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Gang S, Kwon H, Song IH, Namgoong JM. Clinical implications of pediatric biliary intraepithelial neoplasia diagnosed from a choledochal cyst specimen. World J Surg Oncol 2024; 22:105. [PMID: 38643155 PMCID: PMC11031949 DOI: 10.1186/s12957-024-03384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/06/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Biliary intraepithelial neoplasia (BilIN), a noninvasive precursor of cholangiocarcinoma, can manifest malignant transformation. Since cholangiocarcinoma (CCA) may progress due to chronic inflammation in the bile ducts and gallbladder, choledochal cysts are considered a precursor to CCA. However, BilIN has rarely been reported in children, to date. METHODS We reviewed medical records of patients (< 18 years of age, n = 329) who underwent choledochal cyst excision at Asan Medical Center from 2008 to 2022. BilIN was diagnosed in 15 patients. Subsequent analyses were performed of the demographics, surgical procedures, clinical course, and outcomes in these patients. Subgroup analysis and multivariate logistic regression test were performed to identify factors influencing BilIN occurrence. RESULTS The mean age of the patients included in our study was 40.1 ± 47.6 months. In 15 patients, BilIN of various grades was diagnosed. Todani type I was prevalent in 80% of the patients. The median age at surgery was 17 months. During a mean follow-up of 63.3 ± 94.0 months, no adverse events such as stone formation in the remnant intrapancreatic common bile duct and intrahepatic duct or cholangiocarcinoma were observed, indicating a favorable outcome until now. CONCLUSIONS The potential progression of choledochal cysts to BilIN in children was demonstrated. These results could underscore the importance of early and comprehensive excision of choledochal cysts, including resection margins for associated lesions and more thorough postoperative surveillance in patients with or at risk of BilIN.
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Affiliation(s)
- Sujin Gang
- Department of Pediatric Surgery, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea
| | - Hyunhee Kwon
- Department of Pediatric Surgery, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea
| | - In Hye Song
- Department of Pathology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea.
| | - Jung-Man Namgoong
- Department of Pathology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea.
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Bloomfield GC, Nigam A, Calvo IG, Dorris CS, Fishbein TM, Radkani P, Winslow ER. Characteristics and malignancy rates of adult patients diagnosed with choledochal cyst in the West: a systematic review. J Gastrointest Surg 2024; 28:77-87. [PMID: 38353080 DOI: 10.1016/j.gassur.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND The approach to patients with choledochal cysts (CCs) remains varied and subject to institutional practices. Owing to the rarity of the disease, the optimal treatment remains poorly defined, particularly in the adult population. This study aimed to review the literature on adult patients with CCs to evaluate trends of diagnosis and management in Western countries. METHODS A literature search of 3 electronic databases was performed on adult patients diagnosed with CCs in Western institutions. A review of published literature was completed with comprehensive screening by 2 independent reviewers. Studies were analyzed, and data on surgical approach, malignancies, and follow-up were collected. Findings are presented in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTS Of the 3488 articles retrieved, 21 studies evaluated Western adults with CCs for a combined population of 1337 patients. The most common Todani subtypes included types I (64%) and IV (22%). Symptoms at presentation included abdominal pain and jaundice, although many were asymptomatic. Ultrasound was used most frequently for diagnosis, followed by computed tomography and endoscopic cholangiopancreatography. The combined malignancy rate was 10.9%, with cholangiocarcinoma being the most prevalent. Complete extrahepatic cyst resection was standard for type I and IV CCs. Among malignancies, 18.5% and 16.4% were observed in patients with prior resection and internal drainage, respectively. CONCLUSIONS A significant proportion of patients who undergo resection of CC disease harbor malignancy. Cancer risk seems reduced but not eliminated with complete resection, which remains the standard treatment. Additional studies are needed to standardize guidelines for the diagnosis and postoperative care of patients in Western countries.
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Affiliation(s)
- Grace C Bloomfield
- Georgetown University School of Medicine, Washington, District of Columbia, United States
| | - Aradhya Nigam
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, United States
| | - Inochi Gonzalez Calvo
- Georgetown University School of Medicine, Washington, District of Columbia, United States
| | - C Scott Dorris
- Dahlgren Memorial Library, Georgetown University Medical Center, Washington, District of Columbia, United States
| | - Thomas M Fishbein
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, District of Columbia, United States
| | - Pejman Radkani
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, District of Columbia, United States
| | - Emily R Winslow
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Philpose RT, Mohammed AA, Gowni AR. Histopathological Study and Expression of Beta-Catenin in Congenital Choledochal Cyst in a Tertiary Care Pediatric Referral Center in South India. Pediatr Gastroenterol Hepatol Nutr 2024; 27:62-70. [PMID: 38249641 PMCID: PMC10796256 DOI: 10.5223/pghn.2024.27.1.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose Choledochal cysts are congenital anomalies that occur as localized cystic or fusiform dilatations of the biliary tree. Reflux and stasis of pancreatic enzymes in the biliary duct may relate to the development of intestinal metaplasia which might be an important factor related to the carcinogenesis of choledochal cyst, thus the expression of beta-catenin in the metaplastic epithelium might be associated with malignant transformation of choledochal cyst epithelium. Methods This study was conducted at a tertiary care pediatric center between October 2014 and March 2017. Forty patients were evaluated for epithelial lining, mural ulceration, fibrosis, inflammation, and metaplasia. Results Out of 40, 12 cases (30.0%) were the infantile age group and 28 cases (70.0%) were in the classic pediatric group. Ulceration was classified as grade 0 (14 cases, 35.0%), grade 1 (17 cases, 42.5%), or grade 2 (nine cases, 22.5%). Inflammation was classified as grade 0 (2 cases, 5.0%), grade 1 (26 cases, 65.0%), or grade 2 (12 cases, 30.0%). Fibrosis was classified as grade 0 (five cases, 12.5%), grade 1 (11 cases, 27.5%), grade 2 (17 cases, 42.5%), or grade 3 (seven cases, 17.5%). Metaplasia was noted in five (12.5%) out of 40 cases. All choledochal cysts with metaplasia showed beta-catenin nuclear positivity on immunohistochemistry and were followed up. Conclusion This study emphasizes the importance of detailed histopathological examination and documentation of metaplastic changes. Metaplasia was associated with beta-catenin nuclear positivity. These findings suggest a potential role for beta-catenin as a marker of metaplastic changes in choledochal cysts.
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Affiliation(s)
| | - Abdul Aleem Mohammed
- Department of Pathology, Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India
| | - Ashrith Reddy Gowni
- Department of Pediatric Surgery, Niloufer Institute for Women and Child Health, Hyderabad, Telangana, India
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Tang Y, Zhang J, Luo M, Li F, Huang H, Zhou Z, Fan X, Qin Z, He G, Zhuang Y. Preliminary Experience with Continuous Submucosal Anastomosis in Small-Diameter Hepaticojejunostomy during Single-Port Laparoscopic Choledochal Cyst Surgery in Children. Eur J Pediatr Surg 2023. [PMID: 37467774 DOI: 10.1055/a-2133-5202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
PURPOSE Hepaticojejunostomy anastomosis (HJA) is the most challenging aspect in single-port laparoscopic choledochal cystectomy and Roux-en-Y hepaticojejunostomy (SPCH) in children, especially in small-diameter anastomoses (diameters less than 5 mm), which are more susceptible to anastomotic stricture. We developed the continuous submucosal technique for HJA (CS-HJA) to lessen postoperative complications. The purpose of this study is to introduce our preliminary experiences with CS-HJA. METHODS We retrospectively analyzed all available clinical data of children who underwent SPCH surgery between March 2020 and October 2022. We operated with CS-HJA on 10 children who were diagnosed with small-diameter hepaticojejunostomy (diameter less than 5 mm). Data collection mainly included demographic information, imaging data, perioperative details, and postoperative outcomes. Ten patients were included in this study. The average patient age was 55.2 months; the age range was 3 to 120 months, and the average weight was 11.6 kg; male-female ratio was 1:9. The choledocho had fusiform dilatation in five cases and cystic dilatation in five cases. There was no dilatation of the left and right hepatic ducts or intrahepatic bile ducts in all patients. All patients had no dilatation of the left and right hepatic ducts or intrahepatic bile ducts. All patients underwent a single-port laparoscopic bile-intestinal anastomosis using a submucosal jejunal anastomosis technique. Analysis of the duration of the bile-intestinal anastomosis, the length of the child's stay in the hospital after surgery, the intraoperative complications, and the postoperative complications was performed. RESULTS All the 10 patients underwent successful SPCH by CS-HJA technique. The average length of time for hepaticojejunostomy ranged from 22 to 40 minutes, and the postoperative hospital stay was 5.2 to 9.2 days. There were no instances of bile leakage following the operation. At 17 to 30 months of follow-up, there was no abdominal pain or jaundice, and the reexamination of transaminases, bilirubin, and amylase were normal. Ultrasonography showed no bile duct stricture or dilated bile ducts, and the incision is elegant, and the families of the patients were satisfied. CONCLUSION In SPCH surgery in children, the CS-HJA technique is safe and feasible for small-diameter hepaticojejunostomy.
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Affiliation(s)
- Yingming Tang
- Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Jie Zhang
- Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Miao Luo
- Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Fei Li
- Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Huang Huang
- Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Zhou Zhou
- Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Xia Fan
- Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Zhijie Qin
- Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Guoqing He
- Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Yize Zhuang
- Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guizhou, China
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Gao R, Ke M, Shi J, Zhang Y, Zou J, Diao M, Li L. Establishment and validation of a predictive nomogram for the risk of premalignant lesions in children with choledochal cyst. Front Pediatr 2023; 11:1108788. [PMID: 36816382 PMCID: PMC9936067 DOI: 10.3389/fped.2023.1108788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Choledochal cyst (CDC) increases the risk (2.5%-30%) of malignancy. Metaplasia and dysplasia have been recognized as premalignant lesions among CDCs. This study aimed to evaluate the risk factors of metaplasia and dysplasia in CDC children. METHODS Two hundred and ten CDC children who underwent cyst excision and Roux-en-Y hepaticojejunostomy at our institution between July 2020 and November 2021 were included and randomly divided into the training set and validation set. Univariate and multivariate logistic regression analysis were used to identify independent risk factors of premalignant lesions in the training set and build a predictive nomogram. The performance and discriminatory abilities of the nomogram were further assessed and validated in the validation set. RESULTS Of the 210 CDC children, 78 (37.1%) patients developed premalignant lesions. Age (OR, 1.011, 95%CI, 1.000-1.022, P = 0.046), symptoms duration (OR, 1.021, 95%CI, 1.001-1.042, P = 0.036), cyst diameter (OR, 1.737, 95%CI, 1.328-2.273, P < 0.001), recurrent attacks of biliary pancreatitis (OR, 3.653, 95%CI, 1.205-11.076, P = 0.022), and biliary operation history (OR, 5.860, 95%CI, 1.268-27.084, P = 0.024) were identified as independent risk factors. Based on these predictors, a predictive nomogram was generated. The AUC of the nomogram was 0.873 in the training set and 0.793 in the validation set, indicating that it was robust and well calibrated. CONCLUSIONS A novel nomogram to the individualized risk of premalignant lesions in CDC children was successfully built, on the basis of age, symptoms duration, cyst diameter, recurrent attacks of biliary pancreatitis, and biliary operation history. This nomogram, combined with the final pathological results, can help clinicians to develop more efficient follow-up strategies for the high-risk children with CDC.
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Affiliation(s)
- Ruyue Gao
- Department of Pediatric Surgery, Children's Hospital Capital Institute of Pediatrics, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Meng Ke
- Department of Pediatric Surgery, Children's Hospital Capital Institute of Pediatrics, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Shi
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yandong Zhang
- Department of Pathology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jizhen Zou
- Department of Pathology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Mei Diao
- Department of Pediatric Surgery, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Long Li
- Department of Pediatric Surgery, Children's Hospital Capital Institute of Pediatrics, Beijing, China.,Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, Beijing, China.,Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment (2021RU015), Chinese Academy of Medical Sciences, Beijing, China
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YARDIMCI VH, EKEMEN S, BARUT AY. Safra Kesesi Adenomyomatozisi Prekanseröz Lezyon mudur? Ki-67 ve P53 Pozitif Ekspresyonunun Normal Safra Kesesi Dokusu ile Karşılaştırılması. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1033234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Amaç: Safra kesesi adenomyomatozisinin (SKA) kesin patogenezi hala tam olarak açıklanamamıştır, tanı ve tedavisine ilişkin bazı tartışmalar mevcut. Başlangıçta kanser öncesi bir lezyon olarak kabul edilen adenomyomatozis, son zamanlarda yapılan çalışmalarda safra kesesinin sıklıkla kolesistit ve kolelitiazis ile ilişkili iyi huylu bir değişikliği olarak kabul edilmektedir. Bu çalışmada, SKA patogenezini araştırmak için; aynı hastada safra kesesi normal ve adenomyomatozis dokusunda, tümör hücrelerinin proliferatif aktivitesini gösteren biyobelirteç düzeyleri ve neoplastik doku pozitiflik paternini gösteren biyobelirteç düzeylerinin karşılaştırılması amaçlanmıştır.Yöntem: 2019-2020 yılları arasında toplam 750 laparoskopik kolesistektomi uygulanan hastanın patoloji raporları incelenmiş, adenomyomatozis tanısı alan 20 vaka retrospektif olarak değerlendirilmiştir. Proliferasyon belirteci olarak Ki-67 ve neoplastik aktivite belirteci olarak P53, safra kesesi normal dokusu ile adenomyomatozis dokusunda ayrı ayrı değerlendirilmiştir.Bulgular: Safra kesesi normal ve adenomyomatozis dokusundaki Ki-67 indeksi ortalama değerleri karşılaştırıldığında, istatistiksel olarak anlamlı fark bulundu (p<0,000). Ancak bu iki grup P53 indeksi ortalama değerleri açısından karşılaştırıldığında istatistiksel fark bulunamadı (p=0,062).Sonuç: Çalışmada adenomyomatozis dokularında anlamlı derecede yüksek Ki-67 proliferasyon belirteci düzeyleri tespit edilmesine karşın, safra kesesi kanserinin yaygın P53-pozitiflik paterninin bu dokularda normal dokularla karşılaştırıldığında anlamlı farklar saptanmaması, SKA’nin kanser öncüsü bir lezyon olmayıp, iyi huylu proliferatif bir değişiklik olduğunu destekler görünmektedir.
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Our Experience with Cyst Excision and Hepaticoenterostomy for Choledocal Cyst: A Single Center Case Review of 16 Patients. Medicina (B Aires) 2022; 58:medicina58030416. [PMID: 35334592 PMCID: PMC8948927 DOI: 10.3390/medicina58030416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Choledocal cyst is a rare congenital disease of the biliary tree defined by dilatation of the extrahepatic and/or intrahepatic biliary ducts. Untreated, it leads to complications such as cholangitis, stone formation and malignant degeneration. The standard treatment for choledocal cyst is complete excision and subsequent biliary reconstruction via hepaticojejunostomy or hepatiocoduodenostomy. Materials and Methods: We report our experience with 16 pediatric cases of choledocal cyst over a 10-year period. Results: The predominant symptoms were nausea and jaundice, both at 62.5% (n = 10), followed by abdominal pain at 56.3% (n = 9). Ultrasonography was the diagnostic method used in all patients. Computed tomography was used in 75% (n = 12) and magnetic resonance imaging in 25% (n = 4) of cases. Age at the time of intervention ranged from 2 months to 17 years with a mean of 4 years and 5 months. The open approach was used in nine patients and the laparoscopic approach was used in seven patients, with one conversion to open surgery. Complete excision of the choledocal cyst was performed in 15 cases (93.7%), and partial excision with mucosectomy was performed in one case (6.2%). Eight patients (50%) underwent hepaticoduodenostomy and eight (50%) underwent hepaticojejunostomy, out of which one was attempted laparoscopically but was converted. We had a postoperative complication rate of 12.5% (n = 2) represented by anastomotic leak and pancreatitis. Conclusions: From our experience with these cases, we concluded that a wide hepaticoduodenostomy constitutes a favorable choice over the traditional hepaticojejunostomy, being more physiological and less time consuming.
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Takano S, Hasegawa T, Masuda K, Hanaki T, Tokuyasu N, Sakamoto T, Nosaka K, Fujiwara Y. Precancerous Pyloric Gland Metaplasia in the Biliary Epithelium Associated with Congenital Biliary Dilatation in a Three-Month-Old Infant. Yonago Acta Med 2022; 65:96-100. [DOI: 10.33160/yam.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/20/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Shuichi Takano
- Department of Gastrointestinal and Pediatric Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Toshimichi Hasegawa
- Department of Gastrointestinal and Pediatric Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Kohga Masuda
- Department of Gastrointestinal and Pediatric Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Takehiko Hanaki
- Department of Gastrointestinal and Pediatric Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Naruo Tokuyasu
- Department of Gastrointestinal and Pediatric Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Teruhisa Sakamoto
- Department of Gastrointestinal and Pediatric Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Kanae Nosaka
- Department of Pathology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Department of Gastrointestinal and Pediatric Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
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Warren B, Han S, Shah RJ. Dysplastic progression of a choledochal cyst on video cholangioscopy. Endoscopy 2021; 53:E285-E286. [PMID: 33032353 DOI: 10.1055/a-1252-2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Benjamin Warren
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samuel Han
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Raj J Shah
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Aydin Mericöz C, Hacihasanoglu E, Muraki T, Pehlivanoglu B, Memis B, Mittal P, Polito H, Saka B, Everett R, Sarmiento J, Kooby D, Maithel SK, Erkan M, Basturk O, Reid MD, Adsay V. Evaluation and Pathologic Classification of Choledochal Cysts: Clinicopathologic Analysis of 84 Cases From the West. Am J Surg Pathol 2021; 45:627-637. [PMID: 33481384 DOI: 10.1097/pas.0000000000001666] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Choledochal cyst (CC) is believed to be a mostly Asian disorder. As a clinically defined entity, its pathologic correlates are poorly characterized. Eighty-four resected CCs from the West were reanalyzed. After applying established Japanese criteria, 9/66 with available imaging were disqualified and 10/39 with preoperative cyst typing had to be recategorized. None had been diagnosed with, or evaluated for, pancreatobiliary maljunction, but on retrospective analysis of radiologic images, 12/66 were found to have pancreatobiliary maljunction. The clinical findings were: F/M=5.7; mean age, 48; most (77%) presented with abdominal pain; mean size, 2.9 cm; choledocholithiasis 11%. Gross/histologic examination revealed 3 distinct pathology-based categories: (I) Cystic dilatation of native ducts (81%). (II) Double bile duct (13%), almost all of which were found in women (10/11); all were diagnosed by pathologic examination, and not preoperative diagnosis. (III) Gastrointestinal (GI) duplication type (6%). Microscopic findings of the entire cohort included mucosal-predominant lymphoplasmacytic inflammation (50%), follicular cholangitis (7%), mucosal hyperplasia (43%; 13% with papillae), intestinal metaplasia (10%), BilIN-like hyperplasia (17%), erosion/ulceration (13%), and severe dysplasia-mimicking atypia including "detachment atypia" and micropapillary degeneration (11%). Carcinomatous changes were seen in 14 cases (17%) (high-grade dysplasia/carcinoma in situ in 7, intraductal papillary neoplasm 1, and invasive carcinoma 6); and 13/14 of these occurred in pathologic category I, all with cyst size >1 cm. In conclusion, diagnostic imaging guidelines used in Asia are not routinely used (but should be adopted) in the West. Pathologically, cases designated as CC are classifiable in 3 groups: category 1 (dilated native duct type), more prone to carcinomatous change; category 2, double-duct phenomenon (all but 1 being female in this study); and category 3, GI-type duplication. Overall, 17% of CCs show carcinomatous change (50% of them invasive). CC specimens should be carefully examined with this classification and submitted entirely for assessment of at-risk mucosa and cancerous transformation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Mert Erkan
- Surgery, Koç University School of Medicine
- Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Olca Basturk
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Volkan Adsay
- Departments of Pathology
- Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
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Nawabi A, Jabbari J, Nawabi P. Surgical management of a massive choledochal cyst. J Surg Case Rep 2021; 2021:rjab006. [PMID: 33613964 PMCID: PMC7884067 DOI: 10.1093/jscr/rjab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Choledochal cysts (CC) are congenital bile duct anomalies, typically present in children. The size of CC vary, but they rarely exceed 9 cm. Surgical resection is the mainstay of treatment. This case report presents 18-year-old female with jaundice and abdominal pain. On imaging she was found to have a type I CC versus a type IVa CC. She was taken to the operating room where she was found to have a 20 cm type I CC. The patient experienced complete recovery after total resection of the extrahepatic cyst with reconstruction with a Roux-en-Y hepaticojejunostomy. Preoperative diagnosis of the type of CCs can be challenging. Proper imaging preoperatively can aid in diagnosis of these cysts, but delineation of anatomy and type may not always be possible. If treated in a timely manner, it can help prevent both long- and short-term complications.
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Affiliation(s)
- Atta Nawabi
- The University of Kansas, Department of Surgery, Kansas City, KS 66160, USA
| | - Javaneh Jabbari
- The University of Kansas, Department of Surgery, Kansas City, KS 66160, USA
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Uecker M, Lehmann U, Braubach P, Schukfeh N, Madadi-Sanjani O, Ure BM, Petersen C, Kuebler JF. Choledochal Cysts Resected during Childhood Show No Mutations of KRAS and BRAF as Early Markers of Malignancy in Cholangiocytes. Eur J Pediatr Surg 2021; 31:20-24. [PMID: 32820496 DOI: 10.1055/s-0040-1715610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION In patients with choledochal cysts (CDC), a hyperplasia-dysplasia-carcinoma sequence can lead to biliary tract malignancy. The limited data available suggest that the risk decreases considerably after excision in childhood. We analyzed samples of resected CDC from pediatric patients histologically and performed mutational analysis of the proto-oncogenes KRAS and BRAF as early markers of malignant alteration in cholangiocytes. MATERIALS AND METHODS After institutional review board approval, patients undergoing resection for CDC in our center from 2011 to 2019 were retrospectively identified. Histopathological reports were searched for inflammation and endothelial alteration. Cases with sufficient tissue specimen were tested for KRAS codon 12/13 and BRAF codon 600 mutations by pyrosequencing. RESULTS In total, 42 patients underwent resection for choledochal cyst in the study period. Median age at surgery was 2.4 years (range = 18 days-18 years). Histopathological analysis showed no malignancy, but various degrees of inflammation or fibrosis in approximately 50% of the patients and in all age groups. Sufficient tissue for mutation analysis was available for 22 cases, all of which tested negative for KRAS or BRAF mutation. CONCLUSION In our series, chronic inflammatory changes were frequently present in CDC of infants and children. However, the lack of KRAS and BRAF mutations suggests that no malignant changes have been initiated in this group of European patients undergoing early resection.
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Affiliation(s)
- Marie Uecker
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Ulrich Lehmann
- Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Peter Braubach
- Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Nagoud Schukfeh
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | | | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Claus Petersen
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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13
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de Kleine RH, Schreuder AM, ten Hove A, Hulscher JBF, Borel Rinkes IHM, Dejong CHC, de Jonge J, de Reuver P, Erdmann J, Kazemier G, van Gulik TM, Gouw ASH, Porte RJ. Choledochal malformations in adults in the Netherlands: Results from a nationwide retrospective cohort study. Liver Int 2020; 40:2469-2475. [PMID: 32562356 PMCID: PMC7540385 DOI: 10.1111/liv.14568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Patients with a choledochal malformation, formerly described as cysts, are at increased risk of developing a cholangiocarcinoma and resection is recommended. Given the low incidence of choledochal malformation (CM) in Western countries, the incidence in these countries is unclear. Our aim was to assess the incidence of malignancy in CM patients and to assess postoperative outcome. METHODS In a nationwide, retrospective study, all adult patients who underwent surgery for CM between 1990 and 2016 were included. Patients were identified through the Dutch Pathology Registry and local patient records and were analysed to determine the incidence of malignancy, as well as postoperative mortality and morbidity. RESULTS A total of 123 patients with a CM were included in the study (Todani Type I, n = 71; Type II, n = 10; Type III, n = 3; Type IV, n = 27; unknown, n = 12). Median age was 40 years (range 18-70) and 81% were female. The majority of patients (99/123) underwent extrahepatic bile duct resection, with additional liver parenchyma resections in eight patients, only exploration in two, and a local cyst resection in eight patients. Postoperative 30-day mortality was 2% (2/123) and limited to patients who underwent liver resection. Severe morbidity occurred in 24%. In 14 of the 123 patients (11%), a malignancy was found in the resected specimen. One patient developed a periampullary malignancy 7 years later. CONCLUSIONS In a large Western series of CM patients, 11% were found to have a malignancy. This justifies resection in these patients, despite the risk of morbidity (24%) and mortality (2%).
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Affiliation(s)
- Ruben H. de Kleine
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationDepartment of SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - A. Marthe Schreuder
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Anneke ten Hove
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationDepartment of SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Jan B. F. Hulscher
- Division of Pediatric surgeryDepartment of SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | | | - Cornelis H. C. Dejong
- Department of SurgeryUniversity Medical Center MaastrichtMaastrichtthe Netherlands,Department of SurgeryRWTH Uniklinikum AachenAachenGermany
| | - Jeroen de Jonge
- Department of SurgeryErasmus Medical CenterRotterdamthe Netherlands
| | - Philip de Reuver
- Department of SurgeryRadboud University Nijmegen Medical CenterNijmegenthe Netherlands
| | - Joris Erdmann
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands,Department of SurgeryUniversity of LeidenLeiden University Medical CenterLeidenthe Netherlands
| | - Geert Kazemier
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - the PALGA Foundation
- PALGA Foundation. The nationwide network and registry of histo‐ and cytopathology in the Netherlands
| | - Thomas M. van Gulik
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Annette S. H. Gouw
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Robert J. Porte
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationDepartment of SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
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14
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Serin KR, Ercan LD, Ibis C, Ozden I, Tekant Y. Choledochal cysts: Management and long-term follow-up. Surgeon 2020; 19:200-206. [PMID: 32690464 DOI: 10.1016/j.surge.2020.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/07/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Choledochal cysts are congenital anomalies that can occur at any level of the biliary tree. They carry long-term risk of biliary complications and cancer development. Complete excision of all involved bile ducts is recommended. METHODS Patients treated between 1995 and 2019 were reviewed retrospectively. RESULTS Sixty patients; 46 female and 14 male with a median age of 41 years (range 13-83) were included in the study. Mild abdominal pain was the most common presenting symptom (60%). Majority of the patients had Todani type I cysts (67%). Concomitant biliary malignancy was diagnosed in five patients (9%). Eight patients were followed-up conservatively (13%). Twenty-five patients were treated by excision of the extrahepatic bile ducts and Roux-en-Y hepaticojejunostomy, liver resection was added in seven, pancreatoduodenectomy was done in three and liver transplantation in one. There was no perioperative mortality. Postoperative complications developed in 17 patients (34%), two requiring surgical treatment. Four of the five patients with malignancies died at a median 42 months (range 6-95) following surgery. Median 62 months (range 8-280) follow-up was available in 45 surgically treated patients, 19 followed-up for more than 10 years. None of the patients developed malignancy during follow-up. Four patients (17%) were readmitted for anastomotic strictures requiring treatment. CONCLUSION The majority of choledochal cysts are Todani type-I and early cyst excision is the mainstay of management, which may decrease the risk of malignant transformation.
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Affiliation(s)
- Kursat Rahmi Serin
- Hepatopancreatobiliary Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Leman Damla Ercan
- Hepatopancreatobiliary Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Cem Ibis
- Hepatopancreatobiliary Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Ilgin Ozden
- Hepatopancreatobiliary Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Yaman Tekant
- Hepatopancreatobiliary Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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15
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Morrow MK, Li A, Perez-Atayde AR, Vargas SO. Congenital Epidermoid Cyst of the Liver: A Rare Entity Characterized by Antenatal Onset, Slow Postnatal Growth, and Consistent Histologic and Immunohistologic Features. Pediatr Dev Pathol 2020; 23:181-188. [PMID: 31510861 DOI: 10.1177/1093526619875237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are only 15 reported hepatic epidermoid cysts; they include patients presenting congenitally through adulthood, with varied speculations about pathogenesis. Aside from recently reported pancytokeratin staining, no other descriptions have included immunohistochemistry. Splenic epidermoid cysts were recently characterized as positive for HBME-1, p63, CEA, CK7 (luminal), and CK19. We interrogate 2 hepatic epidermoid cysts with a broad panel of immunohistochemistry, with the aim of elucidating histogenesis. METHODS Archives were searched for "liver," "hepatic," and "cyst." Hepatic cysts lined by squamous epithelium were included. Clinical records, macroscopic findings, and hematoxylin and eosin and immunohistochemically stained slides were reviewed. RESULTS We identified 2 patients with epidermoid cysts of the liver, first detected on antenatal ultrasound. Both were females and asymptomatic; neither had other congenital abnormalities. Cysts enlarged slowly after birth. Resection was at ages 2 and 6 months, done to avoid potentially more difficult surgery in the future. Cysts were unilocular (4.8 cm) and multilocular (7.0 cm). Both were lined by stratified nonkeratinizing squamous to focally transitional-like epithelium and surrounded by paucicellular fibrous stroma. In the multilocular cyst, hepatocytes and fibrous stroma populated septa. Epithelium was positive for HBME-1, p63, CK19, CEA, Cam5.2, and CK7, negative for EMA, D2-40, WT-1, calretinin, and Ca19-9. Cytogenetic analysis of one showed a normal female karyotype. During the study period, 22 other pediatric liver cysts were diagnosed. CONCLUSION Hepatic epidermoid cyst is a distinct entity, rare but nevertheless constituting 8% of pediatric hepatic cysts at our institution. It is characterized by intrauterine onset and growth roughly commensurate with that of the fetus/infant; it is apparently unsyndromic. It may be unilocular or multilocular. It stains for an array of epithelial markers as well as HBME-1. Strong immunohistochemical overlap with splenic epidermoid cyst points to a shared pathogenesis and detracts from hypotheses that hepatic epidermoid cysts derive from hepatic elements.
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Affiliation(s)
- Matthew K Morrow
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Aofei Li
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Sara O Vargas
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
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16
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Management of Choledochal Cysts at a Tertiary Care Centre: A Nine-Year Experience from India. Surg Res Pract 2020; 2020:8017460. [PMID: 32373713 PMCID: PMC7191366 DOI: 10.1155/2020/8017460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Although choledochal cyst disease is seen predominantly in childhood, it is becomingly increasingly diagnosed in adult patients. Methods Data of 36 patients with choledochal cysts managed in our institute between January 2010 and December 2018 were retrospectively analyzed. Results Median age at presentation was 37 years (range: 13–72 years). Female-to-male ratio was 3.5 : 1. All patients were symptomatic, and abdominal pain was the most common symptom. 72.2% had other associated conditions. There was a considerable delay from the onset of symptoms to referral, median duration being 348 days. There were 28 cases of type I (77.8%), 5 cases of type IVA (13.9%), and 3 cases of type IVB (8.3%). Cyst excision with Roux-en-Y hepaticojejunostomy was performed in 29 (80.55%) cases. This procedure was combined with a left lateral sectionectomy, left hepatectomy, and radical cholecystectomy in 1, 2, and 1 cases, respectively. Lilly's technique was used in 2 cases, and cyst excision with hepaticoduodenostomy was performed in 1 case. Early complications were seen in 21 patients (58.3%), and late complications were seen in 5 patients (13.8%). 2 patients were found to have associated malignancies. One patient was detected to have cholangiocarcinoma in the resected liver incidentally, and another patient was diagnosed to have gall bladder cancer intraoperatively. Conclusion Choledochal cysts should be considered in the differential diagnosis of adults presenting with epigastric or right hypochondrium pain or jaundice. A thorough preoperative evaluation is required. Cyst excision with Roux-en-Y hepaticojejunostomy forms the standard treatment in most cases. Long-term follow-up is essential for management of complications and early detection of malignant change.
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17
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Zaccari P, Cardinale V, Severi C, Pedica F, Carpino G, Gaudio E, Doglioni C, Petrone MC, Alvaro D, Arcidiacono PG, Capurso G. Common features between neoplastic and preneoplastic lesions of the biliary tract and the pancreas. World J Gastroenterol 2019; 25:4343-4359. [PMID: 31496617 PMCID: PMC6710182 DOI: 10.3748/wjg.v25.i31.4343] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/13/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
the bile duct system and pancreas show many similarities due to their anatomical proximity and common embryological origin. Consequently, preneoplastic and neoplastic lesions of the bile duct and pancreas share analogies in terms of molecular, histological and pathophysiological features. Intraepithelial neoplasms are reported in biliary tract, as biliary intraepithelial neoplasm (BilIN), and in pancreas, as pancreatic intraepithelial neoplasm (PanIN). Both can evolve to invasive carcinomas, respectively cholangiocarcinoma (CCA) and pancreatic ductal adenocarcinoma (PDAC). Intraductal papillary neoplasms arise in biliary tract and pancreas. Intraductal papillary neoplasm of the biliary tract (IPNB) share common histologic and phenotypic features such as pancreatobiliary, gastric, intestinal and oncocytic types, and biological behavior with the pancreatic counterpart, the intraductal papillary mucinous neoplasm of the pancreas (IPMN). All these neoplastic lesions exhibit similar immunohistochemical phenotypes, suggesting a common carcinogenic process. Indeed, CCA and PDAC display similar clinic-pathological features as growth pattern, poor response to conventional chemotherapy and radiotherapy and, as a consequence, an unfavorable prognosis. The objective of this review is to discuss similarities and differences between the neoplastic lesions of the pancreas and biliary tract with potential implications on a common origin from similar stem/progenitor cells.
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Affiliation(s)
- Piera Zaccari
- Department of Internal Medicine and Medical Specialties, Gastroenterology Unit, Sapienza University of Rome, Rome 00161, Italy
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00161 Rome, Italy
| | - Carola Severi
- Department of Internal Medicine and Medical Specialties, Gastroenterology Unit, Sapienza University of Rome, Rome 00161, Italy
| | - Federica Pedica
- Pathology Department, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan 20132, Italy
| | - Guido Carpino
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome "Foro Italico", Rome 00161, Italy
| | - Eugenio Gaudio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Division of Human Anatomy, Sapienza University of Rome, Rome 00161, Italy
| | - Claudio Doglioni
- Pathology Department, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan 20132, Italy
| | - Maria Chiara Petrone
- PancreatoBiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan 20132, Italy
| | - Domenico Alvaro
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome 00161, Italy
| | - Paolo Giorgio Arcidiacono
- PancreatoBiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan 20132, Italy
| | - Gabriele Capurso
- PancreatoBiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan 20132, Italy
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18
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Knudsen KN, Mortensen MB, Detlefsen S. Squamous cell carcinoma of the common bile duct: A case report with genomic profiling. Pathol Int 2019; 69:427-431. [PMID: 31286611 DOI: 10.1111/pin.12806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Abstract
Squamous cell carcinoma of the extrahepatic bile ducts is a very rare type of cancer with a virtually unknown pathogenesis. We present the case of a 66-year-old woman who underwent a pancreaticoduodenectomy with the postoperative diagnosis of squamous cell carcinoma of the common bile duct. Microscopically, the entire common bile duct showed squamous metaplasia. Besides, an invasive squamous cell carcinoma was found, stage pT3pN0. A next generation sequencing assay covering 315 tumor-related genes revealed genomic alterations in seven genes: FBXW7, CREBBP, CTCF, FAT1, MAGI2, MLL2, and NOTCH1.
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Affiliation(s)
| | - Michael Bau Mortensen
- Department of Surgery, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
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19
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Ten Hove A, de Kleine RHJ, Nijkamp MW, Gouw ASH, Koopman T, Klaase JM. Robot-Assisted Laparoscopic Resection of a Todani Type II Choledochal Malformation. Case Rep Gastroenterol 2019; 13:230-237. [PMID: 31143095 PMCID: PMC6528092 DOI: 10.1159/000500080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/02/2019] [Indexed: 12/30/2022] Open
Abstract
Choledochal malformation (CM) comprise various congenital cystic dilatations of the extrahepatic and/or intrahepatic biliary tree. CM is classified into five different types. Our case describes a 58-year-old man presenting with acute abdominal pain. Further examination showed a Todani type II CM. Treatment for type II is complete cyst excision without the need for an extrahepatic bile duct resection. A robot-assisted laparoscopic resection of the CM was performed and the patient recovered without complications. Pathology results showed a Todani type II malformation in which complete squamous metaplasia has occurred. In this paper, we report, to the best of our knowledge, the first description of a robot-assisted laparoscopic resection of a type II CM.
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Affiliation(s)
- Anneke Ten Hove
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruben H J de Kleine
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten W Nijkamp
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annet S H Gouw
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Timco Koopman
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joost M Klaase
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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20
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Abstract
Introduction A choledochal malformation (CM) is a rare entity, especially in the Western world. We aimed to determine the incidence of CM in the Netherlands and the outcome of surgery for CM in childhood. Methods All pediatric patients who underwent a surgical procedure for type I–IV CM between 1989 and 2014 were entered into the Netherlands Study group on choledochal cyst/malformation. Patients with type V CM were excluded from the present analysis. Symptoms, surgical details, short-term (<30 days) and long-term (>30 days) complications were studied retrospectively. Results Between January 1989 and December 2014, 91 pediatric patients underwent surgery for CM at a median age of 2.1 years (0.0–17.7 years). All patients underwent resection of the extrahepatic biliary tree with restoration of the continuity via Roux-en-Y hepaticojejunostomy. Twelve patients (12%) were operated laparoscopically. Short-term complications, mainly biliary leakage and cholangitis, occurred in 20 patients (22%), without significant correlations with weight or age at surgery or surgical approach. Long-term postoperative complications were mainly cholangitis (13%) and anastomotic stricture (4%). Eight patients (9%) required radiological intervention or additional surgery. Surgery before 1 year of age (OR 9.3) and laparoscopic surgery (OR 4.4) were associated with more postoperative long-term complications. We did not observe biliary malignancies during treatment or follow-up. Conclusion Surgery for CM carries a significant short- and long-term morbidity. Given the low incidence, we would suggest that (laparoscopic) hepatobiliary surgery for CM should be performed in specialized pediatric surgical centers with a wide experience in laparoscopy and hepatobiliary surgery.
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21
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ten Hove A, de Meijer VE, Hulscher JBF, de Kleine RHJ. Meta-analysis of risk of developing malignancy in congenital choledochal malformation. Br J Surg 2018; 105:482-490. [PMID: 29480528 PMCID: PMC5900735 DOI: 10.1002/bjs.10798] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Choledochal malformations comprise various congenital cystic dilatations of the extrahepatic and/or intrahepatic biliary tree. Choledochal malformation is generally considered a premalignant condition, but reliable data on the risk of malignancy and optimal surgical treatment are lacking. The objective of this systematic review was to assess the prevalence of malignancy in patients with choledochal malformation and to differentiate between subtypes. In addition, the risk of malignancy following cystic drainage versus complete cyst excision was assessed. METHODS A systematic review of PubMed and Embase databases was performed in accordance with the PRISMA statement. A meta-analysis of the risk of malignancy following cystic drainage versus complete cyst excision was undertaken in line with MOOSE guidelines. Prevalence of malignancy was defined as the rate of biliary cancer before resection, and malignant transformation as new-onset biliary cancer after surgery. RESULTS Eighteen observational studies were included, reporting a total of 2904 patients with a median age of 36 years. Of these, 312 in total developed a malignancy (10·7 per cent); the prevalence of malignancy was 7·3 per cent and the rate of malignant transformation was 3·4 per cent. Patients with types I and IV choledochal malformation had an increased risk of malignancy (P = 0·016). Patients who underwent cystic drainage had an increased risk of developing biliary malignancy compared with those who had complete cyst excision, with an odds ratio of 3·97 (95 per cent c.i. 2·40 to 6·55). CONCLUSION The risk of developing malignancy among patients with choledochal malformation was almost 11 per cent. The malignancy risk following cystic drainage surgery was four times higher than that after complete cyst excision. Complete surgical resection is recommended in patients with choledochal malformation.
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Affiliation(s)
- A. ten Hove
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationUniversity of Groningen and University Medical Centre GroningenGroningenThe Netherlands
| | - V. E. de Meijer
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationUniversity of Groningen and University Medical Centre GroningenGroningenThe Netherlands
| | - J. B. F. Hulscher
- Division of Paediatric Surgery, Department of SurgeryUniversity of Groningen and University Medical Centre GroningenGroningenThe Netherlands
| | - R. H. J. de Kleine
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationUniversity of Groningen and University Medical Centre GroningenGroningenThe Netherlands
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22
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Abstract
Cholangiocarcinomas (CC) are rare tumors which usually present late and are often difficult to diagnose and treat. CCs are categorized as intrahepatic, hilar, or extrahepatic. Epidemiologic studies suggest that the incidence of intrahepatic CCs may be increasing worldwide. In this chapter, we review the risk factors, clinical presentation, and management of cholangiocarcinoma.
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23
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Kwon DH, Johnson LB, Ozdemirli M. Primary Epidermoid Cyst of Biliary Duct Presenting as Choledochal Cyst. Int J Surg Pathol 2017; 25:619-622. [PMID: 28508685 DOI: 10.1177/1066896917710717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Choledochal cyst is a cystic dilation of the biliary tree that can increase the risk of malignancy in bile ducts and the gallbladder. These are usually lined by bile duct epithelium, which may undergo intestinal and squamous metaplasia. This is the first report of clinically diagnosed type II choledochal cyst that is entirely lined by metaplastic stratified squamous epithelium, unlike most other cysts, which are histologically lined by bile duct epithelium. This observation can potentially explain the underlying pathogenic mechanism of rare reports of squamous cell carcinomas arising in bile duct systems.
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24
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Ikegame K, Takano A, Watanabe H, Yamamoto A, Miyasaka Y, Furuya K, Nakada H, Sugai H, Yasutome M, Inoue M, Hada M, Nakagomi H, Omata M, Oyama T. Biliary cancer developed after the reparative surgery for congenital choledochal cyst: a case report and review of the literature. Int Cancer Conf J 2016; 6:43-49. [PMID: 31149469 DOI: 10.1007/s13691-016-0270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/06/2016] [Indexed: 11/26/2022] Open
Abstract
The incidence of bile duct cancer developed in the patients with congenital choledochal cysts (CC) with a history of reparative surgery is not well known. We experienced a case developed choleductal cancer 45 years after reparative surgery. She underwent reparative surgery with cyst excision and hepatic bile duct duodenal anastomosis at 1 year of age. She developed the symptoms of jaundice, anorexia, and dull pain in the right upper part of the abdomen at 47 years of age. The carcinoma arose from the dilated proximal bile duct anastomosed with the duodenum. Cholestasis and regurgitation of duodenal fluids seemed to have influenced the development of cancer in this patient. We additionally reviewed seven cohort studies concerning the incidence of biliary carcinoma after surgery for congenital choledocal cysts. The incidence of biliary cancer developed after surgery was 2.2 ± 2.5 (ranged 0-6.5)%. We also reviewed 33 Japanese case reports cited in Japan MEDLINE from 1986 to 2015. Regarding the CC types according to the Totani's classification, 12 were type I and 14 type IVa, 1 was type II and 6 were unknown type. The rate of coexistence of pancreaticobiliary maljunction (PBM) was 92%, (22/24; other 9 cases were not documented), and biliary cancer arose from the proximal stump of the reparative surgery in 68% (17/25) and from the distal stump in 32% (8/25) of cases. These findings suggested that the reflux of pancreatic juice due to PBM only partially explained the carcinogenesis of CCs. Intensive follow-up of such patients throughout their lives is necessary to avoid cancer death even after standard reparative surgery.
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Affiliation(s)
- Kou Ikegame
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Atsushi Takano
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Hideki Watanabe
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Atsushi Yamamoto
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Yoshiaki Miyasaka
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Kazushige Furuya
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Haruka Nakada
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Hidemitsu Sugai
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Michiya Yasutome
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Masayuki Inoue
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Masao Hada
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Hiroshi Nakagomi
- 1Department of Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Masao Omata
- 2Department of Internal Medicine, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Toshio Oyama
- 3Department of Pathology, Yamanashi Prefectural Central Hospital, Kofu, Japan
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Ainechi S, Lee H. Updates on Precancerous Lesions of the Biliary Tract: Biliary Precancerous Lesion. Arch Pathol Lab Med 2016; 140:1285-1289. [DOI: 10.5858/arpa.2015-0396-rs] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Precursor lesions of invasive adenocarcinoma of the bile duct (cholangiocarcinoma) have been increasingly recognized during the past decade because of the results of multiple studies on the carcinogenesis of cholangiocarcinoma, technologic advancements in diagnostic imaging modalities, and an increase in the volume of elective procedures. The two main precursor lesions of cholangiocarcinoma that have evolved are biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile duct. These lesions demonstrate histomorphologic similarities to pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm of the pancreas, respectively, whereas mechanisms of carcinogenesis and risk of progressive disease appear distinct. An enhanced understanding of the clinical presentation and pathologic features of precursor lesions of the biliary tract and use of the correct terminology will facilitate efficient communication between surgeons, oncologists, and pathologists and improve quality of patient care.
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Affiliation(s)
- Sanaz Ainechi
- From the Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York
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26
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Takano A, Nakagomi H, Ikegame K, Yamamoto A, Watanabe H, Nakada H, Inoue M, Sugai H, Yasutome M, Furuya K, Hada M, Miyasaka Y, Oyama T, Omata M. Report of a case with gallbladder carcinoma: P53 expression of the peritumor epithelium might predict biliary tract recurrence. Int J Surg Case Rep 2016; 28:325-329. [PMID: 27776323 PMCID: PMC5079237 DOI: 10.1016/j.ijscr.2016.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/15/2016] [Accepted: 10/15/2016] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The over-expression of P53 protein in gallbladder carcinoma is a biomarker correlating with a poor survival. However, the significance of P53 expression in peritumor tissues is unknown. We experienced a case of gallbladder carcinoma where the operative specimen showed over-expression of P53 on the peritumor epithelium, and early recurrence developed at the biliary tract. PRESENTATION OF CASE A 74-year-old female patient was referred to our hospital due to wall thickening of the gallbladder on ultrasonography. Radiographic examinations revealed wall thickening at the fundus of gallbladder and no abnormalities of the biliary tract or surrounding lymph nodes. We performed open cholecystectomy and lymph node dissection without extrahepatic bile duct resection, as a frozen section of the surgical stump of the cystic duct was cancer-free. However, a pathological examination revealed over-expression of P53 protein in the epithelium of the peritumor to the cystic duct, which were diagnosed as normal on hematoxylin eosin staining. The patient developed bile duct metastases, two and half years after the operation. She underwent endoscopic stenting for the obstruction of bile duct with no additional therapy, and died 6 months later. DISCUSSION AND CONCLUSION The immunohistochemical staining of the GB wall or surgical stump for a surgical specimen of GBC may be crucial to predict the bile duct recurrence.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Masao Omata
- Department of Digestive Medicine, Japan; Yamanashi Prefectural Central Hospital, University of Tokyo, Japan
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La Pergola E, Zen Y, Davenport M. Congenital choledochal malformation: search for a marker of epithelial instability. J Pediatr Surg 2016; 51:1445-9. [PMID: 27114310 DOI: 10.1016/j.jpedsurg.2016.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/09/2016] [Accepted: 03/12/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE There is a predisposition to the development of malignancy in congenital choledochal malformation (CCM) although the degree of risk is unknown. We investigated the role of CA19-9 in bile and the MIB-1 (Ki-67) epithelial proliferation index as markers of an at risk choledochal epithelium at the time of definitive surgery. METHODS Bile collected at surgery was analyzed for levels of amylase (as a surrogate of pancreatic reflux) and CA19-9. Immunohistochemical staining for CA19-9 and MIB-1 index (expressed as %) was performed on resected specimens. Data are quoted as median (IQR) and differences assessed using non-parametric statistics. A P value of 0.05 was regarded as significant. RESULTS Our study group consisted of 78 children with CCM (Type 1 fusiform, n=34; Type 1 cystic, n=30 and Type 4, n=14). Median bile CA19-9 was 159,400 (6-1×10(6)) kU/L. There was no correlation with bile amylase (P=0.49) or biliary pressure (P=0.17) but modest correlation with bilirubin (rs=0.24; P=0.02). In contrast, bile amylase was correlated with plasma γ-glutamyl transpeptidase (P=0.02), alkaline phosphatase (P=0.05) and aspartate aminotransferase (P=0.02); and inversely correlated with biliary pressure (rs=-0.38; P<0.0008). Epithelial expression of CA19-9 and MIB-1 was assessed in 43 specimens. CA19-9 was diffusely expressed on all choledochal epithelium. MIB-1 expression was divided into: high expression (>40%) n=3; moderate (20-40%) n=5, low (6-20%) n=7 and very low (≤5%) n=28. There was no correlation with choledochal pressure (P=0.87), CA19-9 (P=0.51) or bile amylase (P=0.55). CONCLUSION Biliary CA19-9 levels were grossly (and unexpectedly) raised in choledochal malformation and appear to arise from biliary rather than pancreatic epithelium. MIB-1 confirms that a small proportion (19%) has marked epithelial proliferation but no clinical correlates could be identified.
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Affiliation(s)
- Enrico La Pergola
- Department of Paediatric Surgery, Kings College Hospital, London, UK (now, Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan)
| | - Yoh Zen
- Institute of Liver Studies, Kings College Hospital, London, UK (now, Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan)
| | - Mark Davenport
- Department of Paediatric Surgery, Kings College Hospital, London, UK (now, Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan).
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28
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Michalinos A, Alexandrou P, Papalambros A, Oikonomou D, Sakellariou S, Baliou E, Alexandrou A, Schizas D, Felekouras E. Intracholecystic papillary-tubular neoplasm in a patient with choledochal cyst: a link between choledochal cyst and gallbladder cancer? World J Surg Oncol 2016; 14:202. [PMID: 27480698 PMCID: PMC4969726 DOI: 10.1186/s12957-016-0962-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/25/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intracholecystic papillary-tubular neoplasms are rare precursor lesions of gallbladder cancer. They were proposed as a separate pathologic entity in 2012 by Adsay et al. for the unification of a variety of mass-forming precursor lesions including papillary adenomas, tubulopapillary adenomas, intestinal adenomas, and others. They are considered homologous to intrapapillary mucinous neoplasms of the pancreas and intrabiliary papillary neoplasms of the common bile duct. In contrast with the commoner flat-type precursor gallbladder cancer lesions, they follow a more indolent clinical course and probably different genetic pathways to carcinogenesis. They are largely uninvestigated with only a handful of studies providing biological and clinical information. Choledochal cysts are dilation of the common bile duct. Diagnosis is usually established during childhood, and only a minority of patients are diagnosed at adulthood. They are of major clinical importance as they are known predisposing factors for biliary carcinogenesis. CASE PRESENTATION The current report describes a patient with a simultaneous diagnosis of choledochal cyst and intracholecystic papillary-tubular neoplasm. The patient underwent excision of the extrahepatic biliary tree for a Todani I choledochal cyst, and histological examination of the specimen revealed an intracholecystic papillary-tubular neoplasm of the gallbladder. Authors describe diagnostic and clinical course of the patient alongside clinical and biological characteristics of these rare lesions. CONCLUSIONS To the best of our knowledge, this is the first report of a patient with a simultaneous diagnosis of choledochal cyst and intracholecystic papillary-tubular neoplasm. Those rare lesions shed light on different forms of gallbladder cancer carcinogenesis and its relationship with choledochal cysts and cholestasis.
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Affiliation(s)
- Adamantios Michalinos
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece.
| | - Parakevi Alexandrou
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Papalambros
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece
| | - Dimitrios Oikonomou
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece
| | - Stratigoula Sakellariou
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Baliou
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Alexandrou
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece
| | - Evangelos Felekouras
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece
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29
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Cottreau J, Costa A, Walsh M, Arnason T. Ciliated Foregut Cyst of the Common Hepatic Duct: An Unusual Mimic of a Type II Choledochal Cyst. Int J Surg Pathol 2016; 24:644-7. [PMID: 27166199 DOI: 10.1177/1066896916648449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ciliated foregut cysts typically arise in the liver and pancreas, with rare cases reported to arise in the gallbladder wall. Herein, we describe an unusual case of a patient with a ciliated foregut cyst arising from the wall of the common hepatic duct, which has not been reported previously. As a result of its unique anatomical location, the cyst was mistaken for a type II choledochal cyst on preoperative imaging. The cyst caused intermittent biliary obstruction that resolved following surgical resection.
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Affiliation(s)
| | - Andreu Costa
- Dalhousie University Medical School, Halifax, Nova Scotia, Canada Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Mark Walsh
- Dalhousie University Medical School, Halifax, Nova Scotia, Canada Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Thomas Arnason
- Dalhousie University Medical School, Halifax, Nova Scotia, Canada Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Silva-Baez H, Coello-Ramírez P, Ixtabalán-Escalante EM, Sotelo-Anaya E, Gallo-Morales M, Cordero-Estrada E, Sainz-Escarrega VH, Ploneda-Valencia CF. Treatment of choledochal cyst in a pediatric population. A single institution experience of 15-years. Case series. Ann Med Surg (Lond) 2015; 5:81-5. [PMID: 26900456 PMCID: PMC4724022 DOI: 10.1016/j.amsu.2015.12.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 12/30/2022] Open
Abstract
Background Choledochal cyst (CC) is a rare congenital anomaly of the bile duct that approximately 75% of the patients are diagnosed in childhood. Without a standardized surgical procedure for the biliary reconstruction, we present our experience over the last 15 years and show the differences between the biliary reconstructions techniques in our population. Methods We did a retrospective hospital archive search for patients admitted to the pediatric surgery department with the diagnosis of a choledochal cyst from January 2000 to June 2015. Results We found 15 patients, of which, 1 was excluded because of missing data from the hospital record. Of the remaining 14, eight had hepaticojejunal (HY) anastomosis in Roux-en-Y, with a 25% rate of complications; six had hepatoduodenal (HD) anastomosis with a rate of complications of 16.6%. The average hospital length of stay in the group of HD vs. HY was 14 ± 1.6-days vs. 19 ± 8.2-days respectively. Discussion There are no standardized surgical reconstruction techniques of the biliary tract after the CC excision, there is literature that supports the biliary reconstruction with an HY and an HD without a distinct advantage over one or the other. Conclusion: In our series HD anastomosis represents a safe procedure with fewer complications than HY. Choledochal cyst is a rare disease either in pediatrics or adults. In the most common type of CC, the surgical excision is the gold standard. The reconstruction of the biliary tract in the case of CC is not standardized. We present the outcome of our series of patients that either HY or HD were performed.
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Affiliation(s)
- Hector Silva-Baez
- Pediatric Division, Pediatric Surgery Department at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - Pedro Coello-Ramírez
- Pediatric Division, Gastroenterology Department at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - Eddy Mizraím Ixtabalán-Escalante
- Pediatric Division, Gastroenterology Department at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - Eduardo Sotelo-Anaya
- Surgery Division, General Surgery Department at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - Mariana Gallo-Morales
- Surgery Division, General Surgery Department at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - Eduardo Cordero-Estrada
- Surgery Division, General Surgery Department at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - Victor Hugo Sainz-Escarrega
- Surgery Division, General Surgery Department at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - César Felipe Ploneda-Valencia
- Surgery Division, General Surgery Department at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
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Ettel M, Eze O, Xu R. Clinical and biological significance of precursor lesions of intrahepatic cholangiocarcinoma. World J Hepatol 2015; 7:2563-2570. [PMID: 26557948 PMCID: PMC4635141 DOI: 10.4254/wjh.v7.i25.2563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/10/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Cholangiocarcinoma (CC) is primarily a malignant tumor of older adults most prevalent in Southeast Asia, where liver fluke infestation is high. However the etiology in western countries is unknown. Although the incidence of extrahepatic cholangiocarcinoma has remained constant, incidence of intrahepatic CC (ICC) which differs in morphology, pathogenesis, risk factors, treatment and prognosis is increasing. While this increase is associated with hepatitis C virus infection, chronic nonalcoholic liver disease, obesity, and smoking, the pathogenesis of ICC and molecular alterations underlying the carcinogenesis are not completely elucidated. Benign biliary lesions such as biliary intraepithelial neoplasia, intraductal papillary neoplasm of the bile duct, von Meyenburg complex or bile duct hamartoma, and bile duct adenoma have been associated with ICC. For each of these entities, evidence suggests or supports a role as premalignant lesions. This article summarized the important biological significance of the precursor lesions of ICC and the molecular mechanisms that may be involved in intrahepatic cholangiocarcinogenesis.
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[Bile duct cysts; an unusual cause of jaundice in paediatrics. Presentation of a case series]. ACTA ACUST UNITED AC 2015; 87:137-42. [PMID: 26471312 DOI: 10.1016/j.rchipe.2015.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 08/12/2015] [Accepted: 08/30/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cysts of the bile duct or choledochal cysts are rare diseases in our area. The aetiology is unknown, with the most accepted hypothesis being a pancreatobiliary maljunction anomaly. OBJECTIVE To analyse the clinical data, diagnosis and treatment of a number of patients with choledochal cyst, as well as presenting an update on this condition. METHOD A retrospective descriptive study was performed on paediatric patients diagnosed with choledochal cyst in the last 20 years in a tertiary hospital. CASE REPORTS A total of 4 choledochal cyst cases in childhood, predominantly female, are pre- sented. The most frequent reason for consultation was vomiting, and presenting with jaundice and choluria in all cases. Patients with choledochal cyst were classified as type I in 3 cases, and one case of type IVa. In all cases surgical treatment was performed; any patient had complications to date. CONCLUSIONS Cysts of the bile ducts have a low prevalence. The treatment of choice is surgical, requiring close monitoring due to the risk of cholangiocarcinoma.
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