Leiomyomas, originating in the bile duct, are very rare, and only few cases have been reported in the literature. We experienced a case of leiomyoma of the distal common bile duct, mimicking bile duct cancer. A 39-year-old woman presented with intermittent jaundice and general weakness for three months. Clinical profiles showed obstructive jaundice, and the abdominal computed tomography and cholangiography revealed diffuse bile duct dilatation with distal common bile duct stricture. A pylorus-preserving pancreaticoduodenectomy was performed and the pathologic specimen disclosed leiomyoma of the common bile duct accompanying severe fibrosis. This is the first case of leiomyoma in the bile duct reported in Korea.
Adult ; Common Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Female ; Humans ; Leiomyoma/*diagnosis/pathology/surgery ; Pancreaticoduodenectomy

Detection of tumors of the ampulla of Vater, including ampullary adenoma, has been improved by routine screening endoscopic procedures and imaging modalities. Endoscopic resection by endoscopic papillectomy is rapidly replacing classic surgical resection and is a less invasive procedure. Endoscopic resection can have a role not only in the final histopathologic diagnosis but also as a definite therapeutic option. However, the indications for endoscopic resection are not fully established, and endoscopic procedures are not standardized. Significant complications, including severe pancreatitis, intractable bleeding and duodenal perforation, are rare but can occur, especially in less experienced hands. Severe pancreatitis is the most feared complication, but it can be prevented by pancreatic duct stent insertion in most cases. However, in some cases, pancreatic stenting can be challenging after resection. Incomplete resections are sometimes performed to avoid complications. Endoscopic surveillance is also important for identifying and managing remnant adenomatous tissue or recurrent lesions. Further technical development is needed to expand the indications for this procedure, minimize complications and ensure a high success rate.
Adenoma/pathology/*surgery ; Ampulla of Vater/pathology/*surgery ; Carcinoma/pathology/*surgery ; Common Bile Duct Neoplasms/pathology/*surgery ; Endoscopy, Digestive System ; Humans

Ampulla of Vater/pathology* ; Carcinoma/pathology* ; Common Bile Duct Neoplasms/surgery* ; Humans

Though surgical resection has been the traditional treatment for tumors of the ampulla of Vater, endoscopic maneuvers such as snare resection, laser photodestruction and electrofulguration have recently been introduced to avoid operation-related morbidity and mortality. From 1994 to 1996, 6 patients with ampullary tumor were managed by endoscopic snare resection and regularly followed. Endoscopic snare resection of the ampullary tumor was technically feasible in all patients and each procedure was performed in a single session. Histologic diagnoses of the resected specimens were adenoma in 4 patients and adenoma with coexistent adenocarcinoma in 2 patients. Resection margins were negative in all patients except 1 with coexistent adenocarcinoma and a radical pancreaticoduodenectomy was performed in that case. For the other patient with adenocarcinoma foci, no further treatment was persued since he was 72-year-old and refused operation. Acute pancreatitis developed in 2 patients after endoscopic therapy, but was resolved with conservative management. There was no procedure-related death. Surveillance duodenoscopy performed at 1 and 6 months after endoscopic resection revealed no evidence of recurrent tumor in 4 patients with adenoma. Among them, 3 patients are alive without evidence of recurrence at 16-37 months after resection, but 1 patient was lost after 9 months of follow-up. The patient with adenocarcinoma in whom a pancreaticoduodenectomy was performed, has been alive without recurrence for 12 months. Oral 5-fluorouracil was administered for the other patient with adenocarcinoma foci. Though he experienced local recurrence at 13 months after the procedure, he has been alive for 28 months after resection. In conclusion, endoscopic snare resection may be applied as a viable alternative to surgery in selected patients with small ampullary tumors.
Aged ; Common Bile Duct Neoplasms/surgery* ; Common Bile Duct Neoplasms/pathology ; Endoscopy ; Female ; Follow-Up Studies ; Human ; Male ; Middle Age ; Pancreaticoduodenectomy ; Vater's Ampulla*

Neuroendocrine tumors of the extrahepatic biliary tree are extremely rare malignancies accounting for 0.2-2.0% of all gastrointestinal carcinoid tumors. Neuroendocrine tumors obstructing the biliary tree are extremely difficult to diagnose preoperatively and nearly impossible to differentiate from cholangiocarcinoma. Statistically, the most common anatomic location in the biliary tree is the common bile duct, followed by the perihilar region. Herein, we present a case of a small cell neuroendocrine carcinoma of the hilum in a 79-year-old man following laparotomy. To our knowledge, this is the first case of small cell type neuroendocrine carcinoma of hilar bile duct reported in Korea.
Aged ; Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis, Differential ; Hepatic Duct, Common/pathology ; Humans ; Male ; Neuroendocrine Tumors/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Ampulla of Vater ; Common Bile Duct ; transplantation ; Duodenum ; surgery ; Gastrointestinal Stromal Tumors ; pathology ; surgery ; Humans ; Male ; Middle Aged

Caroli's disease is a rare congenital hepatobiliary disease characterized by multifocal segmental dilatation of intrahepatic bile ducts affecting all or parts of the liver. Two forms of Caroli's disease are described, the pure form and that associated with periportal fibrosis. The disease may diffusely affect the liver or be localized to one lobe or segment. Less than 20% of all reported cases of Caroli's disease are monolobar type. We report a case of simple type Caroli's disease confined to right lobe of the liver in a 22 year old man. He was admitted due to right upper abdominal pain and diagnosed by magnetic resonance cholangiopancreatography. He was treated with right hepatic lobectomy and recovered completely.
Adult ; Bile Ducts, Intrahepatic/pathology ; Caroli Disease/diagnosis/pathology/*surgery ; Common Bile Duct/surgery ; Diagnosis, Differential ; Hepatectomy ; Humans ; Liver/*pathology ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

OBJECTIVETo investigate the prognostic implication of common bile duct infiltration in the adenocarcinoma of the ampulla of Vater after panreaticoduodenectomy.

METHODSA retrospective study was conducted on clinical manifestation, pathological behavior and survival data in 102 patients with Vater's ampulla adenocarcinoma, who underwent pancreaticoduodenectomy from Jan 1980 to Dec 2003. The result of patients with the common bile duct infiltration were compared with that of those without.

RESULTSThere were 42 cases in stage I (41.2%), 32 in stage II (31.3%), 27 in stage III (26.5%), and 1 in stage IV (1.0%). As for T stage: 9 cases in stage T1 (8.8%), 40 in T2 (39.2%), 25 in T3 (24.5%), and 28 in T4 (27.5%). As regarding to N stage: 76 cases in stage N0 (74.5%) and 26 in N1 (25.5%). Of these 102 cases, microscopic infiltration in the common bile duct (25.0%) was identified in 26 cases. A significant difference was observed between the patients with bile duct infiltration and those without, in the proportion of pancreatic medullae infiltration: 84.6% (infiltration group) versus 34.2% (non-infiltration group, P < 0.001). Twenty-five cases (24.5%) had recurrence and/or metastases postoperatively, with a median survival of 20 months (range, 2 to 93 months). The overall median survival of the whole group was 46.0 months (2 approximately 192 months), with a significant difference between the common bile duct infiltration group (36 months) and the non-infiltration group (49 months, P = 0.0061). The median non-recurrence survival of the whole group was 43 months (2 approximately 192 months), and a significant difference was observed between the common bile duct infiltration group (35 months) and non-infiltration group (47 months, P = 0.0002).

CONCLUSIONIf the adenocarcinoma of the Vater's ampulla infiltrated the common bile duct, the invasion to the pancreatic medulla is likely developed, and usually with a poor non-recurrence and overall survival. Therefore, postoperative chemotherapy/radiotherapy is suggested.

Adenocarcinoma ; diagnosis ; pathology ; surgery ; Adult ; Aged ; Ampulla of Vater ; Common Bile Duct ; pathology ; Common Bile Duct Neoplasms ; diagnosis ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; secondary ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Pancreaticoduodenectomy ; Retrospective Studies ; Survival Rate

Carcinoma of the ampulla of Vater is a relatively rare neoplasm and its longterm survival rate is considerably high. However, because of differences in tumor pathologic features and local invasiveness, a 5-year survival rate differ widely. We present a case of metastatic carcinoma of the ampulla of Vater presenting as a Krukenberg tumor in a 59-year-old woman. Eight months earlier, she had been diagnosed as well-differentiated adenocarcinoma of the ampulla of Vater. Abdominal examination revealed a hard mass with mild tenderness in the RLQ area. The laboratory findings were unremarkable except for mild anemia. CT scan of the abdomen revealed enlargement of both ovaries. An exploratory laparotomy disclosed bilateral ovarian masses, 18 x 12 x 8 cm and 8 x 5.5 x 4 cm in size, respectively. Histologic findings of the both ovarian masses were consistent with metastatic adenocarcinoma from the ampulla of Vater.
Case Report ; Common Bile Duct Neoplasms/surgery ; Common Bile Duct Neoplasms/pathology* ; Female ; Human ; Krukenberg Tumor/secretion* ; Krukenberg Tumor/pathology ; Middle Age ; Ovarian Neoplasms/secondary* ; Tomography, X-Ray Computed ; Vater's Ampulla*/pathology

As recent advances in chemotherapy and surgical treatment have improved outcomes in patients with biliary cancers, the search for an optimal strategy for relief of their obstructive jaundice has become even more important. Without satisfactory relief of biliary obstruction, many patients would be ineligible for treatment. We review all prospective randomized trials and recent retrospective non-randomized studies for evidence that would support such a strategy. For distal malignant biliary obstruction, an optimal strategy would be insertion of metallic stents either endoscopically or percutaneously. Evidence shows that a metallic stent inserted percutaneously has better outcomes than plastic stents inserted endoscopically. For malignant hilar obstruction, percutaneous biliary drainage with or without metallic stents is preferred.
Bile Duct Neoplasms/pathology/surgery ; Biliary Tract Diseases/pathology/*surgery ; Cholangiocarcinoma/pathology/surgery ; Decompression, Surgical ; Drainage/methods ; Endoscopy ; *Evidence-Based Medicine ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive/pathology/*surgery ; Klatskin's Tumor/pathology/surgery ; Stents