A special growth manner of intrahepatic biliary cystadenoma

We report a case of a 56-year-old woman with intrahepatic biliary cystadenoma(IBC)accompanying a tumor embolus in the extrahepatic bile duct,who was admitted to our department on October 13,2008.Imaging showed an asymmetry dilation of the biliary tree,different bile signals in the biliary tree,a multiloculated lesion and an extrahepatic bile duct lesion with internal septation.A regular left hemihepatectomy en bloc was performed with resection of the entire tumor,during which a tumor embolus protruding into the extrahepatic bile duct and originating from biliary duct of segment 4 was revealed.Microscopically,the multiloculated tumor was confirmed to be a biliary cystadenoma with an epithelial lining composed of biliary-type cuboidal cells and surrounded by an ovarian-like stroma.An aggressive en bloc resection was recommended for the multiloculated lesion.Imaging workup,clinicians and surgeons need to be aware of this different presentation.

The relationship between surgery and prognosis of gallbladder carcinoma

OBJECTIVE: To explore the prognostic factors of gallbladder carcinoma and the relationship betweenoperative procedure and prognosis of gallbladder carcinoma.METHOD: A retrospective clinical analysis was made in 56 patients with gallbladder carcinoma who hadundergone surgery at our department from 1995 to 2001.RESULTS: Of the 56 patients, 20 were men and 36 women with a male to female ratio of 1:1. 56. Theirage ranged from 41 to 79 years with a mean of 59.6 years, Thirty-four patients suffered from gallstones.Abdominal pain (83.9%) and jaundice (41.1%) were the main symptoms. Thirty patients (Nevin stageⅡ in 5 patients, Ⅲ in 3, Ⅳ in 4, and Ⅴ in 18) received radical or extended radical resection; non-radicalresection was performed in 11 patients of Nevin stage Ⅴ; and 15 patients of Nevin stage Ⅴ were subjectedto biopsy with or without palliative bypass procedure. Statistical analysis showed that operative procedure,staging of Nevin, and gallstone affected significantly postoperative survival, but age, sex, preoperativeserum bilirubin level, numbers of tumor location, histopathological type and grade were not significantprognostic factors. After radical resection was classified with Nevin staging, we found that all the patientsof stage Ⅱ were alive. Meanwhile the postoperative survival periods of radical resection groups of stage Ⅲto Ⅴ, palliative resection group, and biopsy with/without palliative drainage group were statisticallydifferent.CONCLUSIONS: From Nevin stage Ⅱ to Ⅴ, the survival period of respective stage group, which treatedwith curative operation, became shorter gradually. In those patients of stage Ⅴ, the survival period ofcurative operation group was longer than that of palliative resection group, and that of the latter was betterthan that of biopsy with/without palliative drainage group. So radical resection was still the unique way tobetter prognosis.

Expression of AFPmRAN in blood of patients with recurrent hepatocellular carcinoma

OBJECTIVES: To detect the expression of human alpha-fetoprotein mRNA (AFPmRNA) in peripheralblood (PBL) of recurrent hepatocellular carcinoma (HCC) by using nested reverse transcriptasepolymerase chain reaction (nested RT-PCR) and to discuss relations between AFPmRNA and recurrentHCC.METHODS: Five ml peripheral blood samples were obtained from 19 patients with recurrent HCC. Toidentify HCC cells in PBL, liver-specific AFPmRNA was amplified from the total RNA extractedfrom the whole blood by nested RT-PCR.RESULTS: Seven patients (36.8%) with recurrent HCC were detected AFPmRNA, and 12 patients withrecurrent HCC were AFPmRNA negative (63.2%). There was no significant relation between patientswith AFPmRNA positive and AFPmRNA negative (P】0.05) in judging the origin of recurrent HCC.CONCLUSION: AFPmRNA may not be used as a marker of origin of recurrent HCC.