A case of hepatoma presenting as extrahepatic biliary obstruction due to hemobilia is reported. The patient, a 49-year-old woman, developed jaundice of the obstructive type after a history of B-viral hepatitis. On laparotomy, the liver revealed macronodular cirrhosis without any noticeable mass. A 4-cm sized friable tissue and blood clots were identified within the distended left hepatic duct. Pathologic examination of this tissue confirmed the diagnosis of hepatocellular carcinoma extended in the hepatic duct.
Bile Duct Obstruction, Extrahepatic/*etiology/pathology ; Biopsy ; Carcinoma, Hepatocellular/*complications/pathology/surgery ; Case Report ; Common Bile Duct/pathology ; Female ; Hemobilia/*complications ; Human ; Liver Cirrhosis/diagnosis ; Liver Neoplasms ; Middle Age

A case of hepatoma presenting as extrahepatic biliary obstruction due to hemobilia is reported. The patient, a 49-year-old woman, developed jaundice of the obstructive type after a history of B-viral hepatitis. On laparotomy, the liver revealed macronodular cirrhosis without any noticeable mass. A 4-cm sized friable tissue and blood clots were identified within the distended left hepatic duct. Pathologic examination of this tissue confirmed the diagnosis of hepatocellular carcinoma extended in the hepatic duct.
Bile Duct Obstruction, Extrahepatic/*etiology/pathology ; Biopsy ; Carcinoma, Hepatocellular/*complications/pathology/surgery ; Case Report ; Common Bile Duct/pathology ; Female ; Hemobilia/*complications ; Human ; Liver Cirrhosis/diagnosis ; Liver Neoplasms ; Middle Age

BACKGROUND/AIMS: CyberKnife(TM) stereotactic body radiotherapy (SBRT) has been thought as a promising treatment modality for inoperable or recurred pancreaticobiliary malignancies. But, clinical course of CyberKnife(TM) treatment have not been established yet, so we report the experience of CyberKnife(TM) treatment in 19 patients with recurred or advanced pancreaticobilliary malignancies. METHODS: Between July 2008 and May 2009, 19 patients (gallbladder cancer 4, common bile duct cancer 5, and pancreatic cancer 10) with recurred (12) and advanced pancreaticobiliary cancer (7) underwent CyberKnife(TM) treatment in Soonchunhyang University Hospital. Tumor size was evaluated at 1, 3, 6, 8 and every 3 months after SBRT. RESULTS: The mean age was 60.2 years, and the mean size of target lesions was 28.1+/-1.30 mm. After CyberKnife(TM) treatment, the average size of target lesions was decreased; 2.53+/-4.18 mm from months 0-1 in 19 patients, 2.47+/-4.7 mm from months 1-3 in 15 patients, 0.08+/-5.11 mm from months 3-6 in 12 patients. However, the average size of target lesions was increased 3.67+/-8.98 mm from months 6-8 in 6 patients. There were 2 cases of massive duodenal ulcer bleeding after CyberKnife(TM) treatment, one of them expired due to ulcer bleeding. Also, other minor complications appeared such as 1 case of abdominal pain and 1 case of diarrhea. CONCLUSIONS: CyberKnife(TM) treatment seems to be effective in local control of pancreaticobiliary cancer, but we experienced serious complications. Further prospective studies will be needed for the proper evaluation of role of Cyberknife(TM) treatment in patients with advanced pancreaticobiliary malignancies.
Adult ; Aged ; CA-19-9 Antigen/analysis ; Common Bile Duct Neoplasms/complications/pathology/*surgery ; Female ; Gallbladder Neoplasms/complications/pathology/*surgery ; Gastrointestinal Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/complications/pathology/*surgery ; Radiosurgery ; Retrospective Studies ; Tomography, X-Ray Computed

Extrahepatic cholangiocarcinoma is often clinically challenging to diagnose. Even multidisciplinary approaches which include computed tomography, magnetic resonance imaging, and endoscopic retrograde cholangiography are unsatisfactory in some cases, especially with biliary stricture. Percutaneous transhepatic cholangioscopy (PTCS) with its direct visualization for biopsy appears to be a promising technique for detecting cholangiocarcinoma at an early stage. We report a case of adenocarcinoma in situ of the distal common bile duct (CBD) that was confirmed by PTCS. This case suggests the useful role of PTCS in the differential diagnosis of a distal CBD obstruction, particularly when other diagnostic modalities do not provide definitive information.
Carcinoma in Situ/complications/*diagnosis/pathology/surgery ; Cholangiocarcinoma/complications/*diagnosis/pathology/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis, Extrahepatic/diagnosis/etiology ; Common Bile Duct/*pathology/surgery ; Common Bile Duct Neoplasms/complications/*diagnosis/pathology/surgery ; Constriction, Pathologic ; *Endoscopy, Digestive System ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; Predictive Value of Tests ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo assess the risk factors of stress-related ulcer and gastrointestinal hemorrhage after pancreaticoduodenectomy.

METHODSFrom May 1999 to July 2007, 285 periampullary cancer patients underwent pancreaticoduodenectomy in our hospital. The clinical data, pathological results, type of operation, and postoperative treatment were retrospectively analyzed. Patients with stress-related ulcer and gastrointestinal hemorrhage were selected for risk factor analysis, and other patients were taken as control group.

RESULTS35 patients (12.3%) developed stress-related ulcer and gastrointestinal hemorrhage following pancreaticoduodenectomy. Pathological examination showed pancreatic cancer in 5 cases, duodenal cancer in 8, common bile duct cancer in 10, ampullary carcinoma in 11, and solid-pseudopapillary tumors in 1. Single variate analysis demonstrated that alcohol, preoperative bilirubin level, operation time, lymph node metastasis, prealbumin decrease after operation and other complication were significantly associated with the stress-related ulcer and gastrointestinal hemorrhage. Logistic regression in multivariate analysis revealed that preoperative bilirubin level, operation time, other complication, prealbumin decrease after surgery were independent risk factors.

CONCLUSIONStress-related ulcer and gastrointestinal hemorrhage are one of the most common complications after pancreaticoduodenectomy. Preoperative bilirubin level, operation time, other complications, and prealbumin decrease after operation are four independently risk factors.

Adolescent ; Adult ; Aged ; Alcoholism ; complications ; Ampulla of Vater ; Bilirubin ; blood ; Common Bile Duct Neoplasms ; complications ; pathology ; surgery ; Duodenal Neoplasms ; complications ; pathology ; surgery ; Female ; Gastrointestinal Hemorrhage ; etiology ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Pancreatic Neoplasms ; complications ; pathology ; surgery ; Pancreaticoduodenectomy ; adverse effects ; Peptic Ulcer ; etiology ; Prealbumin ; metabolism ; Retrospective Studies ; Risk Factors ; Stress, Psychological ; complications ; Young Adult

Henoch-Schonlein purpura (HSP) is common in childhood and often self-limiting. There have been limited studies on elderly-onset HSP nephritis (HSPN). A 76-yr-old man was transferred to our hospital with a 1-month history of oliguria, abdominal pain, edema and palpable purpura in the legs. Three months ago, he was admitted to another hospital with jaundice, and consequently diagnosed with early common bile duct cancer. The patient underwent a Whipple's operation. Antibiotics were administrated because of leakage in the suture from the surgery. However, he showed progressive renal failure with edema and purpura in the legs. Laboratory investigations showed serum creatinine 6.4 mg/dL, 24-hr urine protein 8,141 mg/day, myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA) 1:40 and C3 below 64.89 mg/dL. Renal biopsy showed crescentic glomerulonephritis, as well as mesangial and extracapillary Ig A deposition. We started steroid therapy and hemodialysis, but he progressed to end-stage renal failure and he has been under maintenance hemodialysis. We describe elderly onset HSPN with MPO-ANCA can be crescentic glomerulonephritis rapidly progressed to end stage renal failure.
Aged ; Antibodies, Antineutrophil Cytoplasmic/*analysis ; Common Bile Duct Neoplasms/complications/surgery ; Complement C3/analysis ; Creatinine/blood ; Edema/drug therapy ; Enzyme-Linked Immunosorbent Assay ; Glomerulonephritis/pathology ; Humans ; Male ; Purpura, Schoenlein-Henoch/*diagnosis/drug therapy ; Renal Dialysis ; Renal Insufficiency/etiology/pathology ; Steroids/therapeutic use