Carcinoma Of Common Bile Duct Research Articles

Auxiliary diagnosis of periampullary carcinomas by comprehensive next-generation sequencing.

e16221 Background: Periampullary carcinoma, originating from ampulla, head of pancreas, common bile duct and duodenum, is a group of highly heterogeneous tumors with similar clinical presentations and anatomical sites but totally different prognosis. This study aims to investigate the potential diagnostic value of molecular testing in patients with periampullary carcinomas. Methods: This study retrospectively recruited patients diagnosed with periampullary, common bile duct, head of pancreas and duodenum cancers whose tumor tissue or circulating free DNA samples were sent to perform parallel hybridization-based next-generation sequencing of cancer-related genes ranging from 59 to 1021. Differentiated mutated genes were compared between different cancers using Fisher’s exact test and p < 0.05 was significant. Results: A total of 199 patients were enrolled in this molecular analysis, including 74 periampullary carcinomas, 43 duodenal cancers, 31 cancers of the common bile duct and 51 pancreatic head carcinomas. The top five most commonly mutated genes in these cancers were listed in the table. Fisher’s exact test suggested that ARID1A and LRP1B mutations were more frequently identified in duodenal cancer compared to periampullary cancer (p = 0.016 and 0.010, respectively). Compared to common bile duct carcinoma, periampullary cancer had more APC mutations and less ERBB3 mutations (p = 0.017 and 0.027, respectively). Strikingly, there was no APC mutation identified in pancreatic head cancer. Conclusions: Many common mutations were detected in periampullary, common bile duct, head of pancreas and duodenum cancers, such as TP53, KRAS and CDKN2A. However, APC mutation was not detected in pancreatic head carcinoma that is characterized by the worst prognosis. Genetic testing may facilitate distinguish the prognosis of periampullary carcinoma and assist in the differential diagnosis of pancreatic head carcinoma.[Table: see text]

Triple cancer of gallbladder, common bile duct and papilla of Vater: Report of a case and review of literature.

Introduction and importanceSynchronous malignancies of gallbladder and biliary tree are together rare entity whose pathogenesis is yet unknown. We report the case of a triple synchronous cancer of 3 distinct location: gallbladder, common bile duct (CBD) and papilla of Vater.Case presentationAn 84-years-old woman, was admitted to our Hospital with clinics features of obstructive jaundice.Dilatation of the biliary tree and CBD without evidence of gallstones was seen at US. CT scan confirmed distal CBD obstruction.An endo-US showed a nodule of the head of pancreas infiltrating the lower CBD.Finally, hepatic-MRI displayed a gallbladder malignancy with invasion of CBD.Preoperative staging showed 3 diagnostic suspicions: carcinoma of CBD on CT, pancreatic carcinoma on endo-US and malignancy of gallbladder on MRI.A cephalic duodenopancreatectomy and radical gallbladder resection was performed.Final pathology revealed 3 distinct location of moderately differentiated adenocarcinomas: Gallbladder, CBD and Vater's papilla.Microscopic examination didn't detect any direct continuity between the 3 tumors. Metastases were identified in the pancreaticoduodenal, peri-hepatic and peri-gastric lymph nodes.Clinical discussionLiterature displayed 22 cases of synchronous malignancies of gallbladder and CBD and 1 case of triple cancer with associated Vater's papilla carcinoma.In most of these cases, an association with an anomalous pancreatic-bile duct junction was reported.Although the real incidence remain unknown, it was reported to occur in 5–10% of CBD cancers.ConclusionSuspicion of such combination of cancer should be remembered, especially when preoperative investigations don't allow a precise localization of tumor in the biliary tree.

A Case of Common Bile Duct Carcinoma Diagnosed During Follow-up in a Case of Congenital Biliary Dilatation

A Case of Common Bile Duct Carcinoma Diagnosed During Follow-up in a Case of Congenital Biliary Dilatation

Intracholecystic papillary-tubular neoplasms of the gallbladder – A clinicopathological study of 36 cases

Intracholecystic papillary-tubular neoplasms (ICPNs) account for <0.5% of all cholecystectomies. There is a lack of significant published data from the Indian subcontinent on ICPN to the best of our knowledge. The objective of the current study was to describe the clinicopathological features of ICPN of gallbladder from the departmental archives during a 5.5-year period. We also aimed to classify them into various histological subtypes and to correlate the clinicopathological parameters of ICPN with invasive adenocarcinoma.This study included 36 cases diagnosed over a period of 5.5 years (2013–2018). Clinical, radiological and histopathological data were analyzed in detail.The incidence of ICPN was 0.8%. The mean age of patients was 45.7 years with a female to male ratio of 1.3:1. Biliary phenotype was associated with invasion (p ≤0.001). Papillary pattern was present in 15 cases (41.6%) and was associated with invasion (p ≤0.001). High grade dysplasia was seen in 34 cases (94.4%), of which invasion was seen in 18 cases (50%). One case in our study also had synchronous common bile duct carcinoma. Majority (92%) of the patients were alive and well at the end of available follow-up (mean of 7 months and 25 days).ICPNs are mass forming neoplasms of the gallbladder with a slight female predominance. Biliary phenotype has an aggressive course, often associated with an invasive adenocarcinoma component. Papillary configuration of the lesion is significantly associated with an invasive component. Diligent follow-up of these lesions is warranted as they can be associated with other malignancies of the biliary system.

Application of embolization microspheres in interventional therapy of malignant non-hypervascular tumor of liver.

ObjectiveTo investigate the efficacy and safety of transarterial embolization (TAE) using embolization microspheres in the treatment of non-hypervascular malignant liver tumors.MethodsPatients with malignant non-hypervascular liver tumors, who were treated with TAE using embolization microspheres, were selected and analyzed retrospectively. The technical success rate, tumor response, and complications were assessed.ResultsSix patients were included in the study: 1 patient each with hepatocellular-cholangiocarcinoma, intrahepatic cholangiocarcinoma, hepatic metastasis after resection of common bile duct carcinoma, liver metastasis from colon cancer, liver metastasis from esophageal cancer, and liver metastasis from pancreatic cancer. The technical success rate was 100%. At 1 and 3 months after TAE, tumor local reactions were seen in 6/6 and 2/6 patients, respectively, and the tumor necrosis rates were 48%-73% and 22%-68%, respectively. The main complications were those related to the embolization syndrome, including 1 case of liver abscess and 1 case of severe pain on the first day after embolization.ConclusionTAE with embolization microspheres is safe and effective in non-hypervascular liver tumors. It is a feasible option for palliative therapy of these tumors.

Intrapancreatic distal common bile duct carcinoma: Analysis, staging considerations, and comparison with pancreatic ductal and ampullary adenocarcinomas

AbstractDistal common bile duct carcinoma is a poorly characterized entity for reasons such as variable terminology and difficulty in determining site of origin of intrapancreatic lesions. We compared clinicopathologic features of pancreatobiliary-type adenocarcinomas within the pancreas, but arising from the distal common bile duct, with those of pancreatic and ampullary origin. Upon careful review of 1017 pancreatoduodenectomy specimens with primary adenocarcinoma, 52 (5%) qualified as intrapancreatic distal common bile duct carcinoma. Five associated with an intraductal papillary neoplasm were excluded; the remaining 47 were compared to 109 pancreatic ductal adenocarcinomas and 133 ampullary carcinomas. Distal common bile duct carcinoma patients had a younger median age (58 years) than pancreatic ductal adenocarcinoma patients (65 years) and ampullary carcinoma patients (68 years). Distal common bile duct carcinoma was intermediate between pancreatic ductal adenocarcinoma and ampullary carcinoma with regard to tumor size and rates of node metastases and margin positivity. Median survival was better than for pancreatic ductal adenocarcinoma (P=0.0010) but worse than for ampullary carcinoma (P=0.0006). Distal common bile duct carcinoma often formed an even band around the common bile duct and commonly showed intraglandular neutrophil-rich debris and a small tubular pattern. Poor prognostic indicators included node metastasis (P=0.0010), lymphovascular invasion (P=0.0299), and margin positivity (P=0.0069). Categorizing the tumors based on size also had prognostic relevance (P=0.0096), unlike categorization based on anatomic structures invaded. Primary distal common bile duct carcinoma is seen in younger patients than pancreatic ductal adenocarcinoma or ampullary carcinoma. Its prognosis is significantly better than pancreatic ductal adenocarcinoma and worse than ampullary carcinoma, at least partly because of differences in clinical presentation. Use of size-based criteria for staging appears to improve its prognostic relevance. Invasive pancreatobiliary-type distal common bile duct carcinomas are uncommon in the West and have substantial clinicopathologic differences from carcinomas arising from the pancreas and ampulla.

A case of mucinous carcinoma of inferior common bile duct

A case of mucinous carcinoma of inferior common bile duct

Non-icteric common bile duct carcinoma, flat-infiltrating type, accompanied by bile duct stones

Non-icteric common bile duct carcinoma, flat-infiltrating type, accompanied by bile duct stones

317. Surgery for common bile duct carcinoma

Background: Carcinoma of the mid (MCBDC) or distal third (DCBDC) of the common bile duct is a fairly rare nosological entity in the West, accounting for 13–23% of tumours of the extrahepatic bile ducts. The surgical treatment varies in relation to the site: in the case of DCBDC the operation of choice is duodenopancreatectomy (DP), whereas for MCBDC there is still no unanimous consensus of opinion regarding the type of surgery. The prognosis of these tumours is, on the whole, better than that of proximal choledochus cancer.

Signet-ring cell carcinoma of the distal common bile duct: report of a case.

Signet-ring cell carcinoma (SRCC) of the extrahepatic bile duct is a histologically distinct entity classified by the World Health Organization, in which cells containing intracytoplasmic mucin displacing the nucleus predominate.1 SRCC of the gastrointestinal tract is most commonly found in the stomach, and the impact of this histology on the prognosis is controversial.2,3 Well to moderately differentiated adenocarcinoma is the most common histologic type and complete resection is the only potentially curative therapy for distal bile duct cancer.4 However SRCC of extrahepatic bile duct is extremely rare, so its clinico-pathological features and impact on the prognosis are not well known. To the best of our knowledge, only three cases of SRCC of the extrahepatic bile duct have been reported in the English literature.5,6,7 Herein, we present a case of SRCC originating from the epithelium of the distal extrahepatic bile duct.

Intraductal low papillary carcinoma (ILPC) without mass

Intraductal low papillary carcinoma (ILPC) without mass

Mucoepidermoid Carcinoma of the Intrapancreatic Common Bile Duct: Immunohistochemical Profile, Prognosis, and Review of the Literature

Mucoepidermoid carcinoma of the bile duct is a rare entity. Only one mucoepidermoid carcinoma from the common bile duct has been reported in the Korean literature. Herein, we present the first in the English literature. The tumor arose in the intrapancreatic (distal) common bile duct in an 83-year-old woman who presented with obstructive jaundice and elevated liver enzymes. The tumor invaded the underlying pancreas and peripancreatic adipose tissue and showed pagetoid spread into the extrapancreatic common bile duct and cystic duct. The tumor exhibited nests of malignant cells with diffuse CK7 and MUC1 positivity. The basal cells were p63 and CK5/6 positive. The luminal cells were stained with carcinoembryonic antigen, MUC5, and mucicarmine and were focally positive for CK20. There was focal MUC4 staining on the apical luminal border. The neoplastic cells were negative for MUC2 and HER2-neu. We discuss the clinical presentation, diagnostic features, immunohistochemical profile, and prognosis of mucoepidermoid carcinoma of the common bile duct. The features of this neoplasm are further compared with mucoepidermoid carcinoma of the hepatobiliary system, adenosquamous carcinoma, and mucoepidermoid carcinoma of other organs.

Pancreaticobiliary Maljunction Is Associated with Common Bile Duct Carcinoma: A Meta-Analysis

Objective. Pancreaticobiliary maljunction (PBM) has been reported to be associated with an increased risk of gallbladder carcinoma. However, the relationship between PBM and common bile duct carcinoma (CBDC) remains unclear. We aimed to conduct a meta-analysis to determine the available evidence on the association between PBM and CBDC. Methods. The pooled odds ratio (OR) and standard mean differences (SMD) with 95% confidence interval (95% CI) were used to estimate the effects. Results. A total of eight case-control studies and two cohort studies were identified. The incidence of PBM was higher in CBDC patients than in controls (OR = 1.45; 95% CI, 1.19–1.76). Compared with patients without PBM, CBDC patients with PBM were younger at the diagnosis age (SMD = −0.46; 95% CI, −0.64 to −0.28). A difference in the incidence of associated CDC was found between CBDC patients with or without PBM (OR = 2.14; 95% CI, 1.60–2.87). Conclusions. Compared with benign biliary tract diseases, the incidence of PBM was higher in CBDC patients, especially in relatively young patients. We also found that the incidence of CDC was higher in CBDC patients with PBM. These findings showed positive association between PBM and CBDC, which may help in identifying high-risk individuals.

肝外胆管に発生した同時性多発胆管癌の1例

肝外胆管に発生した同時性多発胆管癌の1例

Minimally invasive papillary carcinoma of the extrahepatic bile ducts.

Invasive papillary carcinomas of the Extrahepatic Bile Ducts (EBD) are uncommon (4-5%). The course is less aggressive than conventional adenocarcinomas of the extrahepatic bile ducts. Non-invasive and minimally invasive papillary carcinomas are even rarer, behave as in-situ carcinomas and are associated with excellent long-term prognosis. A variety of lesions of the EBD that show papillary architecture should be distinguished from papillary carcinoma. Here, we report a case of papillary carcinoma of the common bile duct showing minimal invasion. Separation of invasive from non-invasive or minimally invasive papillary carcinoma is critical in estimating the patient outcome.

Laparoscopic cholecystectomy and common bile duct exploration in patients with previous subtotal gastrectomy

Objective To investigate the feasibility and technique in laparoscopic cholecystectomy and exploration of common bile duct (CBD) in patients who have previous subtotal gastrectomy.Methods From January 2001 to October 2010,22 patients who had a history of subtotal gastrectomy received laparoscopic cholecystectomy and CBD exploration in our hospital.In addition,these patients received cholangioscopic lithotomy,electrohydraulic lithotripsy,T-tube drainage,or primary suturing of the CBD wound.Results The procedures were completed successfully in 18 patients.In 4 patients,conversion to laparotomy was necessary because of multiple stones in a stenosed CBD (n=1),severely congested CBD wall with edema (n=1),CBD carcinoma associated with impacted stones (n=1) or Mirzzi syndrome (n =1).T tube drainage was employed in 16 patients,and primary suturing in 2 patients at the end of the operation.There was no hemorrhage,biliary leakage or abdominal infection.At a mean follow-up of 13 (range 3 to 60) months there was no residual stone,biliary stenosis or cholangitis.In 3 patients Stone recurred,and another 3 patients were lost to follow-up.Conclusions A history of subtotal gastrectomy is not a contradiction to laparoscopic cholecystectomy and CBD exploration.With choledocoscopy,surgery can be safe and feasible even for patients with previous gastectomy. Key words: Gastrectomy; Cholecystectomy; aparoscopic; Common bile duct exploration

Non-Epstein-Barr virus associated lymphoepithelioma-like carcinoma of the inferior common bile duct

A carcinoma displaying undifferentiated features with dense lymphoplasmacytic infiltration is defined as a lymphoepithelioma-like carcinoma (LEC), and some of LEC is associated with Epstein-Barr virus (EBV). All of the 13 previously reported cases of LEC of the biliary system were intrahepatic in location. Herein, we describe the first case of LEC of the inferior common bile duct. A 68-year-old Japanese man, who had been previously treated for hepatocellular carcinoma using microwave coagulation therapy, was found to have tumors of the common bile duct and pancreas head. Histopathological study of the resected tumor showed solid or cohesive nests of large undifferentiated cells with irregular large vesicular nuclei and nucleoli. Around the tumor cell nests, dense lymphoplasmacytic infiltration was observed. Focal glandular differentiation (approximately 5%) was also present. These histopathological features corresponded morphologically to LEC. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 7, CK 19 and CA19-9, but negative for CK 20 and Hep Par 1. In situ hybridization for Epstein Barr virus early small RNAs disclosed no nuclear signal in tumor cells. Therefore, a diagnosis of non-EBV-associated LEC of the inferior common bile duct was made. Although the prognosis of the biliary LEC is thought to be better than that of conventional cholangiocarcinoma, the differences in prognosis between EBV-positive and -negative cases have not yet been established. Therefore, additional case studies will be needed to clarify the clinicopathological features of LEC of the biliary tract.

A case of common bile duct carcinoma associated with calcification in the tumor

A 75-year old female came to our hospital due to upper abdominal pain and fever. Imaging diagnosis including CT-scan demonstrated a calcified mass in the common bile duct and the tentative diagnosis of choledocholithiasis was done. In order to remove the stone, endoscopic mechanical lithotripsy and extracorporeal shock wave lithotripsy were attempted with no effect. Peroralchoangioscopy, carried out to apply ellectrohydraulic lithotripsy to the stone, revealed the mass to be a tumor instead of the stone. Only calcified specimen was obtained by tumor biopsy ; however bile juice cytology showed class V and surgical therapy was selected. Histopathological findings of the resected specimen demonstrated a well differentiated adenocarcinoma of the bile duct, associated with necrosis and calcification in it. We experienced a rare case of the common bile duct carcinoma like as the stone because of associated calcification in the tumor.

A case of common bile duct carcinoma in elderly patient with choledochal cyst

A case of common bile duct carcinoma in elderly patient with choledochal cyst

Primary study of diagosis and differential diagnosis in periampullary carcinoma by contrast-enhanced ultrasound

Objective To evaluate the value of contrast-enhanced ultrasound(CEUS)in diagnosis and differential diagnosis of periampullary carcinoma.Methods Twenty-two cases of periampullary carcinoma confirmed by pathology and performed CEUS.They were carcinoma of common bile duct 9 cases,carcinoma of ampulla of Vater 5 cases,carcinoma of duodenal papilla 3 cases and carcinoma of head of pancreas 5 cases.The clearly displaying rate was compared before and after CEUS.The size of lesions,enhancement parameters of beginning time,fading time,intensity and styles were observed.Results The clearly displaying rate of the lesions was improved ftom 55%(12/22)to 95%(21/22)after administering contrast media(SonoVue).There were no significant differences in enhancement beginning time,fading time and intensitv among lesions(P＞0.05).The size of lesions and enhancement styles were obviously different between carcinoma of head of pancreas and other lesions:the size of carcinoma of head of pancreas was bigger(P＜0.05).The most common enhancement style in carcinoma of head of pancreas was heterogeneous,the tumor's protruding into luminal and 'half-moon' sign were not observed;carcinoma of common bile duct,carcinoma of ampulla of Vater,carcinoma of duoderlal papilla were homogenous,the tumor's protruding into luminal and 'half-moon' sign were observed.Conclusions CEUS can significantly improve the clearly displaying rate of periampullary carcinoma,and its qualitative diagnosis;the sizes of lesions and enhancement styles have important value in differential diagnosis of periampullary carcinoma. Key words: UItrasonography; Microbubbles; Ampulla of Vater; Digestive system neoplasms; Diagnosis; differential