Mucinous cholangiocarcinoma, characterized by large quantities of mucin production, is a rare subtype of peripheral cholangiocarcinoma and usually shows rapid progression and a fatal outcome. We report here a case of mucinous cholangiocarcinoma in a 69 year-old man, who was infected with Clonorchis sinensis. Histologically, the tumor was an adenocarcinoma with extensive intracellular and extracellular mucin production, up to 70% of the tumor mass and there was frequent lymphovascular invasion of the tumor cells. The liver adjacent to the mass contained eggs of Clonorchis sinensis in the bile duct lumen and showed ductal epithelial hyperplasia, mucinous metaplasia and adenomatous proliferation of intramural glands. The patient was treated with a right hepatectomy. Four months after the surgery, the tumor recurred in the soft tissue of the right flank.
Aged ; Bile Duct Neoplasms/*complications/secretion ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*complications/secretion ; Clonorchiasis/*complications ; English Abstract ; Humans ; Male ; Mucins/secretion

BACKGROUND: The treatment of intrahepatic stones is difficult because of frequent recurrence and residual stones. There are several suggested methods of treatment which include surgical bile-uct exploration with or without biliary drainage, an endoscopic procedure, transhepatic cholangiolithotomy, and hepatic resection. METHODS: We reviewed the therapeutic results in 96 patients who had hepatolithiasis and received surgery at Soon Chun Hyang University Chunan Hospital during the 10 years from June 1987 to June 1997. We divided them into 2 groups: one was the group of patients receiving a hepatic resection with or without a drainage procedure (resection group), and the other was the group of patients receiving only a T-ube choledochostomy or drainage procedure (nonresection group). RESULTS: The male-to-female ratio was 1:1.74, and the most prevalent age group was the 5th decade (31.3%). The most common symptoms were epigastric pain (61%) and RUQ pain (60%), and the locations of stones were the right intrahepatic duct in 10 cases (10.4%), the left intrahepatic duct in 47 cases (49%), and both intrahepatic duct in 39 cases (40.6%). Operative methods were a resection in 29 cases and a nonresection in 67 cases. The incidence of residual stones were 31.0% in the hepatic resection group and 68.6% in the nonresection group. The postoperative complication rate was 20.6% in hepatic resection group and 38.8% in the nonresection group, and the follow-p study showed the good results (Good & Fair) for 92.5% of the hepatic resection group and 66.7% of the nonresection group. CONCLUSION: The hepatic resection with or without drainage is an adequate treatment for hepatolithiasis. It can eradicate localized intrahepatic calculi, irreversible biliary stricture, an atrophied segment, and, possibly, an associated cholangiocarcinoma, with good results in clinical evaluation.
Calculi ; Cholangiocarcinoma ; Choledochostomy ; Chungcheongnam-do ; Constriction, Pathologic ; Drainage ; Humans ; Incidence ; Postoperative Complications ; Recurrence

BACKGROUND/AIMS: Hilar cholangiocarcinoma is a tumor with poor prognosis although curative surgical resection is known to be the most effective treatment. To obtain negative resection margin is still a challenging problem for surgeons. We designed this study to investigate further the treatment strategies of the hilar cholangiocarcinoma by comparing the prognosis of patients managed by different modalities with special emphasis on the polarity of the resection margin. METHODS: A retrospective clinical study was performed at the Inha University Hospital for 70 patients managed for hilar cholangiocarcinoma from June 1996 to May 2002. RESULTS: The patients consisted of 45 men and 25 women. The average age of the patients was 66.4 years old. The survival rate for 1 year and 3 years and the median survival period were investigated. For the negative resection margin sub-group, those were 100%, 28.6% and 23 months respectively, while those for the positive resection margin sub-group were 70.6%, 10.8% and 19 months respectively. For the palliative bypass surgery sub-group, those were 0%, 0%, and 5 months, for the biliary stent sub-group, those were 5.3%, 0% and 5 months and for the intraductal radiotherapy sub-group, those were 20%, 0% and 7 months respectively. When the patients were divided between the resection and the non- resection groups, those figures were 79.2%, 12.1% and 20 months for the resection group while for the non-resection group, those were 11.9%, 0% and 6 months respectively. Statistical analysis showed that the survival rates for the resection and the non-resection groups were different (p=0.0001). However, the survival difference for the negative and the positive resection margin sub-groups were insignificant (p= 0.2401). For the three sub-groups of the non-resection group, the survival difference for each sub-groups were also insignificant (p=0.2979). Postoperative complication was observed in 12 patients (38.7%). Three patients died and the postoperative mortality rate was 9.7%. CONCLUSION: To improve the survival of the hilar cholangiocarcinoma patients, it is believed that the best treatment is the aggressive resection of the tumor even if it is difficult to obtain negative resection margin. Considering the high morbidity and mortality rate of extensive surgery and comparable survival of the positive resection margin patients, further extension of the extent of resection to obtain negative resection margin should be performed in selected patients.
Cholangiocarcinoma* ; Female ; Humans ; Male ; Mortality ; Postoperative Complications ; Prognosis* ; Radiotherapy ; Retrospective Studies ; Stents ; Survival Rate

Congenital anomalies of the pancreaticobiliary structure may go undetected until adulthood, and they can be the cause of unexplained jaundice, abdominal pain, nausea and vomiting. In addition to such associated disease, as cholangitis, gallstone, cholangiocarcinoma and pancreatitis, recognition of these variant anatomies is clinically important for planning surgery and for preventing inadvertent surgical injury. Although congenital abnormalities and variations of the biliary ducts are common, and variations in the drainage and course of the cystic duct are also frequently seen, variation of the cystic duct opening into the right hepatic duct is rare; further, it is important to avoid erroneous ligation of the hepatic duct during surgery. We report here on a case of aberrant cystic duct opening into the right hepatic duct along with acute pancreatitis.
Abdominal Pain ; Cholangiocarcinoma ; Cholangitis ; Congenital Abnormalities ; Cystic Duct* ; Drainage ; Gallstones ; Hepatic Duct, Common* ; Intraoperative Complications ; Jaundice ; Ligation ; Nausea ; Pancreatitis* ; Vomiting

The authors experienced three cases of cholangiocarcinoma associated with profuse mucin production. We intended to review and summarize the clinical features of these patients to emphasize the clinical importance of mucin-producing cholangiocarcinoma. All patients were female. Symptoms were mainly right upper quadrant pain and jaundice. Diagnosis was made by characteristic endoscopic retrograde cholangiographic findings and computed tomography. Bile ducts were dilatated and obstructive jaundice had developed as a result of the accumulation of mucin realeased by the tumor. Treatments were hepatic lobectomies for two intrahepatic cholangiocarcinoma patients and extrahepatic bile duct resection and hepaticojejunostomy for one patient. There was no postoperative complication. Pathologies were well differentiated papillary adenocarcinoma in two cases. Two patients are still living without recurrence for over three and four years respectively. One patient who had T4 lesion died of recurrence 38 months after operation. Conclusively, aggressive surgical treatment may be justified in the treatment of mucin hypersecreting cholangiocarcinoma even in advanced stage in view of the favorable outcome after radical operation. Further study is needed to clarify its biological behavior.
Adenocarcinoma, Papillary ; Bile Ducts ; Bile Ducts, Extrahepatic ; Cholangiocarcinoma* ; Diagnosis ; Female ; Humans ; Jaundice ; Jaundice, Obstructive* ; Mucins ; Pathology ; Postoperative Complications ; Recurrence

No abstract available.
Bile Duct Neoplasms/complications/*diagnosis/pathology ; *Bile Ducts, Intrahepatic/pathology ; Cholangiocarcinoma/complications/*diagnosis/pathology ; Female ; Humans ; Lithiasis/*etiology/pathology/surgery ; Liver Diseases/*etiology/pathology/surgery ; Middle Aged

OBJECTIVETo evaluate the down stream involvement of the bile duct in hepatolithiasis.

METHODSMechanical damage to bile duct epithelia and long standing cholangitis as result of hepatolithiasis play an important role in the carcinogenesis of bile duct epithelia and stricture of the intra- and extra-hepatic bile duct. Macromorphological and microscopic changes in bile duct mucosa of 100 consecutive patients with hepatolithiasis were investigated using intra- or post-operative cholangioscopy. Biopsy specimens of lesions obtained during cholangioscopy were studied with immunohistochemical staining and flow cytometry to determine proliferative activity and DNA content. Five cases of well-proven cholangiocarcinoma were simultaneously studied as controls.

RESULTSOf the 100 patients, those with chronic cholangitis accounted for 86% (86/100), proliferative lesions 11% (11/100), adenomatous polyps 1% (1/100), and adenocarcinoma 2% (2/100). The obvious mucosal lesion associated with hepatolithiasis was located down-stream of the bile duct, predominantly in the hilar region, e.g. orifices of the right/left hepatic duct and common hepatic duct (73% mucosa lesions in the hilar region). The intensity of cancer embryonic antigen stain and the proliferative cell nuclear antigen index increased with the development of bile duct lesions. Aneuploid DNA presented mainly in the high degree malignant adenocarcinomas (> 80% of cases).

CONCLUSIONSThe obvious mucosal lesions associated with hepatolithiasis were located down-stream of the bile duct, predominantly in the hilar region (73% of mucosal lesions). The proliferative activity of examined bile duct mucosa lesions increased with the development of pathological deterioration, which may contribute to the development of hilar bile duct stricture and hilar cholangiocarcinoma.

Adult ; Aged ; Bile Ducts ; pathology ; Carcinoembryonic Antigen ; analysis ; Cholangiocarcinoma ; etiology ; Humans ; Lithiasis ; complications ; pathology ; Liver Diseases ; complications ; pathology ; Middle Aged ; Proliferating Cell Nuclear Antigen ; analysis

Inflammatory pseudotumor is an uncommon mass which develops most frequently in the lung of young adults. It is characterized by localized fibrous proliferations with chronic inflammatory cell infiltration. Due to its rarity and similarity in radiologic appearance with malignant hepatic tumors, hepatic inflammatory pseudotumor (HIPT) is often misdiagnosed and resected accidentally. We report a case of HIPT which was unnecessarily resected due to synchronous small peripheral cholangiocarcinoma located on the other segment of liver.
Bile Duct Neoplasms/complications/*diagnosis/pathology ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/complications/*diagnosis/pathology ; Fatal Outcome ; Granuloma, Plasma Cell/complications/*diagnosis/pathology ; Humans ; Liver Diseases/complications/*diagnosis/pathology ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the method of palliative drainage by means of metallic indwelling stents or plastic tubes for patients with malignant biliary obstruction.

METHODSFrom January 1995 to February 2001, 243 consecutive patients (161 men and 82 women; aged 26 - 91 years, mean of 61.3 years) with malignant biliary obstruction were treated with transhepatic placement of metallic stents and/or plastic tubes. Among them, 47 patients had pancreatic carcinoma, 98 cholangiocarcinoma, 28 metastatic carcinoma and 60 hepatic carcinoma. 169 stents of nine types were used in this series. After stenting, 47 patients were treated for local tumors. Procedure- and device-related complications were recorded. Patient survival and stent patency rates were calculated with Kaplan-Meier survival analysis.

RESULTSOne hundred and three patients underwent successfully stent placement for the first time. Others had their stents installed 1 - 2 weeks after catheterization. Stents were used in 132 patients. Ninety-five patients were treated with a single stent. Seventeen patients had two stents installed for bilateral drainage, 20 patients had two stents installed from top to bottom to create stenting of adequate length, and 12 patients had stents placed across the ampulla. The 2-month mortality rate was 8.64% (21/243). Major complications occurred in two patients (0.8%, 2/243). Minor complications included self-limited bleeding into the drainage tubes and fever. The average patency of the initial stent was 7.5 months and average survival was 9 months. Thirteen patients received brachytherapy in their stents, 15 extra radiation therapy, and 19 intra-arterial infusion chemotherapy. The 47 patients treated for local tumors had an average survival of 11.3 months (log rank 32.8, P < 0.001) with an average patency of 9.7 months (log rank 4.7, P < 0.05).

CONCLUSIONPercutaneous transhepatic bile drainage as a palliative procedure is well tolerated by patients. After stenting, treatment for local tumor may prolong the duration of stent patency and the survival of patients.

Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms ; complications ; Cholangiocarcinoma ; complications ; Cholestasis ; diagnostic imaging ; therapy ; Drainage ; Female ; Humans ; Liver Neoplasms ; complications ; Male ; Middle Aged ; Palliative Care ; Pancreatic Neoplasms ; complications ; Radiography, Interventional ; Stents

PURPOSE: It is difficult to preoperatively determine the extent of surgery for extrahepatic cholangiocarcinoma due to its proximity to vital structures. Recently the tendency of combined resection of liver and pancreas for the treatment of this appears to be increasing, although, in spite of the expected survival benefit, this radical surgery cannot be applied to all extrahepatic cholangiocarconoma because of the high rate of operative complications. We reviewed patients who had undergone segmental resection of the bile duct vice radical surgery for extrahepatic cholangiocarconoma in order to study their clinical features and to analyze the prognostic factors for survival. METHODS: Thirty-four patients who underwent segmental resection for extrahepatic cholangiocarcinoma, excepting GB cancer, at our center between 1994 to 2000 were included in this study and their medical records were reviewed retrospectively. RESULTS: The mean age of the patients was 63 years and they underwent segmental resection of bile duct and skeletalization of the hepatoduodenal ligament with hepatico-jejunostomy. The mean length of hospital stay after operation was 17.2 days (8~44) and no operative mortality was encountered. Postoperative complications including 5 wound dehiscences, 1 intraperitoneal abscess, 1 pyloric obstruction and 1 case of gastric ulcer bleeding were all improved following conservative management. The mean size of tumors was 2.6 cm and 11 tumors (32%) involved the resection margin. The estimated 2 and 4 year survival rates of the 34 patients following resection was 64% and 22% respectively and the only significant predictive factor for survival following resection was the tumor involvement of resection margin (P=0.045). The 2-year survival rate of the positive margin group was 34%, although that of the free margin group was 74%. CONCLUSION: Segmental resection for extrahepatic cholangiocarconoma may be a reasonable option offering relatively low morbidity and mortality if the resection margin is tumor- free. Additionally, segmental resection may be more beneficial to patients with high operative risk in particular.
Abscess ; Bile Ducts ; Bile Ducts, Extrahepatic* ; Cholangiocarcinoma ; Hemorrhage ; Humans ; Length of Stay ; Ligaments ; Liver ; Medical Records ; Mortality ; Pancreas ; Postoperative Complications ; Retrospective Studies ; Stomach Ulcer ; Survival Rate ; Wounds and Injuries