancy tends to be uncurable at presentation and causes significant morbidity for patients. Palliation for malignant biliary obstruction should be minimally invasive, cost-effective, and aim to improve quality of life of patients. Strategies of endoscopic palliation of malignant biliary obstruction can differ based on sites and degree of biliary obstruction with complex decisions of optimal stent type and placement that involve conscientious planning by a multidisciplinary team.
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Affiliation(s)
- A Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin Liu
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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16
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Hrudka J, Oliverius M, Gürlich R. Pathology of cholangiocellular carcinoma. Cas Lek Cesk 2019; 158:57-63. [PMID: 31109164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cholangiocellular carcinoma (CCC) is a malignant tumor harboring a poor prognosis, occurring in the liver, gallbladder and in extra- or intrahepatic biliary ducts. The article reviews the topic concerning CCC from the point of view of a surgical pathologist. The paper deals with classification of CCC into an intrahepatic/peripheral and hilar/extrahepatic subtype with different morphology, molecular features and prognosis; together with classical gross pathology, histopathology and natural history of CCC. Hilar and extrahepatic CCC share some biological characteristics with pancreatic ductal adenocarcinoma. The review comprises various types of precancerous lesions of biliary tract, summarizes updates in 8th edition of TNM classification and describes the routine issues concerning histopathological diagnostics of CCC, including immunohistochemistry and frozen section methods.
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17
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Abstract
Wandering spleen is a rare entity that results from the absence or maldevelopment of the ligaments that support the spleen in its normal location. As a result, the spleen is hypermobile and may be predisposed to hilar torsion and subsequent infarction, making it a potentially fatal abdominal emergency. We present a case of a 36-year-old Afghan female who presented with an acute abdomen, and was radiologically and surgically confirmed to have a wandering spleen with torsion and complete infarction. Knowledge of this condition and its radiological findings can play a crucial role in making a correct and timely diagnosis.
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Affiliation(s)
- Dawar B Khan
- Department of Radiology, The Aga Khan University, Karachi, PAK
| | | | | | - Sarim D Khan
- Medical College, The Aga Khan University, Karachi, PAK
| | - Rabail Raza
- Department of Radiology, The Aga Khan University, Karachi, PAK
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18
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Kanno Y, Ito K, Koshita S, Ogawa T, Masu K, Kusunose H, Sakai T, Masaki Y, Murabayashi T, Hasegawa S, Kozakai F, Horaguchi J, Matsuo H, Noda Y. EUS-guided Biliary Drainage for Malignant Peri hilar Biliary Strictures after Further Transpapillary Intervention Has Been Judged to Be Impossible or Ineffective. Intern Med 2017; 56:3145-3151. [PMID: 29021470 PMCID: PMC5742384 DOI: 10.2169/internalmedicine.9001-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective Patients with perihilar malignancy often develop recurrence of infectious cholangitis, which makes further transpapillary intervention extremely difficult. As endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) of an intrahepatic bile duct is a possible option for additional intervention, the aim of this study was to estimate the feasibility of such intervention. Methods and Patients Patients who had undergone EUS-BD after further transpapillary intervention was deemed impossible or ineffective were investigated in this study. Those who had not received previous interventions via the papilla were excluded. Procedure-related adverse events, clinical efficacy, and time to recurrence of jaundice or infectious cholangitis transthyretin (TTR) were evaluated. Results Seven patients were eligible for the study between 2007 and 2016 (7 men; mean age, 77 years; 4 with perihilar cholangiocarcinoma and 3 with intrahepatic cholangiocarcinoma). No procedure-related adverse events were observed. EUS-BD was clinically effective and enabled hospital discharge in 4 patients (57%). The TTR in these 4 clinically effective patients was 43, 105, 118, and 147 days after the procedure (median, 112 days). Conclusion EUS-BD was found to be safe and often effective in patients in whom additional transpapillary intervention had become difficult, although its efficacy was limited to a short period.
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Affiliation(s)
| | - Kei Ito
- Sendai City Medical Center, Japan
| | | | | | | | | | | | | | | | | | | | - Jun Horaguchi
- Sendai City Medical Center, Japan
- Natori Chuo Clinic, Japan
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19
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Li YQ, Wang KP, Ben SQ. Insight into the differences in classification of mediastinal and hilar lymph nodes between Wang's lymph node map and the International Association for the Study of Lung Cancer lymph node map. J Thorac Dis 2016; 7:S246-55. [PMID: 26807271 DOI: 10.3978/j.issn.2072-1439.2015.11.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Lung cancer is the leading cause of malignant-tumor-related morbidity and mortality worldwide. Transbronchial needle aspiration (TBNA) has for the past 30 years been an effective technique for the diagnosis and staging of lung cancer. Understanding the anatomy of mediastinal and hilar lymph nodes is essential to improve the yield of TBNA. Wang's lymph node map is based on the lymph node map of the American Thoracic Society (ATS), and on the TBNA technique; it was published in 1994, and has promoted the development of both conventional TBNA (cTBNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In 2009, the International Association for the Study of Lung Cancer (IASLC) developed a new chest lymph node map to reconcile the differences between the Naruke and The Mountain-Dresler (MD)-ATS lymph node maps. The IASLC lymph node map was incorporated into the seventh edition of the tumor, node, metastasis (TNM) staging system for lung cancer, which directly affected the treatment and prognosis of lung cancer. There are significant differences between Wang's lymph node map and the IASLC lymph node map in TNM staging, and it is imperative to understand these differences and correlate these maps for the prognosis and staging of lung cancer using cTBNA or EBUS-TBNA.
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Affiliation(s)
- Ya-Qing Li
- 1 Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310014, China ; 2 Division of Pulmonary Medicine and Critical Care Medicine, Interventional Pulmonology, Johns Hopkins University School of Medicine, Baltimore, USA ; 3 Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Ko-Pen Wang
- 1 Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310014, China ; 2 Division of Pulmonary Medicine and Critical Care Medicine, Interventional Pulmonology, Johns Hopkins University School of Medicine, Baltimore, USA ; 3 Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Su-Qin Ben
- 1 Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310014, China ; 2 Division of Pulmonary Medicine and Critical Care Medicine, Interventional Pulmonology, Johns Hopkins University School of Medicine, Baltimore, USA ; 3 Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
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20
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Soares KC, Kamel I, Cosgrove DP, Herman JM, Pawlik TM. Hilar cholangiocarcinoma: diagnosis, treatment options, and management. Hepatobiliary Surg Nutr 2014; 3:18-34. [PMID: 24696835 DOI: 10.3978/j.issn.2304-3881.2014.02.05] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/30/2013] [Indexed: 12/16/2022]
Abstract
Hilar cholangiocarcinoma (HC) is a rare disease with a poor prognosis which typically presents in the 6(th) decade of life. Of the 3,000 cases seen annually in the United States, less than one half of these tumors are resectable. A variety of risk factors have been associated with HC, most notably primary sclerosing cholangitis (PSC), biliary stone disease and parasitic liver disease. Patients typically present with abdominal pain, pruritis, weight loss, and jaundice. Computed topography (CT), magnetic resonance imaging (MRI), and ultrasound (US) are used to characterize biliary lesions. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) assess local ductal extent of the tumor while allowing for therapeutic biliary drainage. MRCP has demonstrated similar efficacies to PTC and ERCP in identifying anatomic extension of tumors with less complications. Treatment consists of surgery, radiation, chemotherapy and photodynamic therapy. Biliary drainage of the future liver remnant should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Standard therapy consists of surgical margin-negative (R0) resection with extrahepatic bile duct resection, hepatectomy and en bloc lymphadenectomy. Local resection should not be undertaken. Lymph node invasion, tumor grade and negative margins are important prognostic indicators. In instances where curative resection is not possible, liver transplantation has demonstrated acceptable outcomes in highly selected patients. Despite the limited data, chemotherapy is indicated for patients with unresectable tumors and adequate functional status. Five-year survival after surgical resection of HC ranges from 10% to 40% however, recurrence can be as high as 50-70% even after R0 resection. Due to the complexity of this disease, a multi-disciplinary approach with multimodal treatment is recommended for this complex disease.
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Affiliation(s)
- Kevin C Soares
- 1 Department of Surgery, Division of Surgical Oncology, 2 Department of Radiology, 3 Department of Oncology, 4 Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab Kamel
- 1 Department of Surgery, Division of Surgical Oncology, 2 Department of Radiology, 3 Department of Oncology, 4 Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David P Cosgrove
- 1 Department of Surgery, Division of Surgical Oncology, 2 Department of Radiology, 3 Department of Oncology, 4 Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph M Herman
- 1 Department of Surgery, Division of Surgical Oncology, 2 Department of Radiology, 3 Department of Oncology, 4 Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- 1 Department of Surgery, Division of Surgical Oncology, 2 Department of Radiology, 3 Department of Oncology, 4 Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Abstract
Perihilar cholangiocarcinoma (CCA) is the second most common primary malignant tumor of the liver. In the USA, there are approximately 3000 cases of CCA diagnosed annually, with approximately 50-70% of these tumors arising at the hilar plate of the biliary tree. Risk factors include advanced age, male gender, primary sclerosing cholangitis, choledochal cysts, cholelithiasis, parasitic infection, inflammatory bowel disease, cirrhosis and chronic pancreatitis. Patients typically present with jaundice, abdominal pain, pruritus and weight loss. The mainstays of treatment include surgery, chemotherapy, radiation therapy and photodynamic therapy. Specific preoperative interventions for patients with perihilar CCA include endoscopic retrograde cholangiopancreatography, percutanteous transhepatic cholangiography and portal vein embolization. Surgical resection offers the only chance for curative therapy in perihilar CCA. R0 resection is of utmost importance and has been linked to improved survival. Major hepatic resection is needed to achieve both longitudinal and radial margins negative for tumor. Fractionated stereotactic body radiotherapy has shown promising results in CCA. Perihilar CCA typically presents with advanced disease, and many patients receive systemic therapy; however, the response to current regimens is limited. Orthotopic liver transplantation offers complete resection of locally advanced tumors in select patient groups.
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Affiliation(s)
- Vicente Valero
- Department of Surgery, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Harvey 611, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - David Cosgrove
- Division of Surgical Oncology, Department of Medical Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph M Herman
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Harvey 611, 600 N Wolfe Street, Baltimore, MD 21287, USA
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22
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Abstract
This article reviews the preoperative evaluation and operative considerations in patients with hilar cholangiocarcinoma. The preoperative evaluation is based on the imaging evaluation of the longitudinal and radial extent of the tumour along and around the hepatic duct confluence. The use of portal vein embolization to increase the safety of extended hepatectomy and the extent of surgical resection (caudate lobe and portal vein) are discussed within the context of recently published series.
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Affiliation(s)
- Alexander A. Parikh
- Vanderbilt University Medical Center, Division of Surgical OncologyNashville TN
| | - Eddie K. Abdalla
- University of Texas M.D. Anderson Cancer Center, Department of Surgical OncologyHouston TXUSA
| | - Jean-Nicolas Vauthey
- University of Texas M.D. Anderson Cancer Center, Department of Surgical OncologyHouston TXUSA
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