Cholangiocarcinomas originate from the bile duct mucosa and can occur at any level of the biliary tract. Approximately 40 to 60% of cases are found at the hilar level.-Currently, a curative surgical resection is the only treatment method. The surgical treatments of a hilar cholangiocarcinoma are challenging but the diagnostic accuracy has improved with the better preoperative imaging and noninvasive diagnostic techniques. Using the percutaneous transhepatic choledochoscope,-direct visualization of the extent and possible invasion of the tumor is possible, which provides information for determining the extent of the resection. During an endoscopic examination, it is also possible to-pathologically confirm a carcinoma and drain biliary system to relieve an obstruction. Portal vein embolization to increase the volume of the future remaining liver has been attempted in steps of-accomplishing an extended surgical resection of hilar cholangiocarcinoma.- The 5-year survival of hilar cholangiocarcinoma is still poor, ranging from 20~40% after a curative resection with-a median survival of 12-16 months. A R0 resection is the most important prognostic factor that affects the survival significantly . The choice of surgical procedure is determined by the location of the tumor. In general, unilobar involvement even with ipsilateral encasement of the hepatic artery or portal vein branch, and/or ipsilateral secondary biliary radicals with associated lobar atrophy are considered resectable. In carefully selected candidates,-an extended hepatic resection with a concomitant en bloc resection of the vascular structures and accompanied by a reconstruction along with a biliary excision has been advocated for complex hilar tumors to attain some survival benefit through a R0 resection. We review the recent trends in various diagnostic methods and surgical treatments for hilar cholangiocarcinoma.
Atrophy ; Bile Ducts ; Biliary Tract ; Cholangiocarcinoma* ; Hepatic Artery ; Liver ; Mucous Membrane ; Portal Vein ; Prognosis

The optimal management of hepatic metastases in colorectal carcinoma patients has become increasingly complex with the myriad of available treatment options. Because the timing of any therapy has become integral to the success of the treatment, a collaborative approach involving multiple specialties is needed for achieving the best patient outcome. Surgical resection is the most effective therapy for metastatic colorectal cancer isolated to the liver. Liver resection of colorectal metastases is associated with three- and five-year survival rates close to 40~60% and 30~50%, respectively. Because the technique for hepatic resection has improved, patients with multiple, biloba, and huge metastases can undergo resection. Every liver resection should be planned after intraoperative ultrasonography, and an anatomical surgical procedure should be preferred instead of wedge resection. Since some of patients diagnosed with metastatic colorectal disease are initially classified as unresectable, neoadjuvant chemotherapy is being increasingly employed to downsize colorectal metastasis. The greatest benefit of the preoperative approach is the potential to convert patients with initially unresectable metastatic disease to a resectable state. Although various prognostic risk factors have been identified, there has been no dependable staging or prognostic scoring system for metastatic hepatic tumor. As surgeons become more proficient in the technical aspects of resection, the patient selection criteria as based on the biologic determinants of the outcome are becoming increasingly important. The goal of this review is to provide the optimal management, treatment and follow-up for patients with colorectal metastasis to the liver.
Colorectal Neoplasms ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver* ; Neoplasm Metastasis* ; Patient Selection ; Risk Factors ; Survival Rate ; Ultrasonography

Adrenal myelolipoma is a rare benign, non-functioning tumor that is frequently discovered incidentally. We report here on a case of a 47-year-old woman with an incidentally found adrenal tumor. She was slightly obese and had been diagnosed with diabetes. Her blood sugar level was well-controlled with oral hypoglycemic agents. All the laboratory test results were within normal limits. The abdomen CT scan revealed a well-demarcated homogenous solid mass that was 9cm in diameter, and it consisted of fat tissues. The differential diagnosis for malignant tumors was necessary, so we performed complete surgical excision. The patient recovered well without any major complications. If the diagnosis of adrenal myelolipoma is definite, then regular follow-up of this type of patient is sufficient. However, as the differential diagnosis with malignant tumors is rather difficult and as spontaneous hemorrhage can persist in the giant myelolipomas that are greater than 10cm in diameter, performing complete surgical excision is inevitable.
Abdomen ; Adrenal Gland Neoplasms ; Blood Glucose ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypoglycemic Agents ; Middle Aged ; Myelolipoma

A 60-year-old female was admitted with epigastric pain lasting a month. Preoperative diagnosis was choledochal cyst with anomalous pancreaticobiliaryductal union (APBDU), C-P type. A papillary mass measuring 2.5 x 1.9 cm was found adjacent to the pancreaticocholedochal junction. Gallbladder (GB) cancer was also observed. Pyloric-preserving pancreaticoduodenectomy (PPPD) was performed. The patient received adjuvant chemotherapy/radiation therapy on the tumor bed. The gallbladder cancer showed serosal invasion, while the bile duct cancer extended into the pancreas. Although common bile duct (CBD) cancer lesion showed focally positive for p53 and the gallbladder cancer lesion showed negative for p53, the Ki-67 labeling index of the CBD cancer and GB cancer were about 10% and 30%, respectively. Nine months after curative resection, a stricture on the subhepatic colon developed due to adjuvant radiation therapy. Localized peritoneal seedings were incidentally found during a right hemicolectomy. The patient underwent chemotherapy and had no evidence of tumor recurrence for two years after PPPD.
Bile Duct Neoplasms ; Choledochal Cyst ; Colon ; Common Bile Duct ; Constriction, Pathologic ; Female ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Middle Aged ; Neoplasms, Multiple Primary ; Pancreas ; Pancreaticoduodenectomy ; Recurrence ; Seeds

BACKGROUNDS/AIMS: Traumatic pancreatic injury is rare and various surgical procedures can be applied according to the severity of injury. We reviewed our experience of pancreatic injury and investigated the clinical outcome. METHODS: Fifty-six patients were treated conservatively or with surgery for pancreatic injury at the Department of Surgery, Korea University Medical Center of Korea University College of Medicine from January 2001 to February 2012. RESULTS: Forty-one men and 15 women were included (mean age, 32 years; range, 5-66 years). Twelve patients were hypotensive at admission. According to the American Association for the Surgery of Trauma grade, 15 patients were grade I, 16 were grade II, 10 were grade III, 13 were grade IV, and one patient was grade V. A total of 41 patients underwent exploratory surgery. Complications developed in 35 patients, and 19 patients demonstrated intra-abdominal abscesses associated with pancreatic leakage. Four mortalities occurred. More adult patients (n=42) required intensive care than that of pediatric patients (n=14) (p=0.03). However, more pediatric patients had hyperamylasemia at admission (p=0.023). A significantly higher proportion of patients in the hypotensive group had blunt abdominal injuries, associated extra-abdominal injuries, combined intra-abdominal injuries, longer ICU stays, and a higher mortality rate. CONCLUSIONS: Associated intra-abdominal and extra-abdominal injuries are frequent in patients with traumatic pancreatic injury. Despite the complication rate, most patients recovered. Mortalities were associated with combined injuries being placed into bleeding, hypovolemic shock, and multiorgan failure.
Abdominal Abscess ; Abdominal Injuries ; Academic Medical Centers ; Adult ; Female ; Hemorrhage ; Humans ; Hyperamylasemia ; Critical Care ; Korea ; Male ; Pancreatic Fistula ; Shock

PURPOSE: The most important consideration for therapy using MSCs is the differentiation of the target organ's cell type. For in-vitro hepatogenic differentiation of MSCs, the main focus is efficient induction of the MSCs into the endoderm stage. Activin A, which is a signaling molecule that is similar to Nodal, promotes the induction of definitive endoderm from both ESs and MSCs. The protocols for induction into definitive endoderm have shown different efficiency and reproducibility depending on the researchers or the sources of the MSCs. Thus, a study on the various conditions of Activin A is needed to efficiently differentiate MSCs into the definitive endoderm lineage of MSCs. METHODS: MSCs were isolated from human adipose tissues and these were cultured in MCM (MSCs Culture Medium) on a human fibronectin coated plate. At 70~80% confluence, the MSCs were harvested and cultured in MCM supplemented with Activin A, at a 50 ng/mL concentration, and FGF4. The expression of the genes related with MSCs or primitive endoderm were analyzed by RT-PCR. The changes of cell morphology for differentiation were also observed by a light microscope & a SEM. RESULTS: The expression of genes related with primitive foregut endoderm was seen in the groups that were treated with a higher concentration of Activin A. The morphology of the cells that differentiated into definitive endoderm were not different from those of the undifferentiated MSCs. The expression of genes related with functional primitive hepatocytes was seen in the early phase during hepatic differentiation. The cell morphology was changed to a similar cuboidal form in a time-dependent manner. CONCLUSION: Activin A promotes a more rapid induction of definitive endoderm. It also makes an efficient condition for the differentiation into primitive foregut endoderm at a higher concentration.
Activins ; Endoderm ; Fibronectins ; Hepatocytes ; Humans ; Light

PURPOSE: The most important consideration for therapy using MSCs is the differentiation of the target organ's cell type. For in-vitro hepatogenic differentiation of MSCs, the main focus is efficient induction of the MSCs into the endoderm stage. Activin A, which is a signaling molecule that is similar to Nodal, promotes the induction of definitive endoderm from both ESs and MSCs. The protocols for induction into definitive endoderm have shown different efficiency and reproducibility depending on the researchers or the sources of the MSCs. Thus, a study on the various conditions of Activin A is needed to efficiently differentiate MSCs into the definitive endoderm lineage of MSCs. METHODS: MSCs were isolated from human adipose tissues and these were cultured in MCM (MSCs Culture Medium) on a human fibronectin coated plate. At 70~80% confluence, the MSCs were harvested and cultured in MCM supplemented with Activin A, at a 50 ng/mL concentration, and FGF4. The expression of the genes related with MSCs or primitive endoderm were analyzed by RT-PCR. The changes of cell morphology for differentiation were also observed by a light microscope & a SEM. RESULTS: The expression of genes related with primitive foregut endoderm was seen in the groups that were treated with a higher concentration of Activin A. The morphology of the cells that differentiated into definitive endoderm were not different from those of the undifferentiated MSCs. The expression of genes related with functional primitive hepatocytes was seen in the early phase during hepatic differentiation. The cell morphology was changed to a similar cuboidal form in a time-dependent manner. CONCLUSION: Activin A promotes a more rapid induction of definitive endoderm. It also makes an efficient condition for the differentiation into primitive foregut endoderm at a higher concentration.
Activins ; Endoderm ; Fibronectins ; Hepatocytes ; Humans ; Light

PURPOSE: Human mesenchymal stem cells (hMSCs) have the potency for self-renewal and differentiation into various kinds of cells. The hMSCs are obtained from the various tissues, including adipose tissue, bone marrow and cord blood. The extracellular matrix (ECM) is an important factor that affects cell adherence, growth, migration, apoptosis and differentiation both in vitro and vivo. The adipose-derived mesenchymal stem cells (AD-MSCs) have CD29 (integrin) on the cell surface, which is the receptor for fibronectin. The aim of this study is to validate the efficacy of ECM, and especially fibronectin, for cell expansion. METHODS: The AD-MSCs were obtained from the abdominal fat of humans. These cells were seeded onto culture plates coated with fibronectin-Human (FN) and plates without ECM (control). The cells were incubated for 3 passages and the cellular morphology was simultaneously observed with microscopy. CCK-8 assay was performed to compare the proliferation ability in each condition at the same passage. Immunocytochemistry staining for integrin-beta1 was performed to observe the cell to cell interaction. RESULTS: The hAD-MSCs in the FN-coated and non-coated plates exhibited cytoplasm staining for integrin-beta1. In all the cultures, extended fibroblastic-shaped cells that turned into rhomboid cells were most frequently observed. The cell growth rates for the non coated culture plate were lower than those for the FN coated plates. After 72 hour culture under the different coated concentrations of FN and the non coated condition (control), the control group had a lower growth rate. In the culture with a FN coated plate, a significant change was observed as compared with that of the control group. We observed an increase in cell proliferation, with a maximum of 140%, on the FN coated plate by performing CCK-8 assay. In comparison, integrin beta1 on the cells was more expressed in the FN-coated plates than that in the non-coated plates. CONCLUSION: The cell morphology can be changed faster in the FN coated culture plates than that in the non coated culture plates. Because proliferation and adhesion with FN can enhance the expansion, the culture within a FN coated plate is needed to encourage hAD-MSCs to proliferate in vitro.
Abdominal Fat ; Adipose Tissue ; Antigens, CD29 ; Apoptosis ; Bone Marrow ; Cell Adhesion ; Cell Proliferation ; Cytoplasm ; Extracellular Matrix ; Fetal Blood ; Fibronectins ; Humans ; Immunohistochemistry ; Mesenchymal Stromal Cells ; Microscopy ; Seeds ; Sincalide

PURPOSE: Human mesenchymal stem cells (hMSCs) have the potency for self-renewal and differentiation into various kinds of cells. The hMSCs are obtained from the various tissues, including adipose tissue, bone marrow and cord blood. The extracellular matrix (ECM) is an important factor that affects cell adherence, growth, migration, apoptosis and differentiation both in vitro and vivo. The adipose-derived mesenchymal stem cells (AD-MSCs) have CD29 (integrin) on the cell surface, which is the receptor for fibronectin. The aim of this study is to validate the efficacy of ECM, and especially fibronectin, for cell expansion. METHODS: The AD-MSCs were obtained from the abdominal fat of humans. These cells were seeded onto culture plates coated with fibronectin-Human (FN) and plates without ECM (control). The cells were incubated for 3 passages and the cellular morphology was simultaneously observed with microscopy. CCK-8 assay was performed to compare the proliferation ability in each condition at the same passage. Immunocytochemistry staining for integrin-beta1 was performed to observe the cell to cell interaction. RESULTS: The hAD-MSCs in the FN-coated and non-coated plates exhibited cytoplasm staining for integrin-beta1. In all the cultures, extended fibroblastic-shaped cells that turned into rhomboid cells were most frequently observed. The cell growth rates for the non coated culture plate were lower than those for the FN coated plates. After 72 hour culture under the different coated concentrations of FN and the non coated condition (control), the control group had a lower growth rate. In the culture with a FN coated plate, a significant change was observed as compared with that of the control group. We observed an increase in cell proliferation, with a maximum of 140%, on the FN coated plate by performing CCK-8 assay. In comparison, integrin beta1 on the cells was more expressed in the FN-coated plates than that in the non-coated plates. CONCLUSION: The cell morphology can be changed faster in the FN coated culture plates than that in the non coated culture plates. Because proliferation and adhesion with FN can enhance the expansion, the culture within a FN coated plate is needed to encourage hAD-MSCs to proliferate in vitro.
Abdominal Fat ; Adipose Tissue ; Antigens, CD29 ; Apoptosis ; Bone Marrow ; Cell Adhesion ; Cell Proliferation ; Cytoplasm ; Extracellular Matrix ; Fetal Blood ; Fibronectins ; Humans ; Immunohistochemistry ; Mesenchymal Stromal Cells ; Microscopy ; Seeds ; Sincalide

PURPOSE: Cell therapy for various diseases has gained wide acceptance. Because most patients with chronic liver failure have mild-to-severe liver cirrhosis, there are many limitations to clinical applications. We analyzed how to increase cell engraftment in rats with liver fibrosis. METHODS: We used analbuminemic SD rats (NARs) as recipients of syngeneic CAG-EGFP SD hepatocytes obtained by the 2 perfusion method. Hepatic fibrosis was induced with thioacetamide in drinking water for 6 weeks in the recipient NARs. NARs were pre-treated with gadolinium, doxorubicin, and gliotoxin before hepatocyte transplantation. We evaluated the degree of cell engraftment by RT-PCR and immunofluorescent staining for GFP and albumin. The transplanted cells were detected by immunostaining for albumin, and serum albumin was also measured. RESULTS: Although detection of GFP by RT-PCR was variable, albumin was detected in all groups 4 wks after hepatocyte transplantation. GFP and albumin were also detected by immunofluorescent staining 1 and 4 wks after cell transplantation. In control rats, albumin production was maximal at 3 wks, and after that it rapidly decreased. In the gadolinium and doxorubicin-treated group, albumin production was increased up to 4 wks. Albumin production in the gadolinium-treated group was superior to that of the doxorubicin-treated group. CONCLUSION: Kupffer cells play the most important role in cell engraftment in hepatic fibrosis. Therefore, perturbation of kupffer cells in hepatic fibrosis is needed to increase cell engraftment.
Animals ; Cell Transplantation ; Doxorubicin ; Drinking Water ; End Stage Liver Disease ; Fibrosis ; Gadolinium ; Gliotoxin ; Hepatocytes ; Humans ; Kupffer Cells ; Liver ; Liver Cirrhosis ; Perfusion ; Rats ; Serum Albumin ; Thioacetamide ; Tissue Therapy ; Transplants