Situs inversus, a left-to-right transposition of the normally asymmetrical organs of the body, is a rare anomaly that occurs in 1:5,000-1:10,000 adults. In the total form, the thoracic organs, as well as the abdominal organs, are completely reversed in a "mirror image" of their normal arrangement. Herein, we present a case of an adenocarcinoma of the proximal bile duct in a 68-year-old man with total situs inversus. Without any technical problems, he successfully underwent a bile-duct resection and bilioenteric anastomosis. He did well postoperatively, and after one course of chemotherapy, was discharged on postoperative day 12. A review of the international literature on this subject is presented.
Adenocarcinoma ; Adult ; Aged ; Bile Duct Neoplasms* ; Bile Ducts* ; Bile* ; Drug Therapy ; Humans ; Situs Inversus*

The prognosis for hilar cholangiocarcinoma is limited by tumor spread along the biliary tree leading to refractory obstructive cholestasis, cholangitis, and liver failure. Palliation with biliary endoprostheses results in median survival times of 4-6 months for advanced bile duct cancer. Photodynamic therapy (PDT) is a local photochemical tumor treatment consisting of a photosensitizing agent combined with laser irradiation of a distinct wavelength. Tumor ablation with PDT combined with biliary stenting reduces cholestasis and significantly improves median survival time. However, the treatment is not widely available, and the photosensitizers used for PDT cause prolonged photosensitivity. Optimum control of tumor spread along the bile ducts and control of cholestasis and cholangitis will prolong survival in one to two thirds of patients, and renders them suitable for other antitumor therapies.
Bile Duct Neoplasms/*drug therapy ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*drug therapy ; Humans ; *Photochemotherapy ; Treatment Outcome

The patient was a 70-year-old male whose chief complaints were obstructive jaundice and weight loss. Abdominal imaging studies showed a 2.5 cm sized mass at the distal common bile duct, which was suggestive of bile duct cancer. Eccentric enhancing wall thickening in the transverse colon was also shown, suggesting concomitant colon cancer. A colonoscopy revealed a lumen-encircling ulcerofungating mass in the transverse colon, that was pathologically proven to be adenocarcinoma. The bile duct pathology was also adenocarcinoma. Pylorus-preserving pancreaticoduodenectomy and extended right hemicolectomy were performed under the diagnosis of double primary cancers. Postoperative histopathologic examination revealed moderately differentiated mucinous adenocarcinoma of transverse colon cancer, and mucinous adenocarcinoma of the distal common bile duct. Immunohistochemical staining studies showed that the bile duct cancer had metastasized from the colon cancer. The patient recovered uneventfully from surgery and will be undergoing chemotherapy for three months.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Aged ; Bile Duct Neoplasms ; Bile Ducts ; Colon, Transverse* ; Colonic Neoplasms ; Colonoscopy ; Common Bile Duct Neoplasms ; Common Bile Duct* ; Diagnosis ; Drug Therapy ; Humans ; Jaundice, Obstructive* ; Male ; Mucins* ; Neoplasm Metastasis ; Pancreaticoduodenectomy ; Pathology ; Weight Loss

A 61-year-old male who complained of right upper quadrant pain was referred to the authors for evaluation after his computed tomography suggested biliary adenocarcinoma. The lesion consisted of multiple cysts with papillary mass and peri-ampullay mass. The patient underwent an operation due to a clinical suspicion of biliary cystadenocarcinoma, but the pathology confirmed biliary papillomatosis (BP) after diagnosing intrahepatic papillary neoplasm with high-grade dysplasia and invasive adenocarcinoma with papillary neoplasm from the distal common bile duct to the duodenum. BP is a disease characterized by multiple papillary masses. Its cause has yet to be discovered. It commonly manifests as bile duct dilation but rarely as a ductal cystic change. Under computed tomography or magnetic resonance imaging, both the BP and the cystic neoplasm can show bile duct dilation and a papillary mass, which makes their differential diagnosis difficult. A confirmative diagnosis can be made through a pathologic examination. BP is classified as a benign disease that can become malignant and may recur, though rarely. Its treatment of choice is surgical resection. Laser ablation or photodynamic therapy can be used for unresectable lesions. In the case featured in this paper, biliary papillomatosis was difficult to differentiate from cystic adenocarcinoma due to diffusely scattered multiple large cystic lesions in the liver, and it was histologically confirmed to have become malignant with cystic duct dilation after the operation. This case is reported herein with a literature review.
Adenocarcinoma ; Bile ; Bile Ducts ; Biliary Tract Neoplasms ; Common Bile Duct ; Cystadenocarcinoma ; Cystic Duct ; Diagnosis, Differential ; Dilatation ; Duodenum ; Humans ; Laser Therapy ; Liver ; Magnetic Resonance Imaging ; Male ; Papilloma ; Photochemotherapy

Villous adenomas are benign epithelial lesions with malignant potential which can occur at any site in the gastrointestinal tract. They are usually encountered in the rectum and colon, less frequently in the small bowel and very rarely in the biliary trees. Nine cases of bile duct villous adenomas have been reported in the literature. However, 4 cases of bile duct villous adenomas have been reported in the Korean literature. Recently, we experienced a case of villous adenoma in the common hepatic duct in a 77-year-old man presenting with obstructive jaundice in which preoperative histologic diagnosis of villous adenoma played a critical role in managing this patient. Herein, we present a case report of bile duct villous adenoma and a review of the reported cases in Korea to help define and manage this rare disease entity in the bile ducts. In addition, confusing nomenclature of bile duct adenomas is discussed.
Adenoma, Villous/therapy* ; Adenoma, Villous/diagnosis ; Aged ; Bile Duct Neoplasms/therapy* ; Bile Duct Neoplasms/diagnosis ; Case Report ; Cholestasis/etiology ; Human ; Male

No abstract available
Bile Duct Neoplasms/*drug therapy/mortality ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*drug therapy/mortality ; Humans ; *Photochemotherapy ; Survival Rate

OBJECTIVETo explore the diagnosis and treatment of the cholangiocarcinoma.

METHODSForty one patients with cholangiocarcinoma who were enrolled in our hospital from January 1970 to January 2005 were retrospectively analyzed.

RESULTSAmong these 41 patients, the 1, 3, and 5-year survival rate was 82.3%, 45.8%, 45.8%, respectively, with radical operation, and was 11.0%, 0, 0 with non-radical operation (chi2 = 21.38, P < 0.01). The 1-year and 3-year survival rate was 11.0% and 0 in 9 patients treated with laparatomy, which was not significantly different from those treated with non-radical operation (chi2 = 0.02, P = 0.89). Four patients did not receive operation and all died within one year. Among 25 patients who did not experience lymph node metastasis, the 1, 3, and 5-year survival rate was 58.4%, 27.3%, and 27.3%. Among 16 patients who were found lymph node metastasis, the 1-year and 3-year survival rate was 61.8% and 0 (chi2 = 13.85, P < 0.01).

CONCLUSIONOperation is the most effective treatment for cholangiocarcinoma. Radical operation is the only curative treatment.

Bile Duct Neoplasms ; diagnosis ; pathology ; therapy ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; diagnosis ; secondary ; therapy ; Female ; Humans ; Lymphatic Metastasis ; Male

Animals ; Bile Duct Neoplasms ; Carcinoma, Hepatocellular ; Genetic Therapy ; Liver Neoplasms ; Models, Animal

In the palliative setting, the necessity of biliary drainage of both liver lobes for malignant hilar biliary obstruction remains controversial. However, bilateral biliary drainage is a reasonable option to prevent cholangitis of the undrained lobe and to preserve liver function during the course of chemotherapy. Bilateral biliary drainage can be accomplished by the percutaneous or endoscopic placement of multiple self-expandable metallic stents (SEMS). Although SEMS placement via bilateral (multiple) percutaneous routes is technically simple, multiple percutaneous transhepatic biliary drainage (PTBD) may lead to additional morbidity. SEMS placement via a single percutaneous route is a useful method; however, negotiation of a guidewire into the contralateral bile duct is occasionally impossible if the hilar angle between the right hepatic duct and left hepatic duct is acute. Percutaneous dual SEMS placement is generally performed using the stent-in-stent technique (T configuration or Y configuration) or the side-by-side technique. In addition, the crisscross technique has been reported as being a useful method for trisegmental drainage. The side-to-end technique is also useful for multiple SEMS placement. In the future, the combination of percutaneous intervention and endoscopic ultrasonography-guided procedures may be effective in the management of malignant hilar biliary obstruction.
Bile Ducts ; Biliary Tract Neoplasms ; Cholangitis ; Drainage ; Drug Therapy ; Hepatic Duct, Common ; Liver ; Methods ; Negotiating ; Stents*

OBJECTIVETo evaluate the efficacy and toxicity of concurrent chemoradiotherapy for patients with locally advanced unresectable extrahepatic cholangiocarcinoma.

METHODSThirty-eight patients with locally advanced unresectable extrahepatic cholangiocarcinoma admitted in Shaoxing People's Hospital from February 2007 to February 2012 were enrolled in the study. They were randomized into sequential chemoradiotherapy (n=19) or concurrent chemoradiotherapy group (n=19). All patients were treated with intensity modulated radiation therapy (IMRT). Patients in concurrent chemoradiotherapy group received the regimen of gemcitabine plus oxaliplatin. Tumor response and adverse effects were observed periodically. The primary end points were disease progression-free survival (PFS) and overall survival (OS).

RESULTSThe response rates of sequential chemoradiotherapy and concurrent chemoradiotherapy groups were 42.1% (8/19) and 63.2% (12/19). The disease control rates of them were 78.9% (15/19) and 84.2% (16/19))， respectively. The median PFS of sequential chemoradiotherapy group and concurrent chemoradiotherapy group was 8.3 (95%CI: 7.6-9.0) and 10.4 months (95%CI: 9.4-11.4, P=0.037), and the median OS in two groups were 14.2 (95%CI: 12.6-15.8) and 15.6 months (95%CI: 14.2-17.0, P=0.095), respectively. The major adverse reactions were controllable hematology toxicity and gastrointestinal reaction. There was no significant difference in incidence of adverse reactions between two groups (P>0.05).

CONCLUSIONSequential chemoradiotherapy and concurrent chemoradiotherapy may improve PFS and OS in patients with locally advanced unresectable extrahepatic cholangiocarcinoma, and both are well-tolerated. In addition, concurrent chemoradiotherapy might provide additional PFS benefit and would be preferable.

Bile Duct Neoplasms ; therapy ; Bile Ducts, Intrahepatic ; pathology ; Chemoradiotherapy ; Cholangiocarcinoma ; therapy ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Disease-Free Survival ; Humans ; Organoplatinum Compounds ; therapeutic use ; Survival Rate