Diagnosis Of Bile Duct Cancer Research Articles

Strategies and tactics to perform safe pancreaticoduodenectomy for 94-year-old patient: report of a case

BackgroundDespite improvement of postoperative management, pancreatoduodenectomy still has a high rate of major complications. Therefore, careful assessment is critically important when we consider high risk surgery for extremely elderly patients.Case presentationA 94-year-old man, who suffered dark urine, epigastric pain, and loss of appetite, was diagnosed as bile duct cancer and underwent endoscopic retrograde biliary drainage. He has past history of hypertension and paroxysmal atrial fibrillation. Computed tomography (CT) showed a nodule in the lower bile duct, which was slowly enhanced by dynamic CT. The patient was evaluated whether he overcomes pancreatoduodenectomy by cardiac ultrasonography, brain magnetic resonance angiography, nutritional evaluation (rapid turnover proteins), and CT-based general assessment, including sarcopenia and osteopenia. The patient was independent in activities of daily living and has enough ejection fraction of 65%, and examinations revealed no impairment of cognitive function, sarcopenia, and osteopenia. With a diagnosis of bile duct cancer with no distant metastasis, the patient underwent subtotal stomach-preserving pancreatoduodenectomy with lymph node dissection. Operation time was 299 min and estimated blood loss was 100 ml. Pathological examination revealed papillary adenocarcinoma of the bile duct (pT3N1M0 Stage IIIB). Enteral nutrition was given through jejunostomy and then the patient started oral intake after an evaluation of swallowing function. Postoperative course was uneventful and all drains including pancreatic duct stent, biliary stent, and jejunostomy were removed by 3 weeks after operation. The levels of rapid turnover proteins dropped at postoperative day 7, but recovered at 1 month after operation via appropriate nutrition and rehabilitation. He remains well with no evidence of tumor recurrence as of 1 year after resection.ConclusionsWe herein report successfully treated cases of bile duct cancer in 94-year-old patient by pancreatoduodenectomy with careful evaluation of osteopenia, sarcopenia and nutrition.

“Diagnostic-Therapeutic Management in Patients with Extrahepatic Bile Duct Cancer”

Introduction: Biliary tract tumors, or cholangiocarcinomas (CCAs), comprise a heterogeneous group of malignant tumors that can affect any part of the biliary tree, from the interlobular canals of Hering to the primary biliary duct. In the last 20-30 years, the incidence of these tumours has increased especially after the introduction of the new imaging techniques endoscopic retrograde cholangiopancreatography (ERCP, percutaneous transhepatic cholangiography) and the increased interest for this pathology. Objective: To evaluate the diagnostic methods and therapeutical results in patients with extrahepatic bile duct cancer. Material and Method: This cross-sectional study was conducted in the Department of Surgery, Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from Jun-2018 to July-2021. We included 124 consecutive patients with suspected bile duct cancer who underwent endoscopic retrograde cholangiopancreatography (ERCP). Every patient underwent an ultrasound (US) examination before ERCP. ERCP was considered as the “gold standard” for diagnosis. The therapy applied consisted of endoscopic stenting, US guided biliary drainage or surgery. The sensitivity, specificity and accuracy were calculated for every tumour localisation and also globally for all tumours. Results. The sensitivity, specificity and accuracy of US were 85.9%, 76.9% and 84.4% for hilar localization, 59.1%, 50% and 57.1% for the mid common bile duct (CBD) and 33.3%, 42.8% and 36.8% for the distal CBD tumours. The global performances for US in diagnosing extrahepatic chlonagiocarcinoma were 73.5%, 61.5% and 70.9%. In 73 cases (74.5%) an endoscopic stent was placed. In 11 cases (11.2%) we performed an US guided biliary drainage and in 14 cases (14.2%) surgery was recommended. Conclusion: Ultrasonography proved to be a reliable method for the diagnosis of bile duct cancer in spite of its low accuracy for distal localization. The combination of the two investigations (US and ERCP) was very efficient in the management of these patients. Endoscopic stenting for hilar localization is a good therapeutical option.

Diagnostic accuracy of administrative database for bile duct cancer by ICD-10 code in a tertiary institute in Korea

BackgroundAdministrative database provides valuable information for large cohort studies, especially when tissue diagnosis is rather difficult such as the diagnosis for bile duct cancer (BDC). The aim of this study was to evaluate the diagnostic accuracy of administrative database for BDC by International Classification of Diseases (ICD)-10 codes in a tertiary institute. MethodsBDC and control groups were collected from 2003 to 2016 at Seoul National University Bundang Hospital. Cases of BDC were identified in the National Health Insurance Service (NHIS) database by ICD 10-code supported by V code. The control group was selected from cases without ICD-10 codes for BDC. A definite or possible diagnosis was defined according to pathologic reports. Medical records, images, and pathology reports were analyzed to evaluate ICD-10 codes for BDC. Sensitivity, specificity, positive predictive value, and negative predictive value for BDC were analyzed according to diagnostic criteria and cancer locations. ResultsA total of 1707 patients with BDC and 1707 controls were collected. Among those with BDC, 1320 (77.3%) were diagnosed by definite criteria. Most (99.4%) of them had adenocarcinoma. Rate of definite diagnosis was the highest for ampulla of Vater (88.9%), followed by that for extrahepatic (84.9%) and intrahepatic (68.3%) BDCs. False positive cases commonly had hepatocellular carcinomas. For overall diagnosis of BDC, sensitivity, specificity, positive predictive value, and negative predictive value were 99.94%, 98.33%, 98.30%, and 99.94%, respectively. Diagnostic accuracies were similar regardless of diagnostic criteria or tumor locations. ConclusionsAdministrative database for BDC collected according to ICD-10 code with V code shows good accuracy.

Granular Cellular Tumor: A Disease to know and to recognize

We report here a rare case of granular cell tumor (GCT) operated on with diagnosis of bile duct cancer. All clinical, biological, morphological, operative and histological characteristics are described in this observation. We have done a whipple resection and postoperative course was uneventful. The patient is alive and well at postoperative month. This is the rare disease which must be known by the surgical community to choose the adequate surgery.

Karnofsky Performance Score Is Predictive of Survival After Palliative Irradiation of Metastatic Bile Duct Cancer.

Palliative irradiation is effective in alleviating symptoms in patients with metastatic cancer in general. However, little data exist regarding irradiation of metastatic bile duct cancer. Selection of the best regimen for such a patient should be based on their survival prognosis. This study included five patients irradiated for metastatic bile duct cancer and aimed to identify predictors of survival by analyzing six factors: age, gender, general condition (Karnofsky performance score), metastatic site receiving palliative irradiation, metastases outside irradiated sites and time between diagnosis of bile duct cancer and palliative irradiation. In the whole series, median survival was 3 months. Survival rates at 3 and 6 months were 40% and 40%, respectively. A Karnofsky performance score >70% had a borderline significant association with better survival (p=0.05). Karnofsky performance score was identified as predictor of survival and should be considered when assigning the radiation regimen to patients with metastatic bile duct cancer.

The morphofunctional and biochemical characteristics of opisthorchiasis-associated cholangiocarcinoma in a Syrian hamster model

The validity of the experimental models of pathologies is one of the key challenges in translational medicine. Cholangiocarcinoma, or bile duct cancer, ranks second among oncological diseases of the liver. There is a strong association between bile duct cancer and parasitic infestation of the liver caused by trematodes in the Opisthorchiidae family. We recently demonstrated that cholangiocarcinoma can develop in Syrian hamsters (Mesocricetus auratus) infected by Opisthorchis felineus and administered with dimethylnitrosamine. However, there is still no description of how this experimental model can be used in translational research. The aim of this work was to study the morphological, functional, and biochemical characteristics during cholangiocarcinoma development in Syrian hamsters infected by O. felineus and administered with dimethylnitrosamine. The experiment lasted 30 weeks with combined administration of dimethylnitrosamine in drinking water at a dose of 12.5 ppm and a single injection of 50 metacercariae O. felineus. It was shown that the development of cholangiocarcinoma (18 weeks) increased the total number of basophils, eosinophils, and monocytes; the relative number of granulocytes, as well as the amount of total and direct bilirubin; and the cholesterol and ALT levels; however, it reduced the relative number of lymphocytes. Based on pathological, morphometric, and biochemical analyses, our model has characteristics similar to those in patients with opisthorchiasis-associated cholangiocarcinoma. Thus, this model can be used to test anticancer drugs, to study the mechanisms of cholangiocarcinogenesis, and to search for molecular markers for early diagnosis of bile duct cancer.

The morphofunctional and biochemical characteristics of opisthorchiasis-associated cholangiocarcinoma in a Syrian hamster model

The validity of experimental models of pathologies is one of the key challenges in translational medicine. Cholangiocarcinoma, or bile duct cancer, ranks second among oncological diseases of the liver. There is a strong association between bile duct cancer and parasitic infestation of the liver caused by trematodes in the family Opisthorchiidae. We have recently demonstrated that cholangiocarcinoma can develop in Syrian hamsters (Mesocricetus auratus) infected by Opisthorchis felineus and administered with dimethylnitrosamine. However, there is still no description of how this experimental model can possibly be used in translational research. The aim of this work was to study the morphological, functional and biochemical characteristics during cholangiocarcinoma development in Syrian hamsters infected by O. felineus and administered with dimethylnitrosamine. The experi­ment lasted 30 weeks with combined exposure to dimethylnitrosamine in drinking water at a dose of 12.5 ppm and a single injection of 50 metacercariae O. felineus. It was shown that the development of cholangiocarcinoma (18 weeks) increased the total number of basophils, eosinophils and monocytes, the relative number of granulocytes, the amount of total and direct bilirubin, and cholesterol and ALT levels, but reduced the relative number of lymphocytes. Based on pathological, morphometric and biochemical analyses, our model has characteristics similar to those in patients with opisthorchiasisassociated cholangiocarcinoma. Thus, this model can be used to test anticancer drugs, to study the mechanisms of cholangiocarcinogenesis and to search for molecular markers for early diagnosis of bile duct cancer.

Diagnosis of bile duct cancer by bile cytology: usefulness of post-brushing biliary lavage fluid.

Background: Pathologic evidence of biliary diseases can be obtained from cytology in addition to endoscopic retrograde cholangiopancreatography (ERCP); however, the diagnostic effectiveness is not satisfactory. Study aim: This retrospective, single-center study evaluated the efficacy of various sampling methods for the cytologic diagnosis of bile duct cancer. Patients and methods: Biliary samples included bile that was simply aspirated, brush smear, brush-rinsed saline, and post-brushing biliary lavage fluid. A set of samples was compared for cytologic efficacy in 76 patients with surgically proven bile duct cancer and in 50 patients with benign biliary stricture. Results: The cytologic sensitivity for diagnosing biliary cancer was 34 % with aspirated bile, 32 % with brush smear, 43 % with brush-rinsed saline, and 70 % with post-brushing biliary lavage fluid, in contrast to the null false-positive result in the benign cases. The sensitivity of cytology was significantly higher with post-brushing lavage fluid than with the other three sampling methods (P < 0.0001), and post-brushing lavage fluid improved the cumulative sensitivity by 24 % (P = 0.002). The sensitivity of biliary cytology was also associated with the amount of aspirated bile (P = 0.01) and with the aspiration site (P = 0.03). The rate of cancer positivity in a cytology set differed according to the tumor macroscopic type (85 % in the protruding type vs. 40 % in the flat type; P = 0.003), and according to the size of the cancer (87 % for tumors ≥ 50 mm vs. 66 % for tumors < 50 mm; P = 0.02). Conclusions: Post-brushing biliary lavage fluid cytology provides superior diagnostic efficacy, and its addition to ERCP procedures is recommended for obtaining cytologic evidence of bile duct cancer.

Endoscopic tissue sampling of the bile duct: Can we do better?

Endoscopic tissue sampling of the bile duct: Can we do better?

Factors affecting the accuracy of endoscopic transpapillary sampling methods for bile duct cancer

Various methods for endoscopic transpapillary sampling have been developed. However, the factors affecting the accuracy of these methods for bile duct cancer are unknown. The aim of the present study was to determine the factors affecting the accuracy of endoscopic transpapillary sampling methods. We reviewed the results from 101 patients with bile duct cancer who underwent transpapillary sampling by aspiration bile cytology, brushing cytology, and fluoroscopic forceps biopsy. The final diagnosis of bile duct cancer was made on the basis of pathological evaluation of specimens obtained at surgery and the clinical course over at least 1 year in patients not operated on. We carried out subgroup analyses for the factors affecting the accuracy of each transpapillary sampling method. Aspiration bile cytology was carried out 238 times in 77 patients, brushing cytology was carried out 67 times in 60patients, and fluoroscopic forceps biopsy was carried out 64 times in 53 patients. Accuracies of aspiration bile cytology were significantly higher for longer (≥15 mm) biliary cancerous lesions than for shorter (<15 mm) lesions (30% vs 18%, respectively, P = 0.049). Accuracies of brushing cytology and fluoroscopic forceps biopsy were significantly higher for non-flat than for flat-type biliary cancerous lesions (brushing: 58% vs 38%, respectively, P = 0.032; forceps biopsy: 60% vs 33%, respectively, P = 0.043). Endoscopic transpapillary sampling methods are more accurate for longer or elevated (non-flat) biliary cancerous lesions than for shorter or flat lesions.

Mo1508 Bile Aspiration Cytology in Diagnosis of Bile Duct Cancer: Factors Associated With Positive Yields

Mo1508 Bile Aspiration Cytology in Diagnosis of Bile Duct Cancer: Factors Associated With Positive Yields

INTRADUCTAL ULTRASONOGRAPHY BEFORE BILIARY DRAINAGE AND TRANSPAPILLARY BIOPSY IN ASSESSMENT OF THE LONGITUDINAL EXTENT OF BILE DUCT CANCER

Aim: We evaluated the diagnostic efficacy of transpapillary intraductal ultrasonography before biliary drainage (IDUS‐BD) and transpapillary biopsy (TPB) for the assessment of the longitudinal extent of bile duct cancer.Methods: Between November 1999 and January 2005, we performed IDUS‐BD and TPB preoperatively in 27 patients with carcinoma of the extrahepatic bile duct. Following IDUS‐BD, TPB was performed under fluoroscopic guidance immediately after endoscopic sphincterotomy. The diagnostic efficacy of IDUS‐BD and TPB for the longitudinal extent of the cancer and the complications which accompanied the procedure were evaluated.Results: The overall success rate of sampling and the diagnostic accuracy of bile duct cancer by TPB were 85.3% (192/225) and 85% (23/27), respectively. The sensitivity, specificity and accuracy of the assessment of the longitudinal extent of cancer on the hepatic and duodenal sides by IDUS‐BD were 82%, 70%, 78% and 85%, 43%, 70%, respectively. Those by a combination of IDUS‐BD and TPB were 88%, 80%, 85% and 77%, 86%, 80%, respectively. Overestimation of the longitudinal extent of BD cancer by IDUS‐BD was mainly due to inflammation and obscure images, especially resulting from collapse of the bile duct on the duodenal side of the tumor, and was corrected by TPB in four of five patients. No serious complications occurred following the combination of IDUS‐BD and TPB.Conclusions: TPB is useful for preoperative histological diagnosis of bile duct cancer. The combination of IDUS‐BD and TPB is practical for evaluation of its longitudinal extent; basically, IDUS‐BD is sufficient on the hepatic side of the tumor, but concomitant TPB is recommended on the duodenal side.

Preoperative Evaluation of Bile Duct Cancer: MRI Combined with MR Cholangiopancreatography Versus MDCT with Direct Cholangiography

The purpose of this study was to compare the performance of MRI combined with MR cholangiopancreatography (MRCP) with that of MDCT combined with direct cholangiography in the evaluation of the tumor extent and resectability of bile duct cancer with surgical and pathologic findings as the reference standard. From January 2003 to March 2006, 27 patients (18 men, nine women; mean age, 60.8 years; range, 43-80 years) with surgically proven hilar cholangiocarcinoma or common bile duct (CBD) cancer who had undergone preoperative 2D and 3D MRCP with gadolinium-enhanced MRI and triple-phase MDCT with direct cholangiography (ERCP or percutaneous transhepatic cholangiography) were included in this retrospective study. Two experienced radiologists independently reviewed the two image sets. These readers evaluated the longitudinal extent of the tumor for involvement of the secondary confluence of both intrahepatic ducts and the intrapancreatic CBD, vascular involvement of the tumor, lymph node metastasis, and tumor resectability. The radiologists' performance was evaluated by calculation of sensitivity, specificity, and overall accuracy. Correlation was made with the resected specimens or findings at surgical exploration. For each reviewer, the overall accuracy rates for predicting involvement of the bilateral secondary biliary confluences and the intrapancreatic CBD were 90.7% and 87.0% for MRI with MRCP and 85.1% and 87.0% for MDCT with direct cholangiography. The differences were not statistically significant for either image set for either reviewer (p > 0.05). In the assessment of vascular involvement, lymph node metastasis, and tumor resectability, the readers' diagnostic performance using MRI with MRCP was similar to that with MDCT with direct cholangiography (p > 0.05). In the diagnosis of bile duct cancer with a noninvasive procedure, the information regarding tumor extent and resectability obtained with contrast-enhanced MRI combined with MRCP is comparable with that obtained with MDCT with direct cholangiography.

Usefulness of 18F‐fluorodeoxyglucose positron emission tomography in differential diagnosis and staging of cholangiocarcinomas

(18)F-Fluoro-2-deoxy-d-glucose positron emission tomography ((18)FDG-PET) is promising for diagnosis and treatment of various malignancies. The aim of this study was to evaluate the clinical usefulness of (18)FDG-PET in differential diagnosis and staging of cholangiocarcinomas according to the intrahepatic, perihilar and common bile duct lesions and to compare with computerized tomography (CT) scan. From January 2000 to September 2003, 54 patients with suspected cholangiocarcinoma underwent abdominal CT scan and (18)FDG-PET within a 2-week period. The PET images were analyzed visually and semiquantitatively. The overall accuracy of (18)FDG-PET for discriminating malignant diseases of bile duct from benign conditions was slightly higher than that of CT scan (88.9% vs 81.5%). The sensitivity of (18)FDG-PET in perihilar cholangiocarcinoma was lower than the value of intrahepatic and common bile duct cancers (83.3% vs 91.3%, 90.9%); moreover, in cases of perihilar cancer, the sensitivity of (18)FDG-PET was lower than that of CT scans (83.3% vs 91.7%). (18)FDG-PET detected nine distant metastatic lesions not found by other imaging studies and excluded two patients who potentially had resectable condition in other imaging studies from unnecessary laparotomy. The clinical usefulness of (18)FDG-PET in differential diagnosis of bile duct cancers is related to the site of primary disease. Although it is a helpful method for differential diagnosis especially in cases of intrahepatic and common bile duct cancers, (18)FDG-PET can not provide confirmative clues in perihilar cholangiocarcinoma. (18)FDG-PET may hold promise in the detection of hidden distant metastasis and can play an additional role in the evaluation of resectability. (18)FDG-PET can be complementary to CT scan in diagnosing and staging of cholangiocarcinoma.

Detection of Human Aspartyl (Asparaginyl) Beta-Hydroxylase and Homeobox B7 mRNA in Brush Cytology Specimens from Patients with Bile Duct Cancer

The diagnosis of bile duct cancer is hampered by the low sensitivity of intraductal brush cytology and forceps biopsy. In the present study real-time reverse transcription polymerase chain reaction (RT-PCR) assays for the detection of human aspartyl (asparaginyl) beta-hydroxylase (HAAH) and homeobox B7 (HoxB7) mRNA from intraductal brush cytology specimens were established. Both markers are overexpressed in biliary cancer cell lines and possibly involved in the pathogenesis of bile duct cancer. RT-PCR assays were validated for detection limit, in-assay variability, and inter-assay variability. Target gene expression was determined in brush cytology specimens from 16 patients with biliary strictures (11 with histologically proven cholangiocarcinomas and five with benign biliary strictures). The assay was quick (about 3 h), highly sensitive (with detection limits between 3 and 106 molecules), and reproducible (maximum in-assay variability 10.3 %, maximum inter-assay variability 11.8 %). The sensitivity of routine brush cytology alone was 36 % (four of 11 cases), with 100 % specificity. A combination with detection of HoxB7 and HAAH mRNA increased the overall diagnostic sensitivity to 82 %. Detection of these markers using the RT-PCR assays from brush cytology specimens described here may prove to be a useful additional tool for the diagnosis of bile duct carcinoma.

CLINICAL EVALUATION OF THE PERCUTANEOUS TRANSHEPATIC VIDEOCHOLANGIOSCOPE WITH THIN DIAMETER (XCHF‐XP240)

We developed a percutaneous transhepatic videocholangioscope with thin diameter (XCHF‐XP240, video PTCS) in collaboration with Olympus Optical Co., Ltd. (Tokyo, Japan). Its outer diameter is 3.7 mm and channel diameter, 1.2 mm. We used it 40 times in 19 cases (M : F = 15 : 4; average age, 69.1) between April 1998 and October 2004. The indication for use were differential diagnosis of bile duct cancer from other diseases in eight cases, diagnosis of tumor extension of papillary‐type bile duct cancer in three cases, diagnosis of postoperative recurrences of remnant bile duct cancer in three cases, treatment of bile duct stone in two cases, evaluation after placement of expandable metallic stent in two cases and evaluation after radiation therapy for mucin‐producing bile duct tumor in one case. Advantages of the videocholangioscope are: (i) because of the thin diameter, it can be used via expanding percutaneous transhepatic biliary drainage fistula to the size of 12 Fr; (ii) clear images are obtained; (iii) a multiple number of people can observe through the monitor screen; and (iv) it can be used for biliary stone treatment. It is particularly useful for the evaluation of intramucosal superficial extension of papillary‐type bile duct cancer. As it can be applicable not only in preoperative close examination or stone treatment but also to surgical operation. Production of the device for the market is highly anticipated.

Stellenwert der endoskopischen retrograden Cholangiopankreatographie, der perkutan-transhepatischen Cholangiographie, der Endosonographie und der endoluminalen Sonographie in der Behandlung des Gallenblasen- und des Gallengangkarzinoms

Significance of Endoscopic Retrograde Cholangiopancreatography,Percutaneous Transhepatic Cholangiography,Endosonography, and Endoluminal Sonographyin the Treatment of Gall Bladder and Bile Duct CancerEndosonographic findings can confirm the diagnosis ofgallbladder cancer and determine the tumor stage. Endoscopicretrograde cholangiopancreatography (ERC) orpercutaneous transhepatic cholangiography (PTC) andintraductal ultrasound are mainly performed in the presenceof cholestasis. Confirming the diagnosis and stentingcan be performed in one session. There are severaldiagnostic tools necessary in the diagnosis of bile ductcancer. Tumors of the middle and distal part of the extrahepaticbile duct are accessible to endosonography. ERCand PTC are invasive procedures for the diagnosis of bileduct cancer. However, they offer the opportunity to obtainmaterial for cytological and/or histological investigation.Moreover, bile flow can be assured by inserting endoprosthesesduring the procedure. Cholangioscopyand/or intraductal ultrasonography can be performedduring ERC. They confer to the diagnosis of a malignantbile duct tumor and are the most accurate methods todetermine the longitudinal spread.

The role of bile carcinoembryonic antigen in diagnosing bile duct cancer.

It is known that the fluids bathing tumors might contain a higher level of the carcinoembryonic antigen (CEA) than those found in the blood. Therefore, we evaluated the role of bile CEA in diagnosing bile duct cancer. One hundred and thirty two patients were prospectively studied. The patients were divided into 3 groups: the bile duct cancer (n=32), pancreatic cancer (n=16), and benign biliary diseases (n=84) groups. Bile samples were obtained on the next day of the biliary drainage procedures. The mean bile CEA level in those with bile duct cancer (120.6 +/- 156.9 ng/mL) was significantly higher than those with pancreatic cancer and benign biliary diseases (32.0 +/- 28.5 ng/mL, 29.3 +/- 56.3 ng/mL). Using the level of 20 ng/mL, the sensitivity and specificity of bile CEA in the diagnosis of bile duct cancer from benign biliary diseases were 65.6% and 66.7%, respectively. Both the bile CEA and total bilirubin level were found to be an independent factor linked to bile duct cancer. This study result suggests that bile CEA level is a useful supplementary test for diagnosing bile duct cancer.

Expression of oncogene products HER2/Neu and Ras and fibrosis-related growth factors bFGF, TGF-beta, and PDGF in bile from biliary malignancies and inflammatory disorders.

The expression of several growth factors and K-ras gene mutation in bile were studied to better understand the pathogenesis and improve early diagnosis of bile duct cancers. Bile samples were collected from 12 cholangiocarcinomas (CLC), 10 ampullary cancers (APC), 3 gallbladder cancers (GBC), 7 pancreatic cancers (PNC), 9 biliary tract infection (BTI), 8 biliary stone disease (ST), and 5 normal controls (NC). The highest mean value of TGF-beta in bile was in patients with BTI; the mean levels of bFGF and PDGF were highest in CLC, and patients with APC and CLC had higher expression of HER2/Neu than other groups. In bile, a K-ras gene codon 12 mutation was found in 5 of 6 (83%) cases of CLC by the PCR-RFLP method. The results suggest overexpression of bFGF, PDGF, and HER2/Neu and the presence of K-ras mutation are important for carcinogenesis of bile duct cancers, and detection of the above abnormalities in bile is helpful for early diagnosis.

A CASE LOCALIZED INFLAMMATORY BILIARY STENOSIS MIMICKING BILE DUCT CANCER

A case of localized inflammatory biliary stenosis which presented difficulty in differentiation from bile duct cancer is reported. A 66-year-old man was admitted to the hospital because he was pointed out elevations in biliary enzymes at blood biochemical analysis. No anemia nor jaundice was noted. No abdominal tumor was palpated. Abdominal CE-CT revealed a dense tumor shadow at the hepatic hilar region. Endoscopic retrograde cholangio-pancreatography (ERCP) revealed a stenosis covering from the left the and right hepatic ducts to common hepatic duct. Abdominal angiography visualized a faint accumulation of a contrast material where corresponded to the tumor. With a diagnosis of bile duct cancer at the hepatic hilar region, a resection of central two segments of liver and a total resection of caudate lobe were performed. Histopathologically, no malignancy was confirmed, and infiltration of inflammatory cells mainly comprizing of lymphocytes and plasmacytes and proliferation of fibroblasts were demonstrated in the vicinity of the bile duct. It was chronic inflammatory stenosis of the dile duct. It is etiologically suggested that the biliary stenosis in this case might be unlikely caused by secondary sclerotic cholangitis due to bacterial ascending cholangitis, but likely by localixed primary sclerotic cholangitis (PSC), that is a specific type of PSC.