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Tatsumi R, Ichihara S, Suii H, Yamaguchi M, Arakawa T, Nakajima T, Kuwata Y, Ozeki I, Hige S, Toyota J, Karino Y. Bile duct adenoma: imaging features and radiologic-pathologic correlation. Jpn J Radiol 2020; 38:561-571. [PMID: 32128668 DOI: 10.1007/s11604-020-00938-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 02/19/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE This study aimed to reveal characteristic imaging features of bile duct adenoma (BDA) by radiologic-pathologic correlation. MATERIALS AND METHODS We retrospectively analyzed pathological and imaging findings of seven patients with BDA. RESULTS The median maximum diameter of BDA was 5.5 mm. Six lesions had hemispheric morphology. Seven lesions were located in the liver subcapsular region, and proliferation of bile ductules without atypia and fibrous stroma was observed. Two lesions had different microscopic findings. In both lesions, proliferation of bile ductules without atypia was observed in the margin. In one lesion, the percentage of fibrosis and hyalinization was higher at the center than at the margin. In the other lesion, inflammatory cell infiltration was observed in the center. On contrast-enhanced imaging, BDAs showed hypervascularity in the early phase and prolonged enhancement in the delayed phase. On contrast-enhanced multidetector computed tomography during hepatic arteriography, two lesions showed ring-like enhancement in the first phase and prolonged enhancement in the second phase. These were the different histopathologic features of BDAs between the margin and center. CONCLUSION Bile duct adenoma can be characterized as a small semicircular lesion located in the liver subcapsular region, which show hypervascularity in the early phase with prolonged enhancement.
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Affiliation(s)
- Ryoji Tatsumi
- Department of Gastoroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, Hokkaido, 060-0033, Japan.
| | - Shin Ichihara
- Department of Surgical Pathology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, Hokkaido, 060-0033, Japan
| | - Hirokazu Suii
- Department of Gastoroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, Hokkaido, 060-0033, Japan
| | - Masakatsu Yamaguchi
- Department of Gastoroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, Hokkaido, 060-0033, Japan
| | - Tomohiro Arakawa
- Department of Gastoroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, Hokkaido, 060-0033, Japan
| | - Tomoaki Nakajima
- Department of Gastoroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, Hokkaido, 060-0033, Japan
| | - Yasuaki Kuwata
- Department of Gastoroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, Hokkaido, 060-0033, Japan
| | - Itaru Ozeki
- Department of Gastoroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, Hokkaido, 060-0033, Japan
| | - Shuhei Hige
- Department of Gastoroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, Hokkaido, 060-0033, Japan
| | - Joji Toyota
- Department of Gastoroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, Hokkaido, 060-0033, Japan
| | - Yoshiyasu Karino
- Department of Gastoroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, Hokkaido, 060-0033, Japan
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2
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Hohmann J, Loddenkemper C, Albrecht T. Assessment of a biliary hamartoma with contrast-enhanced sonography using two different contrast agents. Ultraschall Med 2009; 30:185-188. [PMID: 18726842 DOI: 10.1055/s-2008-1027324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 49 year old male with carcinoma of the esophagus was staged using conventional US of the abdomen. US revealed signs of cirrhosis and a hyporeflexive focal liver lesion of about 5 mm in diameter was found. Low-MI contrast-enhanced ultrasound (CEUS) with SonoVue (Bracco, Milano, Italy) showed an enhancement pattern which was typical for benign liver lesions while high-MI CEUS with Levovist (Schering, Berlin, Germany) revealed a contrast defect in the liver late phase (4:30 min p. i.) which is typical for a malignant lesion. Due to these findings the lesion was evaluated as a potentially malignant lesion and a biopsy was performed. Histology showed a benign biliary hamartoma and incomplete cirrhosis. The findings confirmed that liver-specific contrast agents have the ability to detect very small focal liver lesions not derived from hepatic tissue but may lead to a misinterpretation as a malignant lesion. Nevertheless biliary duct adenomas are benign lesions with almost the same perfusion properties as normal liver parenchyma. Therefore, while using SonoVue, such a misinterpretation of these very common but in most cases very small and not detectable lesions seems unlikely.
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Affiliation(s)
- J Hohmann
- Department of Radiology, University Hospital Basel, Petersgraben 4, Basel.
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3
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Marcos Hernández R, Rodríguez Pascual A, Martín Fernández J, Ramos Guillén P, Galván Huarte M, Gutiérrez Calvo A, Díez Alonso M, Granell Vicent FJ. [Hepatobiliary cystoadenomas]. Cir Esp 2006; 79:375-8. [PMID: 16769003 DOI: 10.1016/s0009-739x(06)70894-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cystoadenomas of the liver are rare cystic tumors that have seldom been reported. Accurate preoperative diagnosis is difficult because they are usually mistaken for more frequent lesions. Due to their malignant potential, complete surgical removal of the lesion is required. Correct diagnosis is guided by clinical history, radiological imaging, and laboratory parameters. We report two of these rare cases and discuss the spectrum of presentation, pathological features and treatment of these tumors.
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Affiliation(s)
- Ruth Marcos Hernández
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Departamento de Cirugía, Universidad de Alcalá de Henares, Madrid, España.
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4
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Maeda E, Uozumi K, Kato N, Akahane M, Inoh S, Inoue Y, Beck Y, Goto A, Makuuchi M, Ohtomo K. Magnetic resonance findings of bile duct adenoma with calcification. ACTA ACUST UNITED AC 2006; 24:459-62. [PMID: 16958429 DOI: 10.1007/s11604-006-0044-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
Computed tomographic (CT) and magnetic resonance (MR) appearances of bile duct adenoma (BDA in a patient who underwent partial hepatectomy of segment 8 are presented. BDA showed a ring-shaped hyperdense area suggesting calcification and ring enhancement on CT. It appeared hypointense on both T1- and T2-weighted MR images. Preoperatively, the diagnoses considered included metastatic carcinoma, cholangiocarcinoma, tuberculosis, and rare tumors such as epithelioid hemangioendothelioma. The radiological findings were confirmed by pathological investigation.
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Affiliation(s)
- Eriko Maeda
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan.
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5
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Otani K, Tohara K, Mihara K, Ueki T, Tanaka M, Sakaguchi S, Matsui T, Yao T, Haraoka S, Iwashita A. [A case of intrahepatic bile duct adenoma]. Nihon Shokakibyo Gakkai Zasshi 2006; 103:37-43. [PMID: 16444984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Keisuke Otani
- Department of Gastroenterology, Fukuoka University Chikushi Hospital
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6
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Jain M, Ahluwalia C, Agarwal K, Pathania OP. Cytological diagnosis of cholangiocarcinoma with rib metastasis in a young female--a case report. INDIAN J PATHOL MICR 2004; 47:417-20. [PMID: 16295444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Intrahepatic cholangiocarcinomas are second most common primary tumors of the liver. They are usually seen in 6th to 7th decades of life and at an advanced stage leading to poor prognosis. Their occurrence in the young age group is rare. Histopathological features of this tumor are well documented but literature regarding cytomorphological features on FNA is limited. We describe the cytological features of this tumor in a young woman presenting primarily with a rib metastasis. FNA smears from hard lump in the right chest wall and liver mass showed small round tumor cells arranged in the form of sheets, clusters and occasional tubules. The cells showed mild pleomorphism and bland nuclear morphology. Intimately admixed with tumor cells were spindle shaped fibroblastic cells. Serum alpha-fetoprotein level was within normal limit. Special stain for bile and immunocytochemical staining for NSE, chromogranin and CALLA were all negative. Cholangiocarcinoma was diagnosed based on cytological findings and special stains and this diagnosis was histologically confirmed on biopsy.
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Affiliation(s)
- M Jain
- Departments of Pathology and Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi
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7
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Abstract
Biliary cystadenoma is a rare cystic neoplasm and constitutes only 5% of all intrahepatic cysts of biliary origin. We report a case of a 44-year-old woman with huge biliary cystadenoma in the subhepatic space, mimicking a cholecystic lymphangioma. Findings of various imaging modalities including reconstructed CT image are presented and correlated with surgical and pathologic findings.
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Affiliation(s)
- I K Hwang
- Department of Radiology, College of Medicine, Hallym University, South Korea
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8
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Abstract
Biliary papillomatosis is a rare disease with strong potential for malignant degeneration. Diagnosis is often not easy and most are made intraoperatively. In the present study, five patients with biliary papillomatosis admitted between 1990 and 1997 were reviewed. Their clinical presentation, radiological and biochemical findings were analysed. The aim of the study was to discern a set of characteristic features that would enable an early diagnosis. All of the five patients presented with recurrent episodes of acute cholangitis and epigastric pain with raised serum alkaline phosphatase. Imaging modalities including ultrasound, CT, endoscopic retrograde cholangio-pancreatogram, MRI and magnetic resonance cholangio-pancreatogram were reviewed. Salient imaging features included a dilated biliary tree with multiple ill-defined and fuzzy filling defects or endoluminal frond-like mass lesions. In conclusion, biliary papillomatosis is a rare but important cause of biliary obstruction with relapsing cholangitis and obstructive jaundice. With a healthy index of suspicion, the diagnosis can be reached when the above features are available.
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Affiliation(s)
- K F Ma
- Department of Diagnostic Radiology, Kwong Wah Hospital, Kowloon, Hong Kong.
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9
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Inagaki M, Ishizaki A, Kino S, Onodera K, Matsumoto K, Yokoyama K, Makino I, Ojima H, Tokusashi Y, Miyokawa N, Kasai S. Papillary adenoma of the distal common bile duct. J Gastroenterol 1999; 34:535-9. [PMID: 10452691 DOI: 10.1007/s005350050310] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 73-year-old man with a papillary adenoma located in the distal common bile duct is reported. He underwent pylorus-preserving pancreatoduodenectomy. The lesion in the common bile duct featured papillary proliferation of the epithelium and fibrous elements with diffuse infiltration by inflammatory cells. Positive staining for MIB-1 (Ki-67) and p53 was identified in the nuclei of the proliferative epithelium. These findings suggested the malignant potential of this lesion. Further progress in imaging diagnostic techniques should increase the frequency with which such lesions are discovered. Even now, if mural irregularities and defects are found in the extrahepatic biliary system, especially the distal common bile duct, the possibility of such borderline biliary adenoma should be taken into consideration when making a diagnosis.
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Affiliation(s)
- M Inagaki
- Second Department of Surgery, Asahikawa Medical College, Japan
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10
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Abstract
The purpose of this study was to describe the ultrasonographic appearance of biliary cystadenomas in cats and compare the findings to a similar rare form of liver tumor in humans. Biliary cystadenomas are uncommon, benign liver tumors of older cats that may occur as focal or multifocal cystic lesions within the liver. The records of 10 cats which had abdominal ultrasonography and histologic diagnosis of biliary cystadenoma were reviewed. The average age of affected cats was 13.3 years (range 10-16 years). Eight cats were neutered males and two were neutered females. In three cats, the tumors were not seen ultrasonographically due to their small size or from being obscured by near-field reverberation echoes. The remaining seven cats had solitary (4 cats) or multifocal (3 cats) masses corresponding to variable ultrasonographic patterns: multilocular masses containing thin-walled cysts, hyperechoic masses with cystic components, or masses of mixed echogenicity with cystic components. The masses had variable ultrasonographic patterns when multifocal disease was present. Recognizable cysts were evident somewhere within the tumors seen ultrasonographically, although sometimes the cysts appeared very small. The biliary cystadenomas were thought to be clinically silent. Although liver enlargement or a cranial abdominal mass was palpable in 4 cats, no consistent trend of clinical signs, CBC or serum biochemical abnormalities could be directly attributed to biliary cystadenoma. The treatment of choice is surgical resection of the tumor, as continued growth may compress adjacent vital structures within the liver. The differential diagnosis of biliary cystadenomas from other cystic liver lesions such as hepatic cysts, hematomas, abscesses, parasitic cysts, or other liver tumors is discussed.
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Affiliation(s)
- T G Nyland
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California, Davis 95616, USA
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Affiliation(s)
- J A Wood
- Department of Radiology, Loma Linda University Medical Center and Children's Hospital, Loma Linda, California, USA
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12
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Gadzijev EM, Pleskovic A, Stanisavljevic D, Ferlan-Marolt V, Trotovsek B. Hepatobiliary cystadenoma can protrude and grow into the bile ducts. Hepatogastroenterology 1998; 45:1446-51. [PMID: 9840081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND/AIMS To evaluate the phenomenon and the potential reasons for protrusion and growth of hepatobiliary cystadenoma into the extrahepatic bile ducts in our patients, accomplished by a review of the data regarding hepatobiliary cystadenomas published elsewhere. METHODOLOGY In a retrospective open study conducted over the last eight years, five patients with hepatobiliary cystadenoma and one patient with hepatobiliary cystadenocarcinoma were operated on. All the patients were females aged between 25 to 61 years. Diagnostic procedures, laboratory, operative and histopathological findings and treatment were evaluated. RESULTS Most of our patients were found to have hepatobiliary cystadenoma located in the left surgical liver. In three out of five patients with HBC mesenchymal stroma was histologically detected. In two of the three, protrusion and growth into the extrahepatic bile ducts was found. CONCLUSION Considering the pathogenesis, location and the morphology of HBC, the mesenchymal stroma may present the competent potential for intraductal progression of the tumor. Radical excision should be performed for successful treatment of hepatobiliary cystadenomas, because of the potential for reoccurrence.
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Affiliation(s)
- E M Gadzijev
- University Medical Center, Department of Gastroenterologic Surgery, Ljubljana, Slovenia
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13
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Abstract
BACKGROUND Multiple biliary papillomatosis is a rare tumour of the biliary tract but is capable of multicentric malignant transformation. The complete removal of these tumours is difficult because it involves a field change of the biliary tract. METHODS Exploration with choledochoscopy is a prerequisite for thorough assessment of the extent of involvement. Incorporation of laser ablation via a laser-delivering fibre with choledochoscopy permits complete removal of the tumour. RESULTS Repeated laser therapy via choledochoscopy through the T-tube tract enables complete ablation of the tumour which changes the outlook of the prognosis. This is confirmed on subsequent cholangiography. CONCLUSIONS Laser therapy via choledochoscopy is a satisfactory mode of treatment for multiple biliary papillomatosis. It enables complete and precise ablation of the tumour which certainly changes the prognosis of this condition.
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Affiliation(s)
- W C Meng
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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14
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Affiliation(s)
- Y Matsuoka
- Department of Radiology, Nagasaki University School of Medicine, Sakamoto, Japan
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15
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Kaneko K, Honda H, Kajiyama K, Yokomizo Y, Hashiguchi N, Fukuya T, Tateshi Y, Ro T, Masuda K. Radiologically identifiable intratumoral portal vein in intrahepatic cholangiomas: a diagnostic pitfall. Abdom Imaging 1996; 21:445-7. [PMID: 8832867 DOI: 10.1007/s002619900100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although intratumoral patent portal vein (ITPV) is one of the characteristic features of benign hepatic lesions, ITPVs can be demonstrated in malignant tumors. We present the spectrum of MR and CT findings of ITPV identified in intrahepatic cholangiomas with pathological correlations. METHODS The ultrasound, CT and/or MRI findings of pathologically-confirmed intrahepatic cholangiomas were reviewed and correlated with surgical specimen or autopsy findings. RESULTS Intratumoral patent vessels were radiographically-demonstrated in 5 patients with intrahepatic cholangiomas. All intratumoral vessels were secondary or tertiary order portal vein branches. Some wall thickening was identified on pathological examinations. CONCLUSION The radiological demonstration of intratumoral portal vein is not a specific sign of benignity. In the case of a hepatic tumor with a patent portal tract, cholangioma should be considered, as well as benign tumors or lymphoma.
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Affiliation(s)
- K Kaneko
- Department of Radiology, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812, Japan
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16
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Martínez Isla A, Rouco Rouco J, Mosquera Luengo J. [Biliary cystadenoma]. Rev Esp Enferm Dig 1996; 88:634-6. [PMID: 8962780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report a case of biliary cystadenoma in a 40 years female who presented with an epigastric abdominal mass. The preoperative diagnosis was made by means of US, CT and MRI. Lack of calcifications and the serological tests ruled out hydatid disease. Total excision by shelling out the lesion from the liver parenchyma was performed. We recommend complete surgical removal as the treatment of choice due to the malignant potential and the high recurrence rate after partial resections.
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17
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Hanazaki K. Intrahepatic biliary cystadenoma demonstrated by intraoperative cholangiography. Hepatogastroenterology 1996; 43:1024-8. [PMID: 8884333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Biliary cystadenomas are rare neoplasms usually found in the liver. These neoplasms have a strong tendency to recur and undergo malignant transformation, and so differentiating between cystadenomas and other cystic lesions of the liver is very important. We describe herein the characteristics of these neoplasms and report the first case of an intrahepatic biliary cystadenoma being demonstrated by intraoperative cholangiography. In our case, intraoperative cholangiography was very useful in differentiating a cystadenoma or cystadeno-carcinoma from other cystic mass lesions of the liver. Not only did it reveal a communication between the intrahepatic bile duct and the cystadenoma, but it also allowed obtain fluid for cytology.
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Affiliation(s)
- K Hanazaki
- Department of Surgery Nagano Red Cross Hospital, Japan
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18
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Abstract
Hepatobiliary cystadenomas are rare, truly benign cystic epithelial tumors with the potential to become cystadenocarcinoma. The initial symptom is vague, nonspecific abdominal pain, frequently in middle-aged women, but patients may be asymptomatic. Abdominal ultrasonography may be diagnostic. Intracystic fluid, obtained by sonographically guided fine-needle aspiration, may contain elevated levels of carcinoembryonic antigen. Complete resection or enucleation is the treatment of choice. We present the cases of two patients with hepatobiliary cystadenoma.
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Affiliation(s)
- Y G Adam
- Section of Surgical Oncology, Kaiser Permanente Mid-Atlantic Region, Springfield, Va 22150, USA
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19
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Menzel J, Foerster EC, Domschke W. Adenoma of the papilla of Vater: a possible role for intraductal ultrasound (IDUS). Z Gastroenterol 1995; 33:539-42. [PMID: 8525658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Like in adenomas of the colon, an adenoma-carcinoma sequence is expected from adenomatous growths in the papilla of Vater. Papilloadenomas must therefore be resected. Imaging techniques have a decisive influence on the choice of operative technique and consequently on perioperative mortality. Using conventional endoscopic ultrasonography, detection of lesions smaller than 10 mm in diameter is rare. The probes available up to now for intraductal sonography with an external diameter of between 3.4 and 12 mm were too rigid and could be inserted transpapillarily in only a few cases. The recent development, however, of high-frequency, extremely flexible ultrasound catheters with an external diameter of 1.17 mm makes intraductal examination of the pancreatic ductal system possible. We present a case of a 66 year-old female patient, in whom, for the first time, a histologically adenomatous lesion of the papilla of Vater could be examined with intraductal sonography using the endoscopic retrograde, transpapillary approach. As there was no evidence of infiltrative growth, the patient underwent a modified duodenum-preserving resection of the pancreatic head. Histological examination of the resected specimen confirmed the preoperative intraductal sonography findings. Since conventional endosonography did not detect the lesion in this case, intraductal sonography with flexible, high-frequency catheters as presented here, clearly may have a role in extending the possibilities of preoperative examination, especially of focal lesions in the periampullary region.
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Affiliation(s)
- J Menzel
- Department of Medicine B, University of Münster, Germany
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20
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Watanabe S, Hirano M, Kato A, Murakami N, Tsunezuka Y, Kikkawa H, Kidani H, Kitagawa K, Masuda S. [A case of biliary cystadenoma communicated with the intrahepatic bile duct]. Nihon Shokakibyo Gakkai Zasshi 1994; 91:207-11. [PMID: 8114329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- S Watanabe
- Department of Surgery, Koseiren Takaoka Hospital
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Izumi R, Shimizu K, Kiriyama M, Hashimoto T, Yagi M, Yamaguchi A, Nagakawa T, Miyazaki I. Hepatic resection guided by needles inserted under ultrasonographic guidance. Surgery 1993; 114:497-501. [PMID: 8396274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Operative ultrasonography for orienting the direction of transection of the liver is often useful in obtaining an adequate disease-free surgical margin. We have devised a new technique for hepatectomy guided by needles inserted under ultrasonographic guidance. METHODS One hundred two hepatectomies were performed between January 1987 and September 1991, and the hepatectomy with this technique was begun in January 1989. RESULTS In 10 of 29 limited hepatectomies performed in the first phase of the period in which this technique was not available, disease-free surgical margin of less than 1 cm was left because of inadequately directed division. Disease-free surgical margin of more than 1 cm was left in 18 of 23 limited hepatectomies in the second phase of the period in which this technique was available. In the other five operations where disease-free surgical margin of less than 1 cm was left, carcinomas were located too close to the major hepatic vessels. The average blood loss during the limited hepatectomies was reduced by this technique. Two-year and 3-year survival of patients undergoing hepatectomy for hepatocellular carcinoma were more favorable in the second phase than in the first phase. CONCLUSIONS Although the difference between the two groups was not significant, this technique is useful in performing adequate transection of the liver.
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Affiliation(s)
- R Izumi
- Department of Surgery 2, Kanazawa University School of Medicine, Japan
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Abstract
In Europe and North America, primary liver tumors are rare. Resection is the only means of cure, but is possible in only 20-30% of the patients affected, so that in all other patients, i.e. the vast majority, only palliative treatment is possible. In a retrospective analysis we investigated the 68 patients we had treated for hepatocellular or cholangiocellular carcinoma of the liver. In 14 patients resection was possible, while 28 patients were treated by chemoembolization and 26 by intraarterial regional chemotherapy to the liver. There was no difference in tumor stage between the two groups receiving different palliative treatments. The patients in whom resection was performed, in contrast, mostly had less advanced tumors. For chemoembolization we used a mixture of Ethibloc, mitomycin, Adriamycin and cisplatin. Up to 1986, the intraarterial chemotherapy was performed with mitomycin and 5-FU. Since 1986 we have used Adriamycin and cisplatin. The overall median survival time was 8 months: after resection 17 months, after chemoembolization 6.5 months, and after intraarterial chemotherapy 6.5 months. There was a significant difference in survival between patients with tumor stage II and those with tumor stages III and IV. On comparing the survival time achieved with our treatments and that ensuing in the natural course of patients with liver tumor we found no improvement.
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Affiliation(s)
- C Kelm
- Klinik für Allgemein- und Thoraxchirurgie, Justus-Liebig-Universität, Giessen
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Honda H, Onitsuka H, Yasumori K, Hayashi T, Ochiai K, Gibo M, Adachi E, Matsumata T, Masuda K. Intrahepatic peripheral cholangiocarcinoma: two-phased dynamic incremental CT and pathologic correlation. J Comput Assist Tomogr 1993; 17:397-402. [PMID: 8388005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To elucidate the characteristic CT findings of intrahepatic peripheral cholangiocarcinoma, two-phased dynamic incremental CT scans of 20 cholangiocarcinomas in 16 patients were carefully analyzed. Dynamic incremental CT scanning was performed after intravenous administration of 100 ml iodinated contrast medium at a rate of 2 ml/s using a power injector. The CT scans (8-16 sections) were obtained during 45-110 s (early phase) and 6-7 min (delayed phase) after commencement of the injection of the contrast medium. On CT, 55% (11 of 20) of intrahepatic peripheral cholangiocarcinomas appeared hypodense in both phases. Most of the tumors (80%) appeared hypodense in the early phase and had increased CT numbers in their delayed images. Lymphadenopathy was observed in 69% (11 of 16) of patients whose main tumors exceeded 3 cm in diameter. All tumors appeared irregular or indistinct. Twenty percent (4 of 20) of the cholangiocarcinomas were difficult to distinguish from hepatocellular carcinomas or hemangiomas.
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Affiliation(s)
- H Honda
- Department of Radiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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24
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Looser C, Triller J, Baer HU, Blumgart LH. [Preoperative diagnosis of proximal bile duct carcinoma using ultrasound and duplex sonography]. Dtsch Med Wochenschr 1993; 118:505-10. [PMID: 8385599 DOI: 10.1055/s-2008-1059356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- C Looser
- Institut für Diagnostische Radiologie, Universität Bern
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25
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Abstract
Cholangiography is the definitive imaging modality for assessing cholangiocarcinoma. This study was designed to evaluate the ultrasound (US) features of cholangiocarcinomas and assess the accuracy of US in mapping tumor site when compared to cholangiography. Findings were correlated with patient survival. Thirty-one patients with an US diagnosis of cholangiocarcinoma underwent cholangiography. The US diagnosis was correct in 29 of 31 cases. Complete agreement with cholangiography occurred in 23 (78%) cases. In six patients, there was discrepancy over the precise tumor location. US diagnosis of cholangiocarcinoma had a high predictive value (0.94) and proved an accurate method of mapping tumor site. Lesions arising in the hilar region carried a worse prognosis (50% were dead within 80 days).
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Affiliation(s)
- S J Garber
- Department of Ultrasound, Middlesex Hospital, London, UK
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26
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Sasaki F, Kido C, Ariyoshi Y. [CT appearance of thorotrast-related and non-thorotrast-related peripheral cholangiocarcinoma]. Nihon Igaku Hoshasen Gakkai Zasshi 1993; 53:163-70. [PMID: 8387672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To assess the differences in CT findings among patients with peripheral cholangiocarcinoma with and without a history of Thorotrast administration, CT studies from 13 Thorotrast patients and eight non-Thorotrast patients were reviewed. Diagnostic and prognostic differences were evaluated between the two groups. Despite periodic imaging surveillance, eight of the 13 (62%) lesions discovered by CT were larger than 6 cm. The prognosis for Thorotrast patients was unfavourable due to difficulties in early detection and complications from associated hepatic fibrosis. The main problem with early detection was that a background of uneven Thorotrast deposits visualized in the liver disguised the tumor as Thorotrast granulations. Although non-Thorotrast patients were not monitored regularly, they had a better chance of undergoing curative resection for the following three reasons: 1) it was easy to detect the tumor (detection rate, 100%); 2) this group rarely had associated liver cirrhosis in noncancerous areas, and 3) non-Thorotrast patients were younger than Thorotrast patients. Early detection of cancer by CA19-9 assay and imaging in asymptomatic subjects without any history of liver disease could be important steps toward the early and radical resection of cancer to achieve a better prognosis.
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Affiliation(s)
- F Sasaki
- Department of Diagnostic Radiology, Aichi Cancer Center Hospital
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27
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Ammann ME, Walter RM, Winkelbauer F, Thurnher S, Staniszewski K, Karnel F. [Value of ultrasound in follow-up of biliary metal stents--initial results]. Ultraschall Med 1993; 14:23-27. [PMID: 8385365 DOI: 10.1055/s-2007-1005209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Self-expandable metallic biliary endoprostheses (= "stents") are an accepted therapeutic alternative in the palliative treatment of malignant biliary obstruction. The physiological direction of bile flow is re-established for a varying period of time. Sonography is an acutely available modality for the evaluation of symptomatic patients who are carriers of such endoprostheses. The cause of recurrent obstructive jaundice can be diagnosed quickly and a new intervention can be planned carefully.
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Affiliation(s)
- M E Ammann
- Ludwig Boltzmann Institut für radiologisch physikalische Tumordiagnostik, Universitätsklinik für Radiodiagnostik Wien
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28
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Shimada H, Izumi T, Note M, Seki H, Nakagawara G. Anterior segmentectomy with caudate lobectomy for hilar cholangiocarcinoma. Hepatogastroenterology 1993; 40:61-4. [PMID: 8385065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
When hepatic resection for hilar chol-angiocarcinoma with impaired hepatic function is performed, minimal resection of the involved segment on the basis of the extent of cancer invasion must be selected so as to minimize the risk of postoperative hepatic failure. We describe our experience with anterior segmentectomy with caudate lobectomy for hilar cholangiocarcinoma in two patients with impaired hepatic function and poor general health. These procedures were curative resections histologically, and were not followed by severe postoperative complications. Anterior segmentectomy together with caudate lobectomy was considered appropriate treatment for hilar cholangiocarcinoma without infiltration of the posterior hepatic branch in patients with impaired hepatic function.
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Affiliation(s)
- H Shimada
- First Department of Surgery, Fukui Medical School, Japan
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29
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Pasanen PA, Partanen KP, Pikkarainen PH, Alhava EM, Janatuinen EK, Pirinen AE. A comparison of ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography in the differential diagnosis of benign and malignant jaundice and cholestasis. Eur J Surg 1993; 159:23-9. [PMID: 8095802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess the accuracy of ultrasonography (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) in distinguishing between benign and malignant causes of jaundice and cholestasis without jaundice. DESIGN Prospective study. SETTING University Hospital in Finland. SUBJECTS A consecutive series of patients with jaundice (n = 187) or cholestasis without jaundice (n = 33). MAIN OUTCOME MEASURES Correlation between diagnosis on imaging and final diagnosis at follow up 6 months later. Final diagnoses made on histology (n = 79), cytology (n = 5), operative or endoscopic findings (n = 96), and clinical course or serology (n = 40). RESULTS The most common benign disease was choledocholithiasis (n = 83) and the most common malignant disease was carcinoma of pancreas (n = 33). The benign nature of the extrahepatic obstruction was correctly defined by US, CT, and ERCP in 53%, 53%, and 90% of patients, respectively, and the corresponding figures for choledocholithiasis were 22%, 25%, and 79% (ERCP compared with each of the other techniques, p < 0.0001). Intrahepatic benign diseases were diagnosed by US and CT in a third of cases. Malignant extrahepatic obstruction was correctly diagnosed in 57%, 80%, and 83%, respectively and the corresponding figures for pancreatic cancer were 60%, 97%, and 89% (US compared with CT, p < 0.01, and with ERCP, p < 0.05). Intrahepatic malignant lesions were diagnosed by US, CT, and ERCP in 100%, 77%, and 60% of patients, respectively. CONCLUSIONS When the obstruction was benign and extrahepatic ERCP was the most accurate, but when it was malignant CT was comparable. Intrahepatic disease was best diagnosed by US and CT. The results emphasise that the three methods of imaging are complementary.
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Affiliation(s)
- P A Pasanen
- Department of Surgery, Kuopio University Hospital, Finland
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30
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Abstract
Endosonography was performed preoperatively in 46 patients with carcinoma of the common hepatic duct and its bifurcation. The results of endosonography were correlated with findings during surgery and pathological examination of the resected specimen and classified according to the new (1987) TNM classification. Overall accuracy in assessing the depth of tumor infiltration was 86.0%. Endosonography was accurate in predicting the presence of lymph nodes but not accurate in defining non-metastatic changes of lymph nodes. Staging of distant metastases was not accurate due to the low penetration depth of ultrasound.
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Affiliation(s)
- T L Tio
- Georgetown University Medical Center, Department of Gastroenterology, Washington, D.C. 2007-22197
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31
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Yamashita Y, Takahashi M, Kanazawa S, Charnsangavej C, Wallace S. Parenchymal changes of the liver in cholangiocarcinoma: CT evaluation. Gastrointest Radiol 1992; 17:161-6. [PMID: 1312967 DOI: 10.1007/bf01888536] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We evaluated parenchymal changes of the liver in 92 patients (41 peripheral types and 51 hilar types) with cholangiocarcinomas studied by bolus-enhanced computed tomography (CT). In 39% of patients with the peripheral type, a wedge-shaped increased enhancement of the liver was observed peripheral to the tumor on bolus-enhanced CT. Tumor was observed in all cases. In 58.8% of patients with the hilar type, a segmental or lobar increased degree of enhancement of the liver was observed, but the tumor was demonstrated in only 58.8%. Atrophy was accompanied by areas of increased enhancement in 80% of hilar type and 25% of peripheral type. Areas of increased degree of enhancement corresponded to a wedged-shaped perfusion defect on CT during arterial portography. On magnetic resonance imaging (MRI), those lesions showed hyperintensity on T2-weighted images. Most of these changes were considered to be due to reversible hepatic parenchymal ischemia secondary to portal vein invasion by the tumor.
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Affiliation(s)
- Y Yamashita
- Department of Radiology, Kumamoto University School of Medicine, Japan
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32
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Outwater E, Kaplan MM, Bankoff MS. Lymphadenopathy in sclerosing cholangitis: pitfall in the diagnosis of malignant biliary obstruction. Gastrointest Radiol 1992; 17:157-60. [PMID: 1312966 DOI: 10.1007/bf01888535] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We retrospectively reviewed abdominal computed tomographic (CT) studies from 20 patients with sclerosing cholangitis and found evidence of abdominal lymphadenopathy in 13 patients. Enlargement occurred primarily in areas draining the liver, such as the gastrohepatic ligament or celiac axis (N = 8), the porta hepatis (N = 7), and the pancreaticoduodenal region (N = 2). One patient had reactive adenopathy and retroperitoneal fibrosis. The presence of benign reactive lymphadenopathy in at least one intraabdominal location was confirmed by pathological examination of excised lymph nodes in seven patients. Malignancy was excluded by surgical exploration or clinical follow-up. We conclude that enlarged lymph nodes are a common finding by CT in patients with sclerosing cholangitis. Enlarged reactive lymph nodes in this condition should not be mistaken for evidence of periportal metastasis or cholangiocarcinoma.
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Affiliation(s)
- E Outwater
- Department of Radiology, New England Medical Center, Boston, Massachusetts
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33
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Affiliation(s)
- A Adam
- United Medical School, Guy's Hospital, London
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34
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Abstract
Free-floating tumor debris or mucobilia as a cause of intermittent obstruction has been described infrequently. A patient with intermittent jaundice caused by tumor emboli from an intrahepatic polypoid mucinous cholangiocarcinoma is presented. Symptoms of intermittent jaundice and midepigastric pain persisted over 5 years despite an initial cholecystectomy and common bile duct exploration before definitive diagnosis and treatment of an hepatic trisegmentectomy (segments II, III, and IV). Intraductal mucin was confirmed intraoperatively and pathologically as the cause of the obstructive jaundice. The patient remains asymptomatic and without evidence of disease more than 5 years postoperatively. This report of a predominantly mucin-producing intrahepatic cholangiocarcinoma details a rare protracted clinical course of intermittent biliary obstruction from mucus emboli and highlights the possibility of long-term survival after complete resection.
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Affiliation(s)
- P J Capizzi
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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35
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Peterson MS, Baron RL, Dodd GD, Zajko AJ, Oliver JH, Miller WJ, Carr BI, Bron KM, Campbell WL, Sammon JK. Hepatic parenchymal perfusion defects detected with CTAP: imaging-pathologic correlation. Radiology 1992; 185:149-55. [PMID: 1326119 DOI: 10.1148/radiology.185.1.1326119] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To determine whether characteristics of focal hepatic parenchymal perfusion defects detected with computed tomographic arterial portography (CTAP) correlate with underlying pathologic processes, 245 perfusion defects detected with CTAP in 60 patients who subsequently underwent definitive hepatic surgery were characterized by shape, location within the liver, and relative attenuation value and were prospectively correlated with sectioned pathologic specimens. Of 177 round perfusion defects, 102 (58%) were malignant and 75 (42%) were benign. Only one (2%) of 53 peripheral wedge-shaped defects was malignant. All 15 peripheral flat defects were benign. Defects in characteristic locations anterior to the porta hepatis (n = 15) and adjacent to the intersegmental fissure (n = 7) were uniformly benign. While 83 (56%) of 147 soft-tissue attenuation defects were malignant, only four (6%) of 68 intermediate-attenuation defects were malignant. Although these characteristics of parenchymal perfusion defects aid in differentiation of benign from malignant processes, all other types of perfusion defects are nonspecific and may require biopsy.
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Affiliation(s)
- M S Peterson
- Department of Radiology, University of Pittsburgh Medical Center
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36
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Looser C, Stain SC, Baer HU, Triller J, Blumgart LH. Staging of hilar cholangiocarcinoma by ultrasound and duplex sonography: a comparison with angiography and operative findings. Br J Radiol 1992; 65:871-7. [PMID: 1330192 DOI: 10.1259/0007-1285-65-778-871] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The pre-operative radiological assessment of proximal bile duct tumours is clinically important as resection may be limited by tumour extension along the bile ducts, into hepatic parenchyma or the adjacent vascular structures. Demonstration of the extent of biliary and vascular involvement can direct additional investigations and definitive treatment. 22 patients with hilar cholangiocarcinoma were studied pre-operatively by conventional ultrasound (US) and duplex sonography (DS). The extent of tumour infiltration and vascular involvement was compared with arteriography and operative findings. Bile duct dilatation and the level of obstruction was documented by US in 22 (100%), and the tumour was shown by US in 19 (86%). In these 19 patients, the extent of extraductal extension compared with operative findings was correct in 13, underestimated in two, and in four infiltration was massed. Vascular patency or involvement was correctly determined by DS in 19 (86%), and by arteriography in 18 (82%). In two of the three incorrect DS interpretations, lobar atrophy and contralateral hypertrophy distorted the hilar anatomy. US with DS is valuable in the pre-operative staging of proximal bile duct tumours in predicting ductal and vascular involvement.
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Affiliation(s)
- C Looser
- Institute for Diagnostic Radiology, Inselspital, University of Berne, Switzerland
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37
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Hausegger KW, Fuhrmann W, Jilek K, Stangl F, Stering R. [Aneurysm of the portal vein due to an infiltrating cholangiocarcinoma]. ROFO-FORTSCHR RONTG 1992; 157:431-2. [PMID: 1327274 DOI: 10.1055/s-2008-1033036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- K W Hausegger
- Zentralröntgeninstitut, Landeskrankenhaus Leoben, Osterreich
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38
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Kuhn M, Neufang KF, Gross-Fengels W, Zieren U. [Liver angiography--technique, indications and significance in focal liver processes]. Aktuelle Radiol 1992; 2:285-92. [PMID: 1329986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Retrospective analysis of 155 liver angiographies and the literature data was carried out to appraise the current relevance of liver angiography in digital subtraction technique (i.a. DSA) for diagnosis of focal liver changes. A focal liver lesion was detected by angiography in 58 out of the 80 patients (72.5%) we investigated with a confirmed hepatic space occupation; an angiography correlate of the tumour type diagnosed was shown in 41 out of 69 (59.4%) of malignancies confirmed by surgery or biopsy histology; in the benign lesions, the angiographic diagnosis was consistent with the histological result in five out of six cases. DSA is thus usually clearly inferior to the tomographic sonography, CT and MRI in detection and qualification of the tumour type. However, it is still indispensable for planning operations or chemoembolization and for exact imaging of the portal perfusion conditions because of the frequent vascular anomalies in the anatomy of the liver.
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Affiliation(s)
- M Kuhn
- Institut und Poliklinik für Radiologische Diagnostik, Universität zu Köln
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39
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Gulliver DJ, Baker ME, Cheng CA, Meyers WC, Pappas TN. Malignant biliary obstruction: efficacy of thin-section dynamic CT in determining resectability. AJR Am J Roentgenol 1992; 159:503-7. [PMID: 1323924 DOI: 10.2214/ajr.159.3.1323924] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Several authorities advocate the use of preoperative angiography to determine the resectability of pancreatic and periampullary tumors, claiming that CT alone is not sufficiently accurate for this purpose. Our objective was to assess the value of CT in predicting surgical resectability in patients with malignant biliary obstruction. MATERIALS AND METHODS We performed a retrospective analysis of 380 consecutive cases of malignant biliary obstruction spanning a 4-year period. Most patients (230) were treated nonoperatively. Sixty-seven patients had surgery, pathologic confirmation of malignancy, and preoperative CT scans available for review. The CT scans were assessed for surgical resectability of tumor by an interpreter who did not know the patient's history. RESULTS Forty-two patients had pancreatic adenocarcinoma, six had ampullary carcinoma, seven had cholangiocarcinoma, and 12 had other malignant neoplasms. Of 47 patients with tumors thought to be unresectable on the basis of CT findings, 42 had tumors that were found to be unresectable at surgery (positive predictive value, 89%). Of 20 patients with tumors thought to be resectable, 16 had tumors that were surgically resectable (positive predictive value, 80%). CT did not show metastases to duodenal lymph nodes (n = 2), portal vein infiltration (n = 1), and small hepatic metastases (n = 1). Visualization of most of these at angiography would not be expected. The CT finding of infiltration of the periarterial fat around the celiac or superior mesenteric arteries was reliable for predicting surgical unresectability. Lymphadenopathy and infiltration of nonperivascular fat planes were less reliable predictors of unresectability. CONCLUSION Although some findings on CT that suggest unresectability are less reliable than others, the accuracy of CT compares favorably with reports on the accuracy of angiography for assessing tumor resectability in cases of malignant biliary obstruction. The addition of angiography to the examination of patients with potentially resectable lesions is not justified when high-quality, thin-section dynamic CT has been performed.
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Affiliation(s)
- D J Gulliver
- Department of Radiology, Duke University Medical Center, Durham, NC 27710
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40
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Agrawal AK, Singh NK, Yadav KN. Ultrasonographic patterns of hepatobiliary mass lesions. J Assoc Physicians India 1992; 40:522-3. [PMID: 1339212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The study deals with an analysis of ultrasonographic (USG) patterns in 100 consecutive patients with hepatobiliary mass lesions. Amoebic liver abscess, carcinoma (CA) gall bladder and secondaries in liver comprised nearly 70% of cases. USG appearances in liver abscess, hepatoma, secondaries in liver and CA gall bladder were variable, but were characteristic in hydatid disease and congenital polycystic disease. Two patients with cholangiocarcinoma revealed dilated biliary channels with an intraluminal mass in common bile duct.
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Affiliation(s)
- A K Agrawal
- Radiology Institute of Medical Sciences, B.H.U. Varanas
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41
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Terada T, Sasaki M, Nakanuma Y, Takeda Y, Masunaga T. Hilar cholangiocarcinoma (Klatskin tumor) arising from intrahepatic peribiliary glands. J Clin Gastroenterol 1992; 15:79-81. [PMID: 1323595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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42
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Yamashita Y, Takahashi M, Kanazawa S, Charnsangavej C, Wallace S. Hilar cholangiocarcinoma. An evaluation of subtypes with CT and angiography. Acta Radiol 1992; 33:351-5. [PMID: 1321653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sixty-seven patients had hilar cholangiocarcinomas which were divided into 3 types based on tumor morphology as observed on cholangiography and CT. The pathology, vascularity, and pattern of tumor spread of these types were compared. Most of the infiltrative tumors (n = 44) were scirrhous adenocarcinomas, which on CT showed poor or no contrast enhancement with frequent lymph node metastases and liver atrophy. At angiography, there was vascular encasement in 52%, in rare cases neovascularity, and tumor stain. The exophytic type (n = 19) was divided into 2 subgroups depending on the main location of the tumor. The nodular subtype (n = 16) was mainly inside the liver and somewhat hypervascular similar to peripheral cholangiocarcinoma, often with intrahepatic metastases. The periductal subtype (n = 3) was hypovascular, similar to the infiltrative cholangiocarcinoma, and had a tendency to spread along the portal vein. The intraductal type (n = 4) was observed as a filling defect on cholangiography. CT revealed an intraluminal low density mass. Histologically, they were papillary adenocarcinomas. The radiologic types of hilar cholangiocarcinoma showed different characteristics with regard to pathologic findings, vascularity, and pattern of spread.
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Affiliation(s)
- Y Yamashita
- Department of Radiology, Kumamoto University School of Medicine, Japan
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43
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Ito K, Honjo K, Matsumoto T, Tanaka R, Nakada T, Nakanishi T. Distinction of hemangiomas from hepatic tumors with delayed enhancement by incremental dynamic CT. J Comput Assist Tomogr 1992; 16:572-7. [PMID: 1321174 DOI: 10.1097/00004728-199207000-00014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To analyze the patterns of contrast enhancement and to evaluate clinical utility, we performed table incremental dynamic CT in 21 patients with 30 hepatic hemangiomas and in 12 patients with 26 malignant neoplasms, which showed delayed enhancement. On incremental CT, dense, spotty peripheral enhancement was present in 23 of the 30 (77%) hemangiomas. In contrast, a circumferential bead- or band-like peripheral enhancement was seen in 19 of 26 (73%) malignant neoplasms. The findings were characteristic. We conclude that incremental CT is useful in the differential diagnosis of hepatic hemangioma in routine examination.
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Affiliation(s)
- K Ito
- Department of Radiology, Yamaguchi University School of Medicine, Japan
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44
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Yoshikawa J, Matsui O, Kadoya M, Gabata T, Arai K, Takashima T. Delayed enhancement of fibrotic areas in hepatic masses: CT-pathologic correlation. J Comput Assist Tomogr 1992; 16:206-11. [PMID: 1312098 DOI: 10.1097/00004728-199203000-00006] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We report a histological analysis of the areas of high density in the postequilibrium and delayed phase CT in 43 focal hepatic lesions. The cases consisted of 16 cholangiocellular carcinomas, 9 hepatocellular carcinomas (including a sclerosing type of hepatocellular carcinoma and a combined hepatocellular-cholangiocellular carcinoma), 13 metastases, 2 granulomas, an inflammatory pseudotumor, a malignant lymphoma, and an epithelioid hemangioendothelioma. Computed tomography was performed after hepatic angiography using 40-50 g iodine and arteriographic CT using 35 g iodine. The areas of delayed enhancement corresponded histologically to fibrotic tissues, from inflammatory change to extensive fibrosis.
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Affiliation(s)
- J Yoshikawa
- Department of Radiology, School of Medicine, Kanazawa University, Japan
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45
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Okazumi S, Isono K, Enomoto K, Kikuchi T, Ozaki M, Yamamoto H, Hayashi H, Asano T, Ryu M. Evaluation of liver tumors using fluorine-18-fluorodeoxyglucose PET: characterization of tumor and assessment of effect of treatment. J Nucl Med 1992; 33:333-9. [PMID: 1311035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To evaluate glucose metabolism in patients with tumors involving the liver, 35 patients with liver lesions had PET using 18F-2-fluoro-2-deoxy-D-glucose (FDG). FDG (148 MBq) was injected and radioactivity of the tumor was scanned dynamically by PET. The rate constants (k1, k2, k3, k4) of FDG in a metabolic model were calculated. The results were compared to hexokinase activity in the excised tumor specimens. k3 was found to reflect tumor hexokinase activity. When k3 was used as an index (cut-off value: 0.025), it was possible to distinguish benign and malignant tumors. k4 was significantly higher in hepatocellular carcinoma. By using k3 and k4 as indices, one could assess the degree of differentiation of hepatocellular carcinoma. After treatment, k3 decreased according to the effectiveness of therapy and thus may be a useful index for quantitatively assessing tumor viability.
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Affiliation(s)
- S Okazumi
- Second Department of Surgery, Chiba University School of Medicine, Japan
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Nicholson DA, Chetty N, Jackson JE, Roddie ME, Adam A. Patency of side branches after peripheral placement of metallic biliary endoprostheses. J Vasc Interv Radiol 1992; 3:127-30. [PMID: 1311615 DOI: 10.1016/s1051-0443(92)72204-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
During a 28-month period, the authors placed 91 Wallstent endoprostheses in 55 patients with malignant obstructive jaundice. Five patients developed recurrent jaundice between 2 and 60 weeks after stent insertion due to stent occlusion by tumor overgrowth on seven occasions. To assess long-term segmental side-branch drainage through the walls of such endoprostheses, the cholangiograms obtained following stent occlusion were reviewed. In all five patients, evidence of drainage of intrahepatic ducts through the side of the mesh was observed. Although the number of patients in the series is small, this initial experience suggests that long metallic endoprostheses can be placed peripherally in the intrahepatic bile ducts without the potential risk of infection or occlusion of undrained, noninvolved segments. This policy may delay or prevent endoprosthesis occlusion in many patients.
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Affiliation(s)
- D A Nicholson
- Department of Diagnostic Radiology, Royal Postgraduate Medical School, Hammersmith Hospital, London, England
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Mairiang E, Elkins DB, Mairiang P, Chaiyakum J, Chamadol N, Loapaiboon V, Posri S, Sithithaworn P, Haswell-Elkins M. Relationship between intensity of Opisthorchis viverrini infection and hepatobiliary disease detected by ultrasonography. J Gastroenterol Hepatol 1992; 7:17-21. [PMID: 1311966 DOI: 10.1111/j.1440-1746.1992.tb00928.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Twenty-four locality-, age- and sex-matched groups of village residents with no light, moderate and heavy Opisthorchis viverrini infection were examined by ultrasonography. Highly significant differences were observed between the groups in the relative size of the left lobe of the liver and the fasting and post-meal size of the gall-bladder. In addition, indistinct gall-bladder wall, the presence of gall-bladder sludge and strongly enhanced portal vein radicle echoes were most frequently observed in the heavily infected group. Two suspected cases of cholangiocarcinoma were identified from the heavy group. The results highlight the importance of intensity of infection on the frequency and severity of fluke-associated hepatobiliary disease.
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Affiliation(s)
- E Mairiang
- Nongrua District Hospital, Khon Kaen Province, Thailand
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Kim CH, Farrugia G, Farnell MB. High-grade obstruction of the proximal extrahepatic bile duct: an unusual complication of duodenal ulcer disease. Am J Gastroenterol 1991; 86:1826-8. [PMID: 1660220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- C H Kim
- Department of General Surgery, Mayo Clinic and Foundation, Rochester, Minnesota
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Majoie CB, Reeders JW, Sanders JB, Huibregtse K, Jansen PL. Primary sclerosing cholangitis: a modified classification of cholangiographic findings. AJR Am J Roentgenol 1991; 157:495-7. [PMID: 1651643 DOI: 10.2214/ajr.157.3.1651643] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C B Majoie
- Department of Diagnostic Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
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50
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Jewkes AJ, Macdonald F, Downing R, Drolc Z, Allum WH. Labelled antibody imaging in pancreatic cancer, cholangiocarcinoma, chronic pancreatitis and sclerosing cholangitis. Eur J Surg Oncol 1991; 17:354-7. [PMID: 1651876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pancreatic and biliary carcinomas are difficult to differentiate clinically from their benign counterparts, chronic pancreatitis and sclerosing cholangitis. Immunohistochemical differences in CEA expression have previously been demonstrated in these conditions. We have therefore investigated the use of a monoclonal anti-CEA antibody (11-285-14) in distinguishing between these conditions in vivo. Twenty-five patients with these four conditions underwent radioimmunolocalisation studies. Diagnosis was confirmed by laparotomy and biopsy (n = 21), CT scanning (n = 1) or ERCP (n = 3). Positive images were obtained in 11/12 pancreatic cancers and 2/3 biliary tumours. However, 4/8 cases of chronic pancreatitis and 1/2 cases of sclerosing cholangitis also had positive images. This high false positive rate suggests that antibody imaging is unable to differentiate reliably between benign and malignant pancreatico-biliary conditions.
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Affiliation(s)
- A J Jewkes
- University Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK
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