What are the new contents of the guideline since 2010?A.Patients with primary and non-primary sclerosing cholangitis (PSC) are included in these guidelines for the diagnosis and management of cholangiocarcinoma.B.Define "related stricture" as any biliary or hepatic duct stricture accompanied by the signs or symptoms of obstructive cholestasis and/or bacterial cholangitis.C.Patients who have had an inconclusive report from MRI and cholangiopancreatography should be reexamined by high-quality MRI/cholangiopancreatography for diagnostic purposes. Endoscopic retrograde cholangiopancreatography should be avoided for the diagnosis of PSC.D. Patients with PSC and unknown inflammatory bowel disease (IBD) should undergo diagnostic colonoscopic histological sampling, with follow-up examination every five years until IBD is detected.E. PSC patients with IBD should begin colon cancer monitoring at 15 years of age.F. Individual incidence rates should be interpreted with caution when using the new clinical risk tool for PSC for risk stratification.G. All patients with PSC should be considered for clinical trials; however, if ursodeoxycholic acid (13-23 mg/kg/day) is well tolerated and after 12 months of treatment, alkaline phosphatase (γ- Glutamyltransferase in children) and/or symptoms are significantly improved, it can be considered to continue to be used.H. Endoscopic retrograde cholangiopancreatography with cholangiocytology brushing and fluorescence in situ hybridization analysis should be performed on all patients suspected of having hilar or distal cholangiocarcinoma.I.Patients with PSC and recurrent cholangitis are now included in the new unified network organ sharing policy for the end-stage liver disease model standard.J. Liver transplantation is recommended after neoadjuvant therapy for patients with unresectable hilar cholangiocarcinoma with diameter < 3 cm or combined with PSC and no intrahepatic (extrahepatic) metastases.
Child ; Humans ; Cholangitis, Sclerosing/diagnosis* ; Constriction, Pathologic/complications* ; In Situ Hybridization, Fluorescence ; Cholangiocarcinoma/therapy* ; Liver Diseases/complications* ; Cholestasis ; Inflammatory Bowel Diseases/therapy* ; Bile Ducts, Intrahepatic/pathology* ; Bile Duct Neoplasms/therapy*

Hepatoblastoma usually occurs in children under the age of 2 years, with very few cases reported in adults. We experienced a case of adult hepatoblastoma in a 36-year-old female with chronic hepatitis B . She had experienced sudden onset abdominal pain. Her serum alpha-fetoprotein level was markedly elevated, and abdominal CT showed a 9-cm mass with internal hemorrhage in the right hepatic lobe with hemoperitoneum, so an emergency hepatic central bisectionectomy was performed. The initial histologic examination revealed that the mass mimicked combined hepatocellular carcinoma and cholangiocarcinoma with spindle-cell metaplasia of the cholangiocarcinoma element. Follow-up abdominal CT performed 3 months later showed a 5.5-cm metastatic mass in the left subphrenic area. Laparoscopic splenectomy with mass excision was performed, and hepatoblastoma was confirmed histologically. A histologic re-examination of previously obtained surgical specimens also confirmed the presence of hepatoblastoma. Metastatic hepatoblastoma was found at multiple sites of the abdomen during follow-up, and so chemotherapy with cisplatin, 5-fluorouracil (5-FU), and vincristine was applied, followed by carboplatin and doxorubicin . Despite surgery and postoperative chemotherapy, she died 12 months after symptom onset.
Adult ; Carcinoma, Hepatocellular/pathology ; Cholangiocarcinoma/pathology ; Cisplatin/therapeutic use ; Diagnostic Errors ; Doxorubicin/therapeutic use ; Drug Therapy, Combination ; Female ; Fluorouracil/therapeutic use ; Hepatitis B, Chronic/complications/diagnosis ; Hepatoblastoma/drug therapy/*pathology/radiography ; Humans ; Liver Neoplasms/drug therapy/*pathology/radiography ; Tomography, X-Ray Computed ; Vincristine/therapeutic use

No abstract available.
Bile Duct Neoplasms/complications/*diagnosis ; *Bile Ducts, Intrahepatic/chemistry/pathology/radiography ; Biopsy ; Cholangiocarcinoma/complications/*diagnosis ; Diagnosis, Differential ; Fever/diagnosis/*etiology ; Humans ; Immunohistochemistry ; Leukocytosis/*diagnosis/etiology ; *Liver/chemistry/pathology/radiography ; Liver Abscess, Pyogenic/*diagnosis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Paraneoplastic Syndromes/*diagnosis/etiology ; Predictive Value of Tests ; Tomography, Spiral Computed ; Tumor Markers, Biological/analysis

BACKGROUND/AIMS: There are several methods for obtaining tissue samples to diagnose malignant biliary strictures during endoscopic retrograde cholangiopancreatography (ERCP). However, each method has only limited sensitivity. This study aimed to evaluate the diagnostic accuracy of a combined triple-tissue sampling (TTS) method (on-site bile aspiration cytology, brush cytology, and forceps biopsy). METHODS: We retrospectively reviewed 168 patients with suspicious malignant biliary strictures who underwent double-tissue sampling (DTS; n=121) or TTS (n=47) via ERCP at our institution from 2004 to 2011. RESULTS: Among the 168 patients reviewed, 117 patients (69.6%) were eventually diagnosed with malignancies. The diagnostic sensitivity for cancer was significantly higher in the TTS group than the DTS group (85.0% vs 64.9%, respectively; p=0.022). Furthermore, the combination of brush cytology and forceps biopsy was superior to the other method combinations in the DTS group. With respect to cancer type (cholangiocarcinoma vs noncholangiocarcinoma), interestingly, the diagnostic sensitivity was higher for cholangiocarcinoma in the TTS group than the DTS group (100% vs 69.4%, respectively; p<0.001) but not for the non-cholangiocarcinoma patients (57.1% vs 57.1%, respectively). CONCLUSIONS: TTS can provide an improved diagnostic accuracy in suspicious malignant biliary strictures, particularly for cholangiocarcinoma.
Aged ; Ampulla of Vater/*pathology ; Bile Duct Neoplasms/complications/diagnosis/pathology ; Bile Ducts, Intrahepatic/*pathology ; Biopsy/*methods ; Biopsy, Needle ; Carcinoma/complications/diagnosis/pathology ; Cholangiocarcinoma/complications/*diagnosis/pathology ; Cholangiopancreatography, Endoscopic Retrograde/*methods ; Cholestasis/etiology ; Common Bile Duct Neoplasms/complications/*diagnosis/pathology ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/complications/*diagnosis/pathology ; Retrospective Studies ; Sensitivity and Specificity

An 80-year-old woman with hilar cholangiocarcinoma was hospitalized due to sudden-onset abdominal pain. Computed tomography revealed hepatic necrosis accompanied with emphysematous change in the superior segment of the right liver (S7/S8), implying spontaneous rupture, based on the presence of perihepatic free air. Although urgent percutaneous drainage was performed, neither pus nor fluids were drained. These findings suggest emphysematous hepatitis with a hepatic mass. Despite the application of intensive care, the patient's condition deteriorated rapidly, and she died 3 days after admission to hospital. Liver gas has been reported in some clinical diseases (e.g., liver abscess) to be caused by gas-forming organisms; however, emphysematous hepatitis simulating emphysematous pyelonephritis is very rare. The case reported here was of fatal emphysematous hepatitis in a patient with hilar cholangiocarcinoma.
Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Bile Duct Neoplasms/complications/diagnosis ; Bile Ducts, Intrahepatic/pathology ; Cefotaxime/therapeutic use ; *Cholangiocarcinoma/complications/diagnosis ; Clostridium Infections/drug therapy/microbiology ; Clostridium perfringens/isolation & purification ; Emphysema/complications/*diagnosis ; Escherichia coli/isolation & purification ; Escherichia coli Infections/drug therapy/microbiology ; Female ; Hepatitis/complications/*diagnosis ; Humans ; Metronidazole/therapeutic use ; *Pneumoperitoneum/complications/diagnosis ; Tomography, X-Ray Computed

Anomalous union of the pancreaticobiliary duct (AUPBD) is a congenital anomaly that is defined as a junction of the bile duct and pancreatic duct outside the duodenal wall. This anomaly results in a loss of normal sphincteric mechanisms at the pancreaticobiliary junction. As a result, regurgitation of pancreatic juice into the biliary system develops and causes choledochal cysts, choledocholithiasis, cholangitis, pancreatitis and malignancy of the biliary tract. Gallbladder cancer or common bile duct cancer associated with AUPBD and choledochal cysts have been frequently reported. But, intrahepatic cholangiocarcinoma associated with this condition has been only rarely reported. Here, we report a case of intrahepatic cholangiocarcinoma associated with AUPBD and choledochal cyst.
Adult ; Bile Duct Neoplasms/*diagnosis/etiology/pathology ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*diagnosis/etiology/pathology ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst/complications/*diagnosis ; Female ; Humans ; Positron-Emission Tomography and Computed Tomography ; 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

No abstract available.
Animals ; Bile Duct Neoplasms/*diagnosis/parasitology/pathology ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*diagnosis/parasitology/pathology ; Clonorchiasis/*complications/pathology ; Clonorchis sinensis/*isolation & purification ; Humans ; Male ; Middle Aged

Subcapsular hematoma is a very rare complication of liver abscess. We report a case of liver abscess with subcapsular hematoma mimicking ruptured hepatic cholangiocarcinoma. A 59-year old man presented with right upper quadrant pain and febrile sense. Computed tomography showed a low attenuated mass with extensive subcapsular hematoma on the right hepatic lobe. The initial impression was a hematoma caused by the rupture of cholangiocarcinoma. Hepatic arteriography was performed, but no active bleeding focus was found. After drainage of the subcapsular hematoma, a hematoma wall biopsy through the drainage catheter and a liver biopsy of the low attenuated mass were performed. The biopsies showed many neutrophils, macrophages, and granulation tissues consistent with an abscess, but no malignant cells were detected. After antibiotics therapy for 6 weeks, computed tomography was performed 4 months later, and revealed complete resolution of the hematoma and the low attenuated hepatic lesion.
Angiography ; Anti-Bacterial Agents/therapeutic use ; Cholangiocarcinoma/diagnosis ; Hematoma/complications/*diagnosis/pathology ; Humans ; Liver Abscess/complications/*diagnosis/pathology ; Liver Diseases/complications/*diagnosis/pathology ; Liver Function Tests ; Male ; Middle Aged ; Tomography, X-Ray Computed

Biliary drainage in patients with malignant biliary obstruction relieves jaundice and prevents the development of cholangitis or hepatic failure from biliary obstruction. Therefore, this may result in better quality of life along with survival prolongation. Biliary stent placement is an effective and safe measure for biliary decompression and is preferred than bypass surgery in high risk patients. Entero-biliary perforation-communication is one of the rare complications of biliary stent. We herein report a case of duodeno-biliary perforation-communication in patient with distal cholangiocarcinoma who presented with duodenal ulcer and obstruction, occurring 4 years later from the metallic biliary stent insertion. Patient was managed with a pyloric metal stent and conservative care.
Aged, 80 and over ; Bile Duct Neoplasms/complications/*diagnosis ; Bile Ducts, Intrahepatic/pathology ; Biliary Fistula/*diagnosis/etiology/pathology ; Cholangiocarcinoma/complications/*diagnosis ; Duodenal Diseases/*diagnosis/etiology/pathology ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology/pathology ; Stents/*adverse effects ; Tomography, X-Ray Computed