Radiological imaging findings may contribute to the differentiation of malignant biliary obstruction from choledocholithiasis in the etiology of acute cholangitis.
Radiological studies play a crucial role in the evaluation of patients with biliary duct obstruction,allowing for the guidance of clinical diagnosis towards a malignant or stone-induced etiology through the recognitio...Radiological studies play a crucial role in the evaluation of patients with biliary duct obstruction,allowing for the guidance of clinical diagnosis towards a malignant or stone-induced etiology through the recognition of relevant imaging features,which must be continuously revisited given their prognostic significance.This article aims to emphasize the importance of recognizing crucial imaging aspects of malignant and stone-induced biliary obstruction.展开更多
A 65-year-old woman was found to have dilatation of the intrahepatic bile duct in the right anterior segment during a general health. Laboratory data were within normal ranges and no solid mass was detected in her abd...A 65-year-old woman was found to have dilatation of the intrahepatic bile duct in the right anterior segment during a general health. Laboratory data were within normal ranges and no solid mass was detected in her abdominal computer tomography (CT) or nuclear magnetic resonance imaging (MRI). However, endoscopic retrograde cholangiopancreatography (ERCP) demonstrated an obstruction of the right bile duct. Intraoperative cholangiography showed stenosis of the intrahepatic bile duct in the anterior inferior segment (B5) and narrowness of the intrahepatic bile duct in the anterior superior segment (B8), so that we strongly suspected intrahepatic cholangiocarcinoma (ICC). Histologically, surgically resected liver specimens, without tumor mass by macroscopic observation, showed intraductal papillary proliferation with fibrovascular cores and intraductal spreading of carcinoma in situ throughout a considerable area, especially in bile ductules around the peripheral small portal area. Furthermore, the immunohistochemical profile of the tumor (MUC5AC+/CK7+) was compatible with an intraductal papillary neoplasm of the bile duct (IPN-B). Consequently, this case was diagnosed as IPN-B with spreading CIS, stageⅠ(pT1, pN0, P0, H1, M0). We report a case of IPN-B with interesting histopathologicalfindings and emphasize that cholangiography is especially helpful for the diagnosis of bile duct dilatation due to infiltration of carcinoma cells.展开更多
In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of fi ve metal stents for a distal common bile duct(CBD) stenosi...In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of fi ve metal stents for a distal common bile duct(CBD) stenosis.All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla.A profoundly dilated CBD with sludge and concrements was seen.To ensure adequate bile drainage an enteral metal stent was inserted in the CBD.This case shows that proximally migrated uncovered metal stents in the CBD can be safely removed endoscopically under certain circumstances.We suggest that in the case of a CBD drainage problem due to an extremely dilated CBD,placement of an enteral metal stent in the CBD could be considered,especially in patients who are unfi t for surgery.展开更多
Congenital bile duct dilatation (CBD) that developed in a parent and son is presented. Familial occurrence of CBD is rare, with only a few male cases having been reported. Since the initial report of CBD occurring in ...Congenital bile duct dilatation (CBD) that developed in a parent and son is presented. Familial occurrence of CBD is rare, with only a few male cases having been reported. Since the initial report of CBD occurring in siblings in 1981, a total of 20 cases (10 pairs) have been published as of 2007. Clinical and genetic features of CBD are discussed.展开更多
BACKGROUND Solid pseudopapillary neoplasms(SPNs)are rare tumors of the pancreas.Typically,they occur in young females,often have characteristic imaging features,such as cystic components and calcification,and have few...BACKGROUND Solid pseudopapillary neoplasms(SPNs)are rare tumors of the pancreas.Typically,they occur in young females,often have characteristic imaging features,such as cystic components and calcification,and have few effects on the pancreatic duct.CASE SUMMARY A 31-year-old man was admitted to our hospital with the chief complaint of epigastric pain.There was only mild tenderness in his upper abdomen,and blood tests showed only a slight increase in alkaline phosphatase.Contrast-enhanced computed tomography showed a 40-mm-diameter,hypovascular mass in the head of the pancreas,and the main pancreatic duct upstream of the mass was severely dilated.Magnetic resonance imaging showed low intensity on T1-weighted images,with high intensity on T2-weighted image in some parts.Pancreatic ductal adenocarcinoma was the primary differential diagnosis.Portal vein infiltration could not be ruled out,so this case was a candidate for neoadjuvant chemotherapy.Subsequently,endoscopic ultrasound-guided fine needle aspiration was performed,and pathological evaluation and immunostaining suggested a diagnosis of SPN.Thus,pancreatoduodenectomy was performed.One year after the operation,the patient is alive with no recurrence.CONCLUSION Main pancreatic duct dilatation is usually a finding of suspected pancreatic cancer.However,pancreatic duct dilatation can occur in SPN depending on the location and growth speed.Therefore,SPN should be considered in the differential diagnosis of tumors with pancreatic duct dilatation,and pathological evaluation by endoscopic ultrasound-guided fine needle aspiration should be actively performed.展开更多
The purpose of this paper was to evaluate the relationship between the thrombosis and secretory duct dilation, lesion size, clinical types, nature （primary or recurrent） and duration of illness in the development of...The purpose of this paper was to evaluate the relationship between the thrombosis and secretory duct dilation, lesion size, clinical types, nature （primary or recurrent） and duration of illness in the development of ranula. A total of 229 cases of sublingual gland cysts were treated with surgical resection from Jan. 1990 to Feb. 2010. The patients＇ data were investigated on histopathological findings, size of ranula, the clinical types, nature of ranula （primary or recurrent） and duration of illness. Sections from the paraffinembeded blocks were HE-stained. CK expression was immunohis-tochemically detected. Among 229 cases the incidence of venous thrombosis was 58.52%. The incidence of venous thrombosis with or without duct dilation was 73.25% and 26.39% respectively, with a significant difference between the two groups （P〈0.005）. The incidence of venous thrombosis of ranulas with diameter larger or less than 3 cm was 72.22% and 46.28% （P〈0.005）. The incidence of venous thrombosis of oral ranula, plunging ranula and mixed ranula was 49.37%, 77.19% and 85.71% respectively, with a significant difference found between oral and plunging or mixed ranula （P〈0.01）. The incidence of venous thrombosis in ranula patients with duration of illness longer or less than 3 months was 69.77% and 51.75% （P〈0.01）. The incidence of venous thrombosis with recurrent and primary ranulas was 51.85% and 64.85%, without a significant difference noted between them （P〉0.05）. It is concluded that the formation of venous thrombosis was related to the dilation of secretory duct, lesion size, clinical types, duration of lesion but formation of venous thrombosis was not related to the nature （primary or recurrent） of ranulas.展开更多
BACKGROUND: Reports on the relationship between pancreaticobiliary maljunction (PBM) and gallbladder carcinoma (GBC) are conflicting. The frequency of PBM in GBC patients and the clinical features of GBC patients with...BACKGROUND: Reports on the relationship between pancreaticobiliary maljunction (PBM) and gallbladder carcinoma (GBC) are conflicting. The frequency of PBM in GBC patients and the clinical features of GBC patients with PBM vary in different studies. DATA SOURCES: English-language articles describing the association between PBM and GBC were searched in the PubMed and Web of Science databases. Nine case-control studies fulfilled the inclusion criteria and addressed the relevant clinical questions of this analysis. Data were extracted independently by two reviewers using a predefined spreadsheet. RESULTS: The incidence of PBM was higher in GBC patients than in controls (10.60% vs 1.76%, OR: 7.41, 95% CI: 5.03 to 10.87, P<0.00001). The proportion of female patients with PBM was 1.96-fold higher than in GBC patients without PBM (80.5% vs 62.9%, OR: 1.96, 95% CI: 1.09 to 3.52, P=0.12). GBC patients with PBM were 10 years younger than those without PBM (SMD: -9.90, 95% CI: -11.70 to -8.10, P<0.00001). And a difference in the incidence of associated gallstone was found between GBC patients with and without PBM (10.8% vs 54.3% OR: 0.09, 95% CI: 0.05 to 0.17, P<0.00001). Among the GBC patients with PBM, associated congenital dilatation of the common bile duct was present with a higher incidence ranging from 52.2% to 85.7%, and 70.0%-85.7% of them belonged to the P-C type of PBM (the main pancreatic duct enters the common bile duct). No substantial heterogeneity was found and no evidence of publication bias was observed.CONCLUSIONS: PBM is a high-risk factor for developing GBC, especially the P-C type of PBM without congenital dilatation of the common bile duct. To prevent GBC, laparoscopic cholecystectomy is highly recommended for PBM patients without congenital dilatation of the common bile duct, especially relatively young female patients without gallstones.展开更多
Type Ⅳ-A choledochal cysts (CCs) are a congenital biliary anomaly which involve dilatation of the extrahepatic and intrahepatic bile ducts. We present the case of a 30-year-old woman with type Ⅳ-A CC, on whom threed...Type Ⅳ-A choledochal cysts (CCs) are a congenital biliary anomaly which involve dilatation of the extrahepatic and intrahepatic bile ducts. We present the case of a 30-year-old woman with type Ⅳ-A CC, on whom threedimensional computed tomography (3D CT) and virtual endoscopy were performed. 3D CT revealed partial dilatation in the posterior branch of the intrahepatic bile duct and a relative stricture between it and the extrahepatic bile duct. Virtual endoscopy showed that this stricture was membrane-like and separated from the surrounding blood vessels. Based on these image findings, complete cyst resection, bile duct plasty for the stricture, and hepaticojejunostomy were safely performed. To the best of our knowledge, there are no reports of imaging by virtual endoscopy of the biliary tract which show the surrounding blood vessels running along the bile duct.展开更多
文摘Radiological imaging findings may contribute to the differentiation of malignant biliary obstruction from choledocholithiasis in the etiology of acute cholangitis.
文摘Radiological studies play a crucial role in the evaluation of patients with biliary duct obstruction,allowing for the guidance of clinical diagnosis towards a malignant or stone-induced etiology through the recognition of relevant imaging features,which must be continuously revisited given their prognostic significance.This article aims to emphasize the importance of recognizing crucial imaging aspects of malignant and stone-induced biliary obstruction.
文摘A 65-year-old woman was found to have dilatation of the intrahepatic bile duct in the right anterior segment during a general health. Laboratory data were within normal ranges and no solid mass was detected in her abdominal computer tomography (CT) or nuclear magnetic resonance imaging (MRI). However, endoscopic retrograde cholangiopancreatography (ERCP) demonstrated an obstruction of the right bile duct. Intraoperative cholangiography showed stenosis of the intrahepatic bile duct in the anterior inferior segment (B5) and narrowness of the intrahepatic bile duct in the anterior superior segment (B8), so that we strongly suspected intrahepatic cholangiocarcinoma (ICC). Histologically, surgically resected liver specimens, without tumor mass by macroscopic observation, showed intraductal papillary proliferation with fibrovascular cores and intraductal spreading of carcinoma in situ throughout a considerable area, especially in bile ductules around the peripheral small portal area. Furthermore, the immunohistochemical profile of the tumor (MUC5AC+/CK7+) was compatible with an intraductal papillary neoplasm of the bile duct (IPN-B). Consequently, this case was diagnosed as IPN-B with spreading CIS, stageⅠ(pT1, pN0, P0, H1, M0). We report a case of IPN-B with interesting histopathologicalfindings and emphasize that cholangiography is especially helpful for the diagnosis of bile duct dilatation due to infiltration of carcinoma cells.
文摘In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of fi ve metal stents for a distal common bile duct(CBD) stenosis.All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla.A profoundly dilated CBD with sludge and concrements was seen.To ensure adequate bile drainage an enteral metal stent was inserted in the CBD.This case shows that proximally migrated uncovered metal stents in the CBD can be safely removed endoscopically under certain circumstances.We suggest that in the case of a CBD drainage problem due to an extremely dilated CBD,placement of an enteral metal stent in the CBD could be considered,especially in patients who are unfi t for surgery.
文摘Congenital bile duct dilatation (CBD) that developed in a parent and son is presented. Familial occurrence of CBD is rare, with only a few male cases having been reported. Since the initial report of CBD occurring in siblings in 1981, a total of 20 cases (10 pairs) have been published as of 2007. Clinical and genetic features of CBD are discussed.
文摘BACKGROUND Solid pseudopapillary neoplasms(SPNs)are rare tumors of the pancreas.Typically,they occur in young females,often have characteristic imaging features,such as cystic components and calcification,and have few effects on the pancreatic duct.CASE SUMMARY A 31-year-old man was admitted to our hospital with the chief complaint of epigastric pain.There was only mild tenderness in his upper abdomen,and blood tests showed only a slight increase in alkaline phosphatase.Contrast-enhanced computed tomography showed a 40-mm-diameter,hypovascular mass in the head of the pancreas,and the main pancreatic duct upstream of the mass was severely dilated.Magnetic resonance imaging showed low intensity on T1-weighted images,with high intensity on T2-weighted image in some parts.Pancreatic ductal adenocarcinoma was the primary differential diagnosis.Portal vein infiltration could not be ruled out,so this case was a candidate for neoadjuvant chemotherapy.Subsequently,endoscopic ultrasound-guided fine needle aspiration was performed,and pathological evaluation and immunostaining suggested a diagnosis of SPN.Thus,pancreatoduodenectomy was performed.One year after the operation,the patient is alive with no recurrence.CONCLUSION Main pancreatic duct dilatation is usually a finding of suspected pancreatic cancer.However,pancreatic duct dilatation can occur in SPN depending on the location and growth speed.Therefore,SPN should be considered in the differential diagnosis of tumors with pancreatic duct dilatation,and pathological evaluation by endoscopic ultrasound-guided fine needle aspiration should be actively performed.
文摘The purpose of this paper was to evaluate the relationship between the thrombosis and secretory duct dilation, lesion size, clinical types, nature （primary or recurrent） and duration of illness in the development of ranula. A total of 229 cases of sublingual gland cysts were treated with surgical resection from Jan. 1990 to Feb. 2010. The patients＇ data were investigated on histopathological findings, size of ranula, the clinical types, nature of ranula （primary or recurrent） and duration of illness. Sections from the paraffinembeded blocks were HE-stained. CK expression was immunohis-tochemically detected. Among 229 cases the incidence of venous thrombosis was 58.52%. The incidence of venous thrombosis with or without duct dilation was 73.25% and 26.39% respectively, with a significant difference between the two groups （P〈0.005）. The incidence of venous thrombosis of ranulas with diameter larger or less than 3 cm was 72.22% and 46.28% （P〈0.005）. The incidence of venous thrombosis of oral ranula, plunging ranula and mixed ranula was 49.37%, 77.19% and 85.71% respectively, with a significant difference found between oral and plunging or mixed ranula （P〈0.01）. The incidence of venous thrombosis in ranula patients with duration of illness longer or less than 3 months was 69.77% and 51.75% （P〈0.01）. The incidence of venous thrombosis with recurrent and primary ranulas was 51.85% and 64.85%, without a significant difference noted between them （P〉0.05）. It is concluded that the formation of venous thrombosis was related to the dilation of secretory duct, lesion size, clinical types, duration of lesion but formation of venous thrombosis was not related to the nature （primary or recurrent） of ranulas.
文摘BACKGROUND: Reports on the relationship between pancreaticobiliary maljunction (PBM) and gallbladder carcinoma (GBC) are conflicting. The frequency of PBM in GBC patients and the clinical features of GBC patients with PBM vary in different studies. DATA SOURCES: English-language articles describing the association between PBM and GBC were searched in the PubMed and Web of Science databases. Nine case-control studies fulfilled the inclusion criteria and addressed the relevant clinical questions of this analysis. Data were extracted independently by two reviewers using a predefined spreadsheet. RESULTS: The incidence of PBM was higher in GBC patients than in controls (10.60% vs 1.76%, OR: 7.41, 95% CI: 5.03 to 10.87, P<0.00001). The proportion of female patients with PBM was 1.96-fold higher than in GBC patients without PBM (80.5% vs 62.9%, OR: 1.96, 95% CI: 1.09 to 3.52, P=0.12). GBC patients with PBM were 10 years younger than those without PBM (SMD: -9.90, 95% CI: -11.70 to -8.10, P<0.00001). And a difference in the incidence of associated gallstone was found between GBC patients with and without PBM (10.8% vs 54.3% OR: 0.09, 95% CI: 0.05 to 0.17, P<0.00001). Among the GBC patients with PBM, associated congenital dilatation of the common bile duct was present with a higher incidence ranging from 52.2% to 85.7%, and 70.0%-85.7% of them belonged to the P-C type of PBM (the main pancreatic duct enters the common bile duct). No substantial heterogeneity was found and no evidence of publication bias was observed.CONCLUSIONS: PBM is a high-risk factor for developing GBC, especially the P-C type of PBM without congenital dilatation of the common bile duct. To prevent GBC, laparoscopic cholecystectomy is highly recommended for PBM patients without congenital dilatation of the common bile duct, especially relatively young female patients without gallstones.
文摘Type Ⅳ-A choledochal cysts (CCs) are a congenital biliary anomaly which involve dilatation of the extrahepatic and intrahepatic bile ducts. We present the case of a 30-year-old woman with type Ⅳ-A CC, on whom threedimensional computed tomography (3D CT) and virtual endoscopy were performed. 3D CT revealed partial dilatation in the posterior branch of the intrahepatic bile duct and a relative stricture between it and the extrahepatic bile duct. Virtual endoscopy showed that this stricture was membrane-like and separated from the surrounding blood vessels. Based on these image findings, complete cyst resection, bile duct plasty for the stricture, and hepaticojejunostomy were safely performed. To the best of our knowledge, there are no reports of imaging by virtual endoscopy of the biliary tract which show the surrounding blood vessels running along the bile duct.
