11/22. Intrahepatic cholangiocarcinoma with multicystic, mucinous appearance and oncocytic change.A case is reported herein of intrahepatic cholangiocarcinoma (ICC) with multicystic, mucinous appearance and oncocytic change. Because of liver dysfunction, a 73-year-old woman was hospitalized in early October 2003. She was diagnosed as having ICC of the right hepatic lobe with occlusion of the hilar and perihilar bile ducts by imaging examination. Extended right lobectomy was performed but the patient died of liver failure on the next day. In surgically resected specimens, the tumor (3 x 3 cm) was mainly located in the right lobe, and tumors infiltrated along the biliary tree as well as invading into the adjacent hepatic parenchyma. The tumor mass had a sponge or honeycomb appearance. Microscopically, these tumors were composed of multiple microcysts filled by abundant mucin and lined by micropapillary adenocarcinoma cells. Their cytoplasm was acidophilic, appearing as an oncocyte, and carcinoma cells were positive for mitochondrial antigen in addition to biliary cytokeratins. There were no ovarian-like stromas around these cystic tumors, and communication of the biliary lumen with these carcinomatous cysts was not evident, thus different from biliary mucinous cystadenocarcinoma and intraductal papillary neoplasm of the liver. This is the third case of multicystic mucinous ICC and the present case might have been derived from intrahepatic peribiliary glands.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
12/22. Cutaneous implantation metastasis of cholangiocarcinoma after percutaneous transhepatic biliary drainage.Percutaneous transhepatic biliary decompression is a preoperative surgical adjunct in patients with obstructive jaundice that has been in use since 1973. It is recommended that this procedure be adopted for both palliative treatment in unresectable patients and as a preoperative means of lowering serum bilirubin in patients with potentially resectable malignancies of the pancreas or biliary tract. Metastatic tumor seeding along the transhepatic biliary catheter is an unusual complication resulting from this procedure but there have been a few cases reported in the literature. Below is a report on a 59-year-old woman in whom the percutaneous transhepatic catheter drainage of the biliary tree, performed before surgical resection of a cholangiocarcinoma, caused cutaneous tumor implantation at the catheter site 3 months later. The clinical aspect was morphea-like and histopathologic examination revealed typical features of a dermal metastasis of adenocarcinoma. immunohistochemistry revealed cytoplasmic positivity for cytokeratin 7-19, specific for the biliary tract epithelium. A review of the literature available led us to conclude that port-site metastasis in patients with obstructive jaundice treated with percutaneous transhepatic biliary decompression was an unusual but possible complication. In fact, many catheter-tract metastatic deposits in the liver parenchyma, detected at autopsy or on operation, are mistakenly identified as hematogenous or lymphatic metastasis and are not attributed to a catheter-related process. We also report on this case because of the atypical morphea-like aspect of the skin metastasis.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
13/22. Intrahepatic cholangiocarcinoma presenting as the budd-chiari syndrome: a case report and literature review.Intrahepatic cholangiocarcinoma, an increasingly recognized primary tumour of the liver, is associated with a very poor prognosis. A patient with this tumour who presented with budd-chiari syndrome (the first to the authors' knowledge in Western literature and only the third patient overall) secondary to extensive thrombosis in his inferior vena cava extending from the right atrium down to his iliac vessels is described. Neither curative nor palliative intervention was deemed to be an option in this patient, who deteriorated rapidly while on anti-coagulants. Postmortem examination confirmed the radiological findings, and histological analysis revealed characteristic appearances of this tumour within the biliary tree and invasion into the inferior vena cava. Furthermore, biliary dysplasia, which can be a precursor to this cancer, was also noted within some of the bile ducts.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
14/22. Magnetic resonance cholangiography.Magnetic resonance cholangiography (MRC) can be performed with data from a routine imaging protocol, without the need for additional pulse sequences or special equipment. We studied three patients with obstructive jaundice who underwent magnetic resonance imaging (MRI) of the liver. T2-weighted fat suppressed fast spin-echo sequences were processed with a maximum intensity projection algorithm to create three-dimensional images of the dilated portions of the biliary tree. Results were correlated with endoscopic retrograde cholangiopancreatography and computed tomography. These images compared favorably with those acquired on scanners in which special breath-holding gradient echo protocols are used.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
15/22. cholangiocarcinoma complicating ulcerative colitis.A case of cholangiocarcinoma complicating ulcerative colitis in a young female Chinese is presented. The interval between the diagnosis of ulcerative colitis and development of bile duct carcinoma was seven years which is relatively short. An irregular stricture of the common bile duct associated with dilatation of the biliary tree and distension of the gallbladder were recognised at endoscopic retrograde cholangiopancreaticogram (ERCP). The clue to the diagnosis was a previous history of chronic diarrhoea. Ulcerative colitis is an uncommon disease in the Chinese population. cholangiocarcinoma is a recognised uncommon complication.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
16/22. cholangiocarcinoma and familial adenomatous polyposis.A case of cholangiocarcinoma occurring in a patient with familial adenomatous polyposis--only the fourth such case reported--is presented. Evidence suggests that tumours of the extrahepatic biliary tree may also be an extra-colonic manifestation of familial adenomatous polyposis.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
17/22. Mucin-hypersecreting papillary cholangiocarcinoma presenting as abdominal wall abscess: CT and spiral CT cholangiography.We describe CT findings of a case of mucin-hypersecreting papillary cholangiocarcinoma (MHPC), with extrahepatic bile leakage to the rectus abdominis muscle via the ligamentum teres hepatis forming an abdominal wall abscess. Endoscopic retrograde cholangiography was unsatisfactory. Spiral three-dimensional CT cholangiography was helpful in assessing the resectability of MHPC by offering anatomic details of the uninvolved biliary tree.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
18/22. Obstructive jaundice associated with polycystic liver disease.A 65 year old patient with polycystic liver disease presented with obstructive jaundice thought to be a cholangiocarcinoma. Subsequent investigations demonstrated a large cyst compressing the confluence of the hepatic ducts. Percutaneous decompression of the biliary tree led to a complication necessitating surgery. Treatment options for symptomatic polycystic liver disease are reviewed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
19/22. Intrahepatic cholangiocarcinoma arising in congenital hepatic fibrosis: report of an autopsy case.We report an autopsy case of a 60-year-old woman who had congenital hepatic fibrosis with intrahepatic cholangiocarcinoma. A white nodular lesion with a surrounding vague gray area was detected in the right lobe of the liver. Microscopically, most of the nodular lesion was a poorly-differentiated adenocarcinoma. In the surrounding gray area, small bile ducts and bile ductules showed prominent epithelial overgrowth, some of which was composed of dysplasia and well-differentiated adenocarcinoma. The background liver showed the characteristic features of congenital hepatic fibrosis. Immunohistochemically, biliary oncofetal markers (mucin core protein 1 and carcinoembryonic antigen) were more frequently and extensively expressed in poorly-differentiated than well-differentiated adenocarcinoma. This is the 4th reported case of intrahepatic cholangiocarcinoma arising in congenital hepatic fibrosis and suggests that malignant transformation via dysplasia occurs in the abnormal intrahepatic biliary tree of older congenital hepatic fibrosis patients.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
20/22. Leakage via aberrant bile duct due to cholangiocarcinoma.The case of a male who had an open cholecystectomy complicated by persistent bile leak from an aberrant bile duct is presented. The persistence and volume of bile leak resulted in subsequent investigation of the biliary tree which demonstrated a cholangiocarcinoma of the right hepatic duct. This case is presented as an unusual presentation of cholangiocarcinoma and to highlight the value of modern techniques in imaging the biliary tree.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
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