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

Majority of malignant neoplasms arising from the extrahepatic bile duct are adenocarcinomas. Carcinoid tumors at this site are extremely rare. We report a 67-year-old woman with malignant carcinoid tumor of the common bile duct. She presented with obstructive jaundice of 1 week's duration. Abdominal CT and ERCP revealed a common bile duct mass. She underwent Whipple's operation and was diagnosed as malignant carcinoid tumor histologically and immunohistochemically.
Aged ; Carcinoid Tumor/*diagnosis/surgery ; Common Bile Duct Neoplasms/*diagnosis/surgery ; Female ; Humans

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

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

Small cell carcinoma is usually seen in the lung, but rarely involves the gastrointestinal tract including biliary tract. A 65 year-old man was admitted because of obstructive jaundice. A smooth-surfaced round intraluminal mass with proximal bile duct dilatation was seen in the proximal common bile duct on endoscopic retrograde cholangiogram. Under the diagnosis of bile duct cancer, pylorus-preserving pancreatoduodenectomy was done. Pathology revealed a 2 cm sized small cell carcinoma in the proximal common bile duct and distal common hepatic duct. On immunohistochemical stain, the tumor cells were positive for neuroendocrine markers CD56 and synaptophysin. After surgery, the patient received 5 cycles of adjuvant chemotherapy with VIP (etoposide, ifosfamide, and cisplatin) regimen. However, the patient died of liver metastasis 12 months after the diagnosis. We report a case of extrapulmonary small cell carcinoma arising from the common bile duct.
Aged ; Bile Duct Neoplasms/complications/*diagnosis/surgery ; Carcinoma, Small Cell/complications/*diagnosis/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; *Common Bile Duct/radiography/radionuclide imaging/surgery ; Fatal Outcome ; Humans ; Liver Neoplasms/diagnosis/secondary ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed

Primary mucosa-associated lymphoid tissue (MALT) lymphoma arising in the common bile duct (CBD) is extremely rare. In our case of MALT lymphoma, CT and MRI showed long, segmental, irregular wall thickening of the CBD and minimal dilatation of the upstream bile duct. A preoperative diagnosis of cholangiocarcinoma was made, but histologic evaluation confirmed MALT lymphoma of the CBD. We herein present a rare case of MALT lymphoma of the CBD with CT and MRI findings.
Aged ; Bile Duct Neoplasms/*diagnosis/surgery ; *Common Bile Duct ; Diagnosis, Differential ; Humans ; Lymphoma, B-Cell, Marginal Zone/*diagnosis/surgery ; Magnetic Resonance Imaging ; Male ; Pancreaticoduodenectomy ; Preoperative Period ; Tomography, X-Ray Computed/*methods

No abstract available.
Aged, 80 and over ; Animals ; Anthelmintics/therapeutic use ; Bile Duct Neoplasms/diagnosis/surgery/ultrasonography ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchiasis/*diagnosis/drug therapy/surgery ; Clonorchis sinensis/isolation & purification ; Common Bile Duct/ultrasonography ; Humans ; Male ; Praziquantel/therapeutic use ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Endoscopic papillectomy is reported to be relatively safe and reliable for complete resection of benign tumors of the major duodenal papilla. We evaluated methods and treatment outcome of the patients who have undergone endoscopic papillectomy. METHODS: Medical records of 22 consecutive patients with tumor of the major duodenal papilla (10 women, 12 men; mean age 55.8+/-2.8 yrs) who have undergone endoscopic papillectomy were reviewed retrospectively. Endoscopic papillectomy was defined the successful when complete excision of the tumor was achieved. RESULTS: Mean duration of follow-up was 8.4+/-2.4 months (range 1-43 months). Endoscopic papillectomy was successful in 16 patients (72.7%), but incomplete resection occurred in 6 patients. Only one patient showed recurrence. Histopathologic evaluation after endoscopic papillectomy revealed adenoma (n=11, 50%), high-grade dysplasia (n=3, 13.6%), adenocarcinoma (n=2, 9.1%), carcinoid (n=1), chronic inflammation (n=3, 13.6%), papillary adenomatous hyperplasia (n=1), and cavernous lymphangioma (n=1). The mean size of the resected lesions was 10.3+/-1.2 mm (range 2-20 mm). There was no factor which could predict the endoscopic success statistically. A pancreatic duct stent was placed in 11 patients (50.0%) and was removed after 3 to 39 days. There were 8 (36.8%) procedure-related complications: bleeding (n=4), papillary stenosis (n=1), perforation (n=1), cholangitis (n=1), and asymptomatic liver function abnormality (n=1). There was no pancreatitis or mortality. All the complications resolved with conservative management. CONCLUSIONS: Endoscopic papillectomy in selected patients seemed to be highly successful and safe. Longer follow-up is needed to assess the long-term efficacy.
Adult ; Aged ; Ampulla of Vater/*surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct Neoplasms/diagnosis/*surgery ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; *Sphincterotomy, Endoscopic ; Treatment Outcome

Carcinosarcoma ; metabolism ; pathology ; surgery ; Common Bile Duct Neoplasms ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Keratins ; metabolism ; Middle Aged ; Vimentin ; metabolism

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