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1/454. Arterial dynamic appearance of common bile duct carcinoma by helical CT on angiography (angio-HCT): four operated cases.

    We present four cases of common bile duct carcinoma in which both angiographic helical CT (angio-HCT) and pancreatoduodenectomy were done in the 3 years since 1995. Angio-HCT was performed with direct infusion of the contrast medium through the gastroduodenal artery inserted on angiography. Angio-HCT displayed the tumors as lower density areas in contrast to the strong enhancement of the circumferential nontumorous areas, including the pancreas and duodenum. ( info)

2/454. Carcinoids of the common bile duct: a case report and literature review.

    Carcinoids of the extrahepatic bile ducts and particularly the common bile duct are extremely rare. A 65-year-old woman presented with obstructive jaundice. Laboratory and imaging studies gave results that were consistent with an obstructing lesion in the common bile duct. In this case, a stent was inserted initially to decompress the bile ducts. Subsequently a laparotomy and pancreaticoduodenectomy were performed and a tissue diagnosis of carcinoid of the common bile duct was made. The patient was well with no evidence of recurrence 17 months postoperatively. The authors believe this is the 19th reported case of an extrahepatic bile duct carcinoid. ( info)

3/454. Study of a primary gastrinoma in the common hepatic duct - a case report.

    Primary endocrine neoplasms of the biliary tract are exceedingly rare. We report on a 60-year-old man with diarrhea, vomiting and gastroesophageal reflux disease, with a primary gastrinoma of the common hepatic duct. The tumor was positive for a variety of immunohistochemical markers. Postoperatively the patient's symptoms disappeared and in the follow-up the patient was symptom free. To our knowledge, this is the first case in the literature of a primary gastrinoma in the common hepatic duct. The fact that the common hepatic duct is not located within the gastrinoma triangle made the diagnosis difficult and the distinct localization made the surgical treatment demanding. ( info)

4/454. Quadruple cancer including bilateral breasts, Vater's papilla, and urinary bladder: report of a case.

    We herein report a rare case of quadruple carcinoma with heterochronous bilateral breast cancer, cancer of Vater's papilla, and cancer of the urinary bladder, which were all curatively resected. A 62-year-old woman previously underwent right and left modified radical mastectomies heterochronously. Recently, a dilatation of the lower bile duct, diagnosed as cancer of Vater's papilla, was resected by a pancreatoduodenectomy. hematuria during surgery led to the discovery of a solid bladder tumor. The tumor was resected by a transurethral resection. The histopathologic findings differed for all four lesions. The patient had an uneventful postoperative course and to date has shown no recurrence. ( info)

5/454. Bilateral ovarian carcinoma metastatic from the ampulla of vater: a rare krukenberg tumor.

    Carcinoma of the ampulla of vater is a relatively rare neoplasm and its longterm survival rate is considerably high. However, because of differences in tumor pathologic features and local invasiveness, a 5-year survival rate differ widely. We present a case of metastatic carcinoma of the ampulla of vater presenting as a krukenberg tumor in a 59-year-old woman. Eight months earlier, she had been diagnosed as well-differentiated adenocarcinoma of the ampulla of vater. Abdominal examination revealed a hard mass with mild tenderness in the RLQ area. The laboratory findings were unremarkable except for mild anemia. CT scan of the abdomen revealed enlargement of both ovaries. An exploratory laparotomy disclosed bilateral ovarian masses, 18 x 12 x 8 cm and 8 x 5.5 x 4 cm in size, respectively. Histologic findings of the both ovarian masses were consistent with metastatic adenocarcinoma from the ampulla of vater. ( info)

6/454. adenoma of the ampulla of vater: a genetic condition?

    The etiology of adenoma of the ampulla of vater is not well understood. Previous authors reported the association of this neoplasm with polycystic kidney disease of two fraternal sisters. They concluded that these two conditions were somehow related. We describe a case of ampullary adenoma associated with polycystic kidney disease. This presentation raises again the question of a possible link between these two diseases. ( info)

7/454. brain metastases from adenoendocrine carcinoma of the common bile duct: a case report.

    A 68-year-old man with metastatic brain tumors from adenoendocrine carcinoma of the common bile duct is reported. A common bile duct tumor and a metastatic liver tumor had been resected 6 years and 3 years prior to admission, respectively. Microscopically they showed two components; moderately differentiated tubular adenocarcinoma and neuroendocrine carcinoma. He presented with headache and vomiting and MRI revealed two metastatic brain tumors. They were successfully resected and radiotherapy was carried out. Histological diagnosis of the metastatic brain tumors was neuroendocrine carcinoma, but carbohydrate antigen (CA)-19-9 and carcinoembryonic antigen (CEA)-immunoreactive cells were observed without glandular pattern. Immunohistochemically serotonin and pancreatic polypeptide were detected, but somatostatin was not. As the endocrine cells demonstrated in the normal extrahepatic bile ducts are only somatostatin-containing D cells, these cells are considered to originate as part of a metaplastic process. To our knowledge, this represents the second case of adenoendocrine carcinoma of the common bile duct. ( info)

8/454. Ampullary somatostatinoma in a patient with Merkel cell carcinoma.

    A 59-yr-old white man with Merkel cell carcinoma of his right leg status post extensive skin resection and chemotherapy had dilated hepatic and common bile ducts on a routine follow-up abdominal CT scan. A 1.9-cm ampullary mass was appreciated on endoscopy. histology showed psammoma bodies and positive immunoperoxidase staining consistent with a somatostatinoma. Merkel cell tumors and somatostatinomas are extremely rare neuroendocrine tumors derived from neural crest cells. Associations have been found between somatostatinomas and other islet cell tumors with multiple endocrine neoplasia syndromes, but no reported association has been published between islet cell tumors and Merkel cell tumors. This patient represents the first documented case of Merkel cell carcinoma and somatostatinoma in a single patient. Such an occurrence may represent a previously undescribed neuroendocrine tumor syndrome, and this possibility should be considered when either tumor is diagnosed. ( info)

9/454. Major hepatectomy combined with pylorus-preserving pancreatoduodenectomy for middle bile duct cancer with multiple lymph node metastases: a case report of 5-year survival.

    Hepatopancreatoduodenectomy has been well established as an aggressive surgical approach for advanced biliary tract malignancy. However, long-term survival of more than 5 years after this operation is rarely reported, especially with bile duct carcinoma. We report herein a 64 year-old man with middle bile duct cancer who underwent extended right hepatectomy combined with pylorus-preserving pancreatoduodenectomy because of widespread intramural extension of the tumor. Resection margin, which is considered the most significant prognostic parameter, was made clear only by additional hepatectomy in this case. In addition, although microscopic examination revealed multiple lymph node involvement up to the superior mesenteric node, the patient has survived 5 years and 6 months without tumor recurrence. It remains unclear whether aggressive lymph node dissection may improve surgical outcome; however, it is thought that surgical clearance of potentially involved nodes and tissue may be the only chance for long-term survival. ( info)

10/454. adenomyoma of the common bile duct.

    An unusual case of adenomyoma of the common bile duct is reported. A 31 year-old woman with intermittent epigastralgia was found to have cholestasis and stenosis of the common bile duct. A malignant tumor could not be excluded. Resection of the common bile duct with the tumor was performed with choledochojejunostomy reconstruction. The tumor consisted of glandular hyperplasia and proliferation of smooth muscle fibers and fibrous connective tissue. The patient was well at the 30-month follow-up. Although the benign tumors of the extrahepatic bile ducts are rare, the clinical importance lies in the recognition that they can cause biliary tract obstruction. Intra-operative frozen section for histologic examination is required to make the diagnosis and plan the surgical procedure. Complete extirpation of the lesion is recommended. A radical operation is not necessary. ( info)
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