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Cetiner OF, Dundar HE, Kantarcioglu-Coskun S, Torun S, Tokmak S. Metastatic Melanoma of the Common Bile Duct Presented with Dyspepsia. Korean J Gastroenterol 2024; 83:163-166. [PMID: 38659253 DOI: 10.4166/kjg.2024.011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/21/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
Malignant melanoma (MM) is an aggressive tumor that can metastasize to any organ, but biliary tract metastasis is scarce. We describe a very rare case of MM metastasis to the common bile duct (CBD), presented with only dyspeptic symptoms. The patient had mildly elevated alkaline phosphatase and gamma-glutamyl transferase levels. Magnetic resonance cholangiopancreatography demonstrated a dilated common bile duct with a distal stricture. The MM diagnosis was established with the ampulla of Vater biopsy specimens obtained by endoscopic retrograde cholangiopancreatography (ERCP), and the patient's symptoms were resolved after biliary stenting. Both primary CBD cancer and other cancer types like MM that metastasize to CBD can cause obstruction and can be manifested only by dyspeptic symptoms. MM metastasis to CBD can cause obstruction manifested only by dyspeptic symptoms without obstructive jaundice. ERCP can be employed as a promising option for treatment and diagnosis. New-onset dyspeptic symptoms in patients with a history of MM should be investigated thoroughly, especially in the context of biliary metastasis.
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Affiliation(s)
| | | | | | - Serkan Torun
- Department of Gastroenterology, Internal Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Salih Tokmak
- Department of Gastroenterology, Internal Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey
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Saedon M, Maroulis I, Brooks A, Alexiou E, Bouliaris K, Amanatidis T, Germanos S. Metastasectomy of pancreatic and periampullary adenocarcinoma to solid organ: The current evidence. J BUON 2018; 23:1648-1654. [PMID: 30610789] [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: 06/09/2023]
Abstract
PURPOSE Pancreatic and periampullary adenocarcinoma have not generally been included in the tumour types considered for metastasectomy. However, there is an increasing interest that metastasectomy in well-selected patients can prolong survival. This review aims to establish the recent evidence on the surgical management of oligometastatic disease and survival outcome in patients who underwent metastasectomy focusing on isolated hepatic and pulmonary metastases. METHODS A systematic search was performed in the PubMed database to identify all original articles on the role of metastasectomy for oligometastasis of pancreatic and periampullary adenocarcinoma. Data on methodologies used, 1,3,5 - year survival and median overall survival were summarized, and used to address relevant clinical questions related to the survival outcome in patients who underwent metastasectomy. RESULTS Sixteen studies were included in this review. All the studies included were retrospective and heterogenous in nature and did not have a uniform reporting on survival outcomes. CONCLUSION There is insufficient evidence to support a change of current practice in managing metastatic pancreatic and periampullary cancer. However, patients with ampullary cancer as the primary and any patients with first recurrence as isolated pulmonary metastases had better prognosis than patients with synchronous metastasis or metastases to the liver. This need to be explored in future studies.
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Affiliation(s)
- Mahmud Saedon
- Nottingham University Hospitals NHS Trust, United Kingdom
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Abstract
Metastasis to the ampulla of Vater from squamous cell carcinoma of the larynx has not been reported previously. In a 71-year-old Turkish patient with squamous cell carcinoma of the larynx a polypoid tumor was observed in the ampulla of Vater. Histopathological examination revealed squamous cell carcinoma compatible with metastasis from laryngeal cancer.
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Affiliation(s)
- Abdullah Büyükçelik
- Department of Medical Oncology, Ankara University, Medical School, Ibni Sina Hospital, Sihhiye, Ankara, Turkey.
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Haidong W, Jianwei W, Guizhong L, Ning L, Feng H, Libo M. Ampullary tumor caused by metastatic renal cell carcinoma and literature review. Urol J 2014; 11:1504-1507. [PMID: 24807772] [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] [Received: 09/02/2012] [Revised: 04/28/2014] [Accepted: 03/10/2013] [Indexed: 06/03/2023]
Abstract
We present a case of a 50-year-old man with a metastasis to the ampulla of vater that led to the discovery of renal cell carcinomas.The man was referred to us because of jaundice.Computed tomography (CT) scan of the abdomen showed irregular masses in the right kidney. Magnetic resonance imaging (MRI) revealed dilatation of the bile duct. The patient underwent right nephrectomy and pancreatoduodenectomy. Postoperative histopathologic examination revealed clear cell carcinoma in both the renal and ampullary lesions. After a 5-year follow-up ,the patient was alive with no evidence of recurrent disease.
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Affiliation(s)
- Wang Haidong
- Beijing jishuitan Hospital, Beijing 100035, China
| | - Wang Jianwei
- Beijing jishuitan Hospital, Beijing 100035, China
| | - Li Guizhong
- Beijing jishuitan Hospital, Beijing 100035, China
| | - Liu Ning
- Beijing jishuitan Hospital, Beijing 100035, China
| | - He Feng
- Beijing jishuitan Hospital, Beijing 100035, China
| | - Man Libo
- Beijing jishuitan Hospital, Beijing 100035, China.
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Schrader H, Wiese M, Ellrichmann M, Belyaev O, Uhl W, Tannapfel A, Schmidt W, Meier J. Diagnostic value of quantitative EUS elastography for malignant pancreatic tumors: relationship with pancreatic fibrosis. Ultraschall Med 2012; 33:E196-E201. [PMID: 21630184 DOI: 10.1055/s-0031-1273256] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE EUS elastography has been used to facilitate the diagnosis of pancreatic cancer, but as yet the interpretation of this procedure has been largely subjective. The present study has been designed to validate a quantitative approach for the analysis of EUS elastography, and to assess its relationship with pancreatic fibrosis. MATERIALS AND METHODS 86 patients with malignant pancreatic masses and 28 control subjects without any evidence of pancreatic diseases were examined by EUS elastography. EUS video sequences were subjected to a quantitative analysis based on mean hue histogram analysis. Pancreatic fibrosis was determined by quantitative morphometry in tissue specimens from 36 patients. RESULTS The mean RGB (red, green, blue) value was significantly higher in the cancer patients compared to the controls (14.0 ± 0.4 vs. 11.5 ± 0.9; p = 0.0085), albeit with significant overlap between the groups. In contrast, a much sharper separation between the groups was obtained based on the individual color values for blue, green and red (p < 0.0001, respectively). By these means, 100 % sensitivity and specificity for the distinction between tumor and normal tissue was obtained for the blue color value, while the red and green color values were less discriminative. The fractional fiber content of the tumors was unrelated to the respective hue histogram color values. CONCLUSION Quantitative EUS elastography allows for clear differentiation between malignant pancreatic tumors and normal tissue. Using this approach, we demonstrated that the stiffness of pancreatic tumors is largely independent of their fiber content.
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Affiliation(s)
- H Schrader
- Medizinische Klinik I, St.-Josef-Hospital
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Kim SH, Hwang HK, Kang CM, Lee WJ. Pancreatoduodenectomy in patients with periampullary cancer after radical subtotal gastrectomy for gastric cancer. Am Surg 2012; 78:E164-E167. [PMID: 22524749] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Sung Hoon Kim
- Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Franssen B, Chan C, Ramírez-Del Val A, Llamas F, López-Tello A. [Renal cell carcinoma metastatic to the duodenum and Vater ampulla: report of two cases]. Rev Gastroenterol Mex 2011; 76:375-379. [PMID: 22188966] [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: 05/31/2023]
Abstract
These two cases of metastatic renal cell carcinoma to the duodenum, adds to the limited experience reported in the literature. Both patients initially presented with upper gastrointestinal bleeding years after they had a nephrectomy. After an extensive diagnostic work-up, they were both submitted to a classic pancreaticoduodenectomy (Whipple's procedure). Only the final histopathological report revealed the diagnosis. Basic recommendations on diagnosis and treatment are discussed in this article and a review of the literature is given.
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Affiliation(s)
- B Franssen
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador, Zubirán
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Horaguchi J, Fujita N, Noda Y, Kobayashi G, Ito K, Obana T, Koshita S, Kanno Y, Ogawa T, Yamashita Y, Kato Y. Endosonography-guided biliary drainage with one-step placement of a newly designed fully covered metal stent for malignant biliary obstruction. Dig Endosc 2011; 23:207. [PMID: 21429037 DOI: 10.1111/j.1443-1661.2010.01081.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Simůnek R, Sirotek L, Sefr R. [Renal cancer metastasis into common bile duct]. Rozhl Chir 2011; 90:190-193. [PMID: 21634099] [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: 05/30/2023]
Abstract
We present rare case of clear cell renal carcinoma metastasis into common bile duct. It is a 9th case listed on the MEDLINE data base from 1966 to 2010.71-year-old woman underwent right nefrectomy for renal cancer G1 in 1986. She was reoperated in 2006 for relaps in renal bed on the right side. Histological examination confirmed clear cell renal carcinoma again. At present, a new liver metastasis in S 4/5 was detected. During the operation we found first described liver metastasis and second another one in common bile duct with intraluminal growth. Before surgery the patient showed neither clinical nor laboratory marks of biliary obstruction. Even abdominal ultrasound, SONO VUE, CT and body PET were negative. We carried out choledochectomy with hepaticojejunoanastomosis sec Roux and liver metastasis was destructed using radiofrequency ablation.
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Affiliation(s)
- R Simůnek
- Chirurgické oddelení, Masarykův onkologický ustav, Brno.
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Lee TH, Park SH, Lee CK, Lee SH, Chung IK, Kim SJ, Kim SW. Ampulla of Vater metastasis from recurrent uterine cervix carcinoma presenting as groove pancreatitis. Gastrointest Endosc 2011; 73:362-3. [PMID: 20950802 DOI: 10.1016/j.gie.2010.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 08/05/2010] [Indexed: 12/15/2022]
Affiliation(s)
- Tae Hoon Lee
- Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
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Nakayama H, Miyazaki S, Kikuchi H, Saito N, Shimada H, Sakai S, Suzuki M, Kimura K. Malignant vaginal melanoma with metastases to the papilla of Vater in a dialysis patient: a case report. Intern Med 2011; 50:345-9. [PMID: 21325769 DOI: 10.2169/internalmedicine.50.4564] [Citation(s) in RCA: 5] [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: 12/29/2022] Open
Abstract
Malignant vaginal melanoma is an extremely rare clinical condition, with less than 150 cases reported to date. A dialysis patient had primary vaginal melanoma with metastases to the papilla of Vater. Gastroduodenoscopy revealed a polypoid tumor. Histological findings revealed vimentin, S-100 protein, HMB45, MelanA-positive sarcoma-like cells. This staining pattern indicated that this tumor was a malignant melanoma of the papilla. Analysis of an autopsy specimen of the papilla of Vater revealed metastasis from the primary vaginal melanoma. Metastasis of a malignant tumor to the gastrointestinal tract, especially to the papilla, is uncommon. Melanoma should be considered in the differential diagnosis of primary gastrointestinal tract malignancy.
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Affiliation(s)
- Hitoshi Nakayama
- Division of Nephrology and Hypertension, Department of Internal Medicine, Shinrakuen Hospital, Japan.
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Weston BR, Ross WA, Liu J, Lee JH. Clinical outcomes of nitinol and stainless steel uncovered metal stents for malignant biliary strictures: is there a difference? Gastrointest Endosc 2010; 72:1195-200. [PMID: 21111871 DOI: 10.1016/j.gie.2010.08.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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] [Received: 05/28/2010] [Accepted: 08/11/2010] [Indexed: 01/09/2023]
Abstract
BACKGROUND Self-expandable metal stents (SEMSs) made from nitinol (N) were developed as a potentially more effective alternative to conventional stainless steel (SS) stents. OBJECTIVE To compare clinical outcomes of N versus SS stents in the management of malignant biliary strictures. DESIGN Retrospective study. SETTING Tertiary-care cancer center. PATIENTS All patients with first-time N (Flexxus) and SS (Wallstent) uncovered biliary SEMSs placed between January 2006 and October 2007. INTERVENTIONS SEMS placement. RESULTS A total of 81 N and 96 SS stents were placed. The most common cancer diagnosis was pancreatic (80.2% N; 62.5% SS; P = .06). The most frequent site of stricture was the common bile duct (85.2% N; 86.5% SS; P = .31). Biliary decompression was achieved in 93.8% of the N group and 86.4% of the SS group (P = .22). Immediate stent manipulation was required in 4 patients in each group. Subsequent intervention for poor drainage was performed in 17 N (21%) and 26 SS (27%) stents at mean times of 142.1 days (range, 5-541 days; median, 77 days) and 148.1 days (range, 14-375; median, 158.5), respectively (P = .17). The occlusion rate between N and SS stents was not significant (P = .42). The overall durations of stent patency in the N and SS group were similar (median 129 and 137 days, respectively; P = .61), including the subgroup analysis performed on patients with pancreatic cancer (P = .60) and common duct strictures (P = .77). Complication rates were low in both groups (early: 3.7% N, 6.3% SS; late: 2.5% N, 3.1% SS). Ninety percent underwent chemotherapy and 38% radiation therapy in each group. LIMITATIONS Retrospective design. CONCLUSION Similar outcomes were achieved with N and SS stents regarding efficacy, duration of stent patency, occlusion rates, and complications. Our results are most applicable to patients with common duct strictures and pancreatic cancer.
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Affiliation(s)
- Brian R Weston
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA
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Marks JA, Rao AS, Loren D, Witkiewicz A, Mastrangelo MJ, Berger AC. Malignant melanoma presenting as obstructive jaundice secondary to metastasis to the Ampulla of Vater. JOP 2010; 11:173-175. [PMID: 20208330] [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: 05/28/2023]
Abstract
CONTEXT Malignant melanoma commonly metastasizes to the small intestine where it can cause pain, bleeding, and obstruction. However, jaundice from metastatic melanoma is relatively uncommon. CASE REPORT A case of known malignant melanoma presenting as new onset obstructive jaundice as a result of a rarely reported metastasis to the ampulla of Vater. CONCLUSION Multidisciplinary management of patients with metastatic melanoma is essential.
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Affiliation(s)
- Joshua A Marks
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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15
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Lyu JW, Park DH, Kim HS, Park JH, Chun CG, Park SH, Cho HD, Lee SH, Kim SJ. Common bile duct thrombi secondary to hepatoma, with biliary invasion mimicking a choledocholithiasis (with video). Gastrointest Endosc 2007; 65:325-6; discussion 326. [PMID: 17258996 DOI: 10.1016/j.gie.2006.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2006] [Accepted: 06/14/2006] [Indexed: 12/10/2022]
Affiliation(s)
- Ji-Won Lyu
- Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea
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van Bokhoven MMJA, Aarntzen EHJG, Tan ACITL. Metastatic melanoma of the common bile duct and ampulla of Vater. Gastrointest Endosc 2006; 63:873-4. [PMID: 16650564 DOI: 10.1016/j.gie.2005.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 12/28/2005] [Indexed: 12/10/2022]
Affiliation(s)
- M M J A van Bokhoven
- Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Cardot-Leccia N, Dahman M, Effi B, Chevallier A, Sejor E, Michiels JF, Saint-Paul MC. [A solitary tumor of the common bile duct: case report of a metastatic melanoma]. ACTA ACUST UNITED AC 2006; 29:1177-9. [PMID: 16505767 DOI: 10.1016/s0399-8320(05)82186-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary malignant melanoma of the bile duct is very rare. We report a case of a malignant melanoma involving the common bile duct in a 41-year-old man. The patient presented to the hospital with an isolated jaundice and underwent pancreaticoduodenectomy. Absolute exclusion of a metastatic tumor is not entirely possible.
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Tang W, Inagaki Y, Kokudo N, Guo Q, Seyama Y, Nakata M, Imamura H, Sano K, Sugawara Y, Makuuchi M. KL-6 mucin expression in carcinoma of the ampulla of Vater: Association with cancer progression. World J Gastroenterol 2005; 11:5450-4. [PMID: 16222735 PMCID: PMC4320352 DOI: 10.3748/wjg.v11.i35.5450] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess histochemical expression of KL-6 and its clinicopathological significance in carcinoma of the ampulla of Vater.
METHODS: Ampullary carcinoma tissues were collected from 38 patients who underwent pancreatoduodenectomy or local resection. Tissues were subjected to immunohi-stochemical analysis using KL-6 antibody.
RESULTS: Positive staining of ampullary carcinoma cells was observed in 26 (68.4%) cases. Staining was not found in the surrounding non-cancer regions of the ampullary tissues. Remarkable KL-6 expression was observed in invasive carcinoma cells in pancreatic and duodenal tissues and in metastatic carcinoma cells in lymph nodes. Positive KL-6 expression was related to lymph node metastasis (P = 0.020), pancreatic invasion (P = 0.016), duodenal invasion (P = 0.034), and advanced stage of TNM clinical classification (P = 0.010). Survival analysis showed that positive expression of KL-6 was related to a poorer prognosis (P = 0.029).
CONCLUSION: The aberrant expression of KL-6 mucin is significantly related to unfavorable behaviors of carcinoma of the ampulla of Vater.
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Affiliation(s)
- Wei Tang
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan.
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Ho MM, Howard TJ, Lillemoe KD. Can pancreaticoduodenectomy be used to palliate selective metastatic malignancies? Case report of malignant fibrous histiocytoma. J Gastrointest Surg 2005; 9:934-7. [PMID: 16137587 DOI: 10.1016/j.gassur.2005.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Revised: 02/15/2005] [Accepted: 04/28/2005] [Indexed: 01/31/2023]
Affiliation(s)
- Mindy M Ho
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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Ball CG, Gmora S, Vollmer CM, Dixon E. An intraluminal lesion in the mid-common bile duct and right hepatic duct causing right portal vein obstruction. J Hepatol 2004; 41:1060. [PMID: 15582143 DOI: 10.1016/j.jhep.2004.09.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Revised: 09/17/2004] [Accepted: 09/29/2004] [Indexed: 12/04/2022]
Affiliation(s)
- Chad G Ball
- Department of Surgery, University of Calgary, Tom Baker Cancer Center, 3604-13th Street SW, Calgary, Alberta, Canada T2T 3R1
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Abstract
BACKGROUND Because of the similarities in terms of carcinogenesis and natural history between cancer of the ampulla of Vater and colorectal cancer, the authors examined whether ampullary and colorectal malignancies occur in the same individuals at increased rates. METHODS We used data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute for the period from January 1973 through December 1999. Person-years of follow-up for patients with ampullary (or colorectal) cancer were used to calculate the expected number of cases of colorectal (or ampullary) cancer as a second primary malignancy. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated using Byar limits and assuming a Poisson distribution. RESULTS The authors identified 2043 white patients with ampullary cancer who were included in the SEER registry between 1973 and 1999. Over an aggregate 5674 person-years of follow-up, 30 patients, compared with an expected 14, developed colorectal cancer, yielding an overall SIR of 2.14 (95% CI, 1.45-3.06). Similarly, 57 of 262,066 white patients with colorectal cancer developed ampullary cancer over an aggregate 1,270,255 person-years of follow-up, yielding an SIR of 2.18 (95% CI, 1.69-2.85). CONCLUSIONS Patients with ampullary cancer are at increased risk for a second primary colorectal malignancy, and patients with colorectal cancer are at increased risk for a second primary ampullary malignancy. These findings suggest that ampullary and colorectal malignancies share common environmental and/or genetic risk factors.
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Affiliation(s)
- Ananya Das
- Division of Gastroenterology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106, USA
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Grasso RF, Bonomo G, Chiappa A, Orsi F, Zbar AP, Mazzarol G, Bellomi M. Malignant metastatic melanoma of common bile duct: virtual CT cholangioscopy findings. Hepatogastroenterology 2003; 50:1333-5. [PMID: 14571730] [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: 04/27/2023]
Abstract
Metastases from melanoma to biliary ducts are little known but not so rare, although only a few cases have been previously described. A case of metastasis from amelanotic melanoma to the common bile duct, appearing as a vegetating lesion and diagnosed by spiral computed tomography, using also computed tomography virtual cholangioscopy, is described. The clinical role of computed tomography virtual cholangioscopy is discussed. Metastases from melanoma are recommended to be considered in differential diagnosis of endoluminal soft masses in the biliary ducts.
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Abstract
A 64-year-old man with Muir-Torre syndrome (MTS), a condition characterized by the association of multiple sebaceous tumours and kerato-acanthomas with internal malignancies, developed a carcinoma of the ampulla of Vater. This is the 2nd reported ampullary carcinoma in 205 reported cases of MTS, suggesting a higher prevalence in MTS patients than in the general population. As an ampullary carcinoma is potentially amenable to surgical resection, particularly when detected early, patients with MTS should undergo regular endoscopic surveillance of the ampulla of Vater.
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Affiliation(s)
- J J Matthews
- Department of Surgery, Derriford Hospital, Plymouth, UK
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Mendoza JL, Lana R, Defarges V, Meroño E, Candía A, Loscos JM. [Late metastasis of hypernephroma of the Vater's ampulla]. Rev Esp Enferm Dig 2001; 93:606-8. [PMID: 11767437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Seo DW. A prospective randomized trial of Teflon versus polyethylene stents for distal malignant biliary obstruction. Gastrointest Endosc 2000; 51:633-5. [PMID: 10896487] [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: 12/10/2022]
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Le Borgne J, Partensky C, Glemain P, Dupas B, de Kerviller B. Pancreaticoduodenectomy for metastatic ampullary and pancreatic tumors. Hepatogastroenterology 2000; 47:540-4. [PMID: 10791233] [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: 02/16/2023]
Abstract
BACKGROUND/AIMS To report the clinical presentation, diagnosis and results of aggressive surgical management in patients with metastatic ampullary and pancreatic tumors. METHODOLOGY Twelve patients underwent pancreaticoduodenectomy for ampullary or pancreatic metastases from January 1, 1987, to June 30, 1998, in 2 institutions. The primary cancer was renal cell carcinoma (n = 5), melanoma (n = 2), venous leiomyosarcoma (n = 1), carcinoid tumor (n = 1), colon carcinoma (n = 1), breast carcinoma (n = 1) and small-cell lung carcinoma (n = 1). The mean interval between primary treatment and metachronous pancreatic metastasis was 88 months. In 3 cases, pancreatic metastases were synchronous with the primary tumor. The main symptoms were jaundice (n = 8) and upper gastrointestinal tract bleeding (n = 2). The principal investigations were computed tomography scan (n = 9), arteriography (n = 7), duodenoscopy (n = 6) and fine-needle aspiration (n = 4). A correct preoperative diagnosis was made for 8 patients. RESULTS In all cases, the pancreatic tumor was resected with intention to cure or provide useful palliation, using pancreaticoduodenectomy for isolated tumors (n = 11) or total pancreatectomy for multiple lesions (n = 1). Three out of 12 patents had positive lymph nodes, and the resection margin was free of disease in all cases. There was no postoperative mortality. Survival after pancreaticoduodenectomy averaged 26 months. Overall survival of patients undergoing pancreaticoduodenectomy was 35% at 2 years and 17% at 5 years. One patient is still alive more than 10 years after pancreaticoduodenectomy. CONCLUSIONS Pancreaticoduodenectomy can be performed safely, representing a suitable option for resection in patients with symptomatic or late isolated pancreatic metastases in the absence of widely metastatic disease. The best indications are solitary metastases from renal cell carcinoma, sarcoma and neuroendocrine tumors. However, there is no evidence of survival benefit after pancreaticoduodenectomy for synchronous tumors or metachronous tumors from melanoma or colon carcinoma.
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Affiliation(s)
- J Le Borgne
- Department of Surgery, Hotel-Dieu, Nantes, France.
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Stein M, Dong PR, McGahan JP, Link DP. Renal cell carcinoma metastatic to the biliary system--effective palliation with biliary stenting, tumour embolization and intraluminal brachytherapy: case report. Can Assoc Radiol J 1999; 50:317-20. [PMID: 10555506] [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] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Affiliation(s)
- M Stein
- Department of Radiology, School of Medicine, University of California-Davis, Sacramento, USA.
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Caballero-Mendoza E, Gallo-Reynoso S, Arista-Nasr J, Angeles-Angeles A. Obstructive jaundice as the first clinical manifestation of a metastatic malignant melanoma in the ampulla of vater. J Clin Gastroenterol 1999; 29:188-9. [PMID: 10478883 DOI: 10.1097/00004836-199909000-00017] [Citation(s) in RCA: 11] [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: 12/19/2022]
Abstract
The authors report a patient with obstructive jaundice as the first clinical manifestation of a primary malignant melanoma metastatic in the ampulla of Vater. After the histologic diagnosis of the metastases was made, the primary tumor was located in the skin of the back. Obstruction jaundice secondary to ampullary obstruction due to metastatic melanoma has only been reported twice, and in neither case was jaundice the first symptom of the disease.
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Affiliation(s)
- E Caballero-Mendoza
- Department of Pathology, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F
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30
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Scotiniotis I, Ginsberg GG. Endoscopic clip-assisted biliary cannulation: externalization and fixation of the major papilla from within a duodenal diverticulum using the endoscopic clip fixing device. Gastrointest Endosc 1999; 50:431-6. [PMID: 10462673 DOI: 10.1053/ge.1999.v50.97369] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- I Scotiniotis
- Division of Gastroenterology, University of Pennsylvania Health Systems, Philadelphia 19104-4283, USA
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31
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Meyers MO, Frey DJ, Levine EA. Pancreaticoduodenectomy for melanoma metastatic to the duodenum: a case report and review of the literature. Am Surg 1998; 64:1174-6. [PMID: 9843339] [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: 02/09/2023]
Abstract
Although melanoma accounts for fewer than 5 per cent of cutaneous malignancies, it is responsible for more than 75 per cent of skin cancer deaths. Metastasis generally proceeds from regional lymph nodes to visceral organs, with the lungs, liver, brain, and bowel being most commonly affected. Herein, we report a case of malignant melanoma metastatic to the ampulla of Vater treated with a pancreaticoduodenectomy.
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Affiliation(s)
- M O Meyers
- Department of Surgery, Louisiana State University Medical, New Orleans, USA
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Janzen RM, Ramj AS, Flint JD, Scudamore CH, Yoshida EM. Obscure gastrointestinal bleeding from an ampullary tumour in a patient with a remote history of renal cell carcinoma: a diagnostic conundrum. Can J Gastroenterol 1998; 12:75-8. [PMID: 9544417 DOI: 10.1155/1998/429832] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Metastasis of renal cell carcinoma to the ampulla of Vater is a rare occurrence. The outlined case, which presented as an upper gastrointestinal bleed, is only the eighth such reported case in the English-language literature. This case is the longest reported time interval between surgical nephrectomy to presentation with ampullary metastasis at 17.5 years. The ampullary source of bleeding in this case was initially obscure and missed by conventional gastroscopy. Diagnosis was made with a side-viewing endoscope, emphasizing the usefulness of this instrument in the investigation of active bleeding from a small bowel source.
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Affiliation(s)
- R M Janzen
- Department of Medicine, University of British Columbia, Vancouver
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33
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Titus AS, Baron TH, Listinsky CM, Vickers SM. Solitary breast metastasis to the ampulla and distal common bile duct. Am Surg 1997; 63:512-5. [PMID: 9168764] [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: 02/04/2023]
Abstract
The indications for pancreaticoduodenectomy have continued to expand over the past 10 to 15 years. This is in large part due to improved diagnostic studies, endoscopic retrograde cholangiopancreaticogram and computed tomography, and decreases in hospital perioperative morbidity and mortality. One third of breast cancer patients will develop metastatic disease usually to the liver, lung, or bone (World J Surg 1994;18:98-111). However, the presentation of painless jaundice due to a single metastatic lesion to the distal common bile duct from ductal adenocarcinoma of the breast is extremely rare. In this case report and review of the literature, we discuss the indications and emerging evidence that pancreaticoduodenectomies can now be performed for localized metastatic disease.
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Affiliation(s)
- A S Titus
- Department of Surgery, University of Alabama at Birmingham 35294, USA
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Sans M, Llach J, Bordas JM, Andreu V, Campo A, Castells A, Mondelo E, Terés J, Rodés J. Metastatic malignant melanoma of the papilla of Vater: an unusual case of obstructive cholestasis treated with biliary prostheses. Endoscopy 1996; 28:791-2. [PMID: 9007447 DOI: 10.1055/s-2007-1005618] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Sans
- Digestive Endoscopy and Gastroenterology Service, Hospital Clinic, Barcelona, Spain
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Miyagishima T, Ohnishi S, Chuma M, Kishimoto A, Kumagai K, Ishizuka J, Kobayashi T, Kamiya K, Fujimoto N, Kamiyama T, Ogasawara K, Hata Y, Takahashi T. Intraluminal tumor of the common bile duct as a metastasis of renal cell carcinoma. Intern Med 1996; 35:720-3. [PMID: 8915699 DOI: 10.2169/internalmedicine.35.720] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A 57-year-old woman was admitted for evaluation of liver dysfunction. A physical examination revealed jaundice and a left abdominal mass, which was diagnosed as being a large renal tumor. Cholangiography showed a smooth filling defect 1 cm in diameter at the common bile duct. Left nephrectomy, and resection of the common bile duct were performed. The pathological diagnosis was metastasis of the common bile duct wall resulting from renal cell carcinoma. Metastatic common bile duct tumors are extremely rare. However, it is important to consider that this is one of the causes of obstructive jaundice.
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Affiliation(s)
- R Silva
- Department of Gastroenterology, Instituto Português Oncologia, Porto, Portugal
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Abstract
A 75 year woman developed a primary malignant melanoma of the gallbladder. The patient presented with abdominal pain in the upper right quadrant typically seen in acute cholecystitis. Neither intravesical concretions nor cholestasis was seen. Ultrasound demonstrated hyperechogenic intraluminal "school of fish" reflections, which are typical for metastatic melanoma to the gallbladder. Intravesical fluid collection was not present. The tumor did not expand past the wall of the gallbladder. The main sonographic features are hyperdense intraluminal strands of tumor and the lack of fluid. Computed tomography showed solid intraluminal masses with hypodensive and partially hyperdensive reticular structure.
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Affiliation(s)
- D Longwitz
- Radiologische Klinik der Augusta-Kranken-Anstalt, Akademisches Lehrkrankenhaus Bochum
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38
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Hakami F, Hannoun L. [Intraluminal metastasis of the common bile duct from renal carcinoma]. Prog Urol 1996; 6:436-8. [PMID: 8763702] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- F Hakami
- Service d'Urologie, Centre Hospitalier Universitaire d'Amiens
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Affiliation(s)
- K A Leslie
- Department of General Surgery, Lahey Clinic, Burlington, MA 01805, USA
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Nakeeb A, Lillemoe KD, Cameron JL. The role of pancreaticoduodenectomy for locally recurrent or metastatic carcinoma to the periampullary region. J Am Coll Surg 1995; 180:188-92. [PMID: 7850053] [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: 01/27/2023]
Abstract
BACKGROUND The efficacy of operative resection of metastatic lesions to the liver, lung, and brain is well established. However, the appropriate management of metastatic or locally recurrent malignancies to the periampullary region is less well established. STUDY DESIGN A retrospective review of The Johns Hopkins Hospital experience with pancreaticoduodenectomy for metastatic or locally recurrent periampullary lesions was performed. RESULTS From 1988 to 1993, 27 patients with a past history of malignancy underwent pancreaticoduodenectomy. In six patients (22 percent), the lesion was determined to be from a metastasis or a local recurrence, and in 21 patients (78 percent), the lesion was a new primary. Patients with metastatic or locally recurrent lesions were younger (51.3 compared to 67.1 years of age) and presented with a shorter interval from their initial neoplasm (33 compared to 120 months). Of the six patients undergoing pancreaticoduodenectomy for a metastatic or locally recurrent lesion, three patients are alive an average of 38 months and three patients died an average of 11 months postoperatively. This compares favorably with the survival rate of the new primary group in which 12 patients are alive a mean of 22 months and nine patients died a mean of 14 months postoperatively. CONCLUSIONS These results suggest that patients with metastatic or locally recurrent lesions in the periampullary region from a previously treated neoplasm should be considered candidates for pancreaticoduodenectomy.
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Affiliation(s)
- A Nakeeb
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
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Hardwigsen J, Berthet B, Le Treut YP. [Intraductal biliary metastasis: metastasis of a metastasis?]. Gastroenterol Clin Biol 1995; 19:134-5. [PMID: 7720980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Affiliation(s)
- M S al-Qudah
- Department of Surgery, Jordan University Hospital, Faculty of Medicine, University of Jordan, Amman
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Abstract
Cholangiocarcinoma is an infrequent complication of inflammatory bowel disease. Although increasing numbers of cholangiocarcinomas are being reported in association with ulcerative colitis, the occurrence of this disease in patients with Crohn's disease is rare. To understand this complication better, we have reported the case of a patient with Crohn's disease in whom cholangiocarcinoma subsequently developed and reviewed the literature.
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Affiliation(s)
- P M Choi
- Department of Gastroenterology, Lahey Clinic Medical Center, Burlington, Massachusetts
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44
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Jones WF, Harford W, Goldschmiedt M. Removal of plastic biliary stents placed through metal stent. Gastrointest Endosc 1993; 39:601. [PMID: 7689995 DOI: 10.1016/s0016-5107(93)70195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
Although metastatic melanoma is renowned for its propensity to spread to a wide range of sites, symptomatic metastases within the biliary tree are very rare. A patient with a past history of melanoma who presented with obstructive jaundice and in whom computerized tomography (CT) scanning revealed a spherical filling defect 1 cm in diameter at the lower end of the common bile duct is reported. The obstructing lesion was thought likely to be a gallstone. However, on surgical exploration it was found to be a polypoid melanoma metastasis, freely mobile within the lumen of the lower duct but attached to its wall by a thin stalk. There was no evidence of metastatic melanoma elsewhere in the abdomen. The tumour was removed without difficulty, completely relieving the obstructive jaundice. The patient remains well 14 months later, with no evidence of recurrent visceral melanoma.
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Affiliation(s)
- J F Thompson
- Sydney Melanoma Unit, Royal Prince Alfred Hospital, New South Wales, Australia
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46
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Abstract
Two of 14 patients with adenomas were without disease 25 and 43 months after ampullary resection. Two patients with an initial diagnosis of malignant neoplasm had no recurrence at 75 and 40 months; one underwent pancreatoduodenectomy at 8 months because of recurrence. Six of nine patients with initial diagnoses of villous adenoma were without disease at 1, 2, 16, 23, 46, and 51 months; three underwent conversion to pancreatoduodenectomy because of invasive carcinoma. Frozen-section studies revealed adenocarcinoma in two patients with villous adenoma but failed to show invasion in one patient. One patient with villous adenoma was mistakenly thought to have carcinoma based on results of frozen-section studies. Local ampullary resection is valuable in treating benign and selected premalignant and malignant ampullary lesions. The threshold for conversion to pancreatoduodenectomy should be low unless ampullectomy is performed with palliative intent.
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Affiliation(s)
- H J Asbun
- Department of General Surgery, Lahey Clinic Medical Center, Burlington, MA 01805
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Abstract
Metastatic cancer of the prostate, presenting with carcinomatous obstruction of the common bile duct as a cause of jaundice and abnormal liver function tests is very unusual. The literature suggests an association between abnormal liver function tests and poor survivability in those patients with liver parenchymal metastases. This case illustrates that patients with abnormal liver function tests on the basis of extrahepatic ductal obstruction may have a better prognosis than those with hepatic disease.
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Affiliation(s)
- W E Bloch
- Department of Urology, University of Miami, Florida
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48
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Kauffmann P, Le Bouedec G, Fondrinier E, Dauplat J. Intracholedocal metastatic thrombus of renal adenocarcinoma. J Chir (Paris) 1992; 129:215-7. [PMID: 1527194] [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: 12/27/2022]
Abstract
The authors report about the intraoperative discovery of a metastatic thrombus in the common bile duct, produced by a right renal adenocarcinoma metastasized in the Vth segment of the liver. As far as the treatment is concerned, in addition to nephrectomy, the use of a simple device allowed intraluminal irradiation with radioiridium. Although this approach is palliative, it resulted from the desire to maintain the patency of the common bile duct by controlling tumor proliferation within the duct. The pathogenesis of this proliferation is discussed. In our opinion, the favorable outcome after 18 months confirms the merits of this therapeutic attitude, which can be used for such tumoral extensions.
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Abstract
One hundred eighty-nine endoscopic biopsies of the papilla of Vater were obtained from 125 patients during a 10-year period. Chronic inflammation was the most common histologic change identified. Of the 44 patients with papillary neoplasia, 42 were diagnosed by endoscopic biopsy. Sixteen of the 18 patients with invasive carcinoma were diagnosed by biopsy. Follow-up biopsies in patients endoscopically managed demonstrated recurrent tumors in 6 of 11 patients. With advances in instrumentation and techniques, pathologists can expect to see increasing numbers of ampullary biopsies. When multiple biopsy fragments are obtained and step sectioned, the diagnostic reliability of endoscopic biopsies in patients with tumors and carcinoma is greater than 90%. The morphologic spectrum of papillary lesions is similar to that seen in the colon with some significant exceptions. Tumor morphology varied considerably from area to area. Variations were seen in the basic architecture (villous-tubular), grade of dysplasia, presence of malignancy, and invasion from fragment to fragment, and in some cases from microscopic field to field. Another notable difference between the ampulla and colon is the rich mucosal lymphatic network of the ampullary region. Thus, any carcinoma invading the lamina propria was diagnosed as invasive carcinoma.
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Affiliation(s)
- R A Komorowski
- Department of Pathology, Medical College of Wisconsin, Milwaukee
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Affiliation(s)
- M Bolkier
- Department of Urology, Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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