Tando
Online ISSN : 1883-6879
Print ISSN : 0914-0077
ISSN-L : 0914-0077
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Volume 28, Issue 5
Displaying 1-16 of 16 articles from this issue
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Original Articles
  • Profile of intrahepatic cholangiocarcinoma associated hepatolithiasis
    Hideki Sasanuma, Naohiro Sata, Kazuhiro Endo, Masaru Koizumi, Yoshikaz ...
    2014 Volume 28 Issue 5 Pages 741-746
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.741
    JOURNAL FREE ACCESS
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    Case-profile investigation of intrahepatic cholangiocarcinoma associated hepatolithiasis was conducted by the Research Program of Intractable Disease provided by the Ministry of Health, Labor, and Welfare of Japan. From 1990 to 2009, 696 patients with hepatolithiasis including 37 concomitant cholangiocarcinomas were recruited from 26 institutions. Patients with prolonged histories of having stones were dominant in the 1990s, while recently, patients were frequently diagnosed with intrahepatic cholangiocarcinoma concurrent with hepatolithiasis. Patients with cholangiocarcinoma diagnosed with intrahepatic tumors represented the majority and had worse outcomes compared to patients initially diagnosed with stenosis or obstructing stones in the intrahepatic bile ducts. Most patients were histopathologically confirmed and evaluated using historical modalities such as ERC, PTC, or PTCS. Newer modalities such as MRI-DWI and FDG-PET, which became available in the 2000s, were hard to evaluate due to an inadequate number of cases. This work was supported partially by the Research Program of Intractable Disease provided by the Ministry of Health, Labor, and Welfare of Japan.
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  • Pathological study of local excision for polyp type ampullary cancer
    Yoshiki Naito, Tetsuji Akiyama, Naoyo Nishida, Koichi Higaki
    2014 Volume 28 Issue 5 Pages 747-755
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.747
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    Localization of cancer is critical to perform local excision for polyp type ampullary cancer (pAC). Imaging diagnosis is, however, limited in exactly identifying the tumor location. We studied four cases of pAC to determine whether or not preoperative identification of tumor location, subtypes, and malignancy potential was possible. All cases were early cancer. In three of four cases (Cases 1, 2, and 4), the tumor was located from the duodenum to the common channel of the major duodenal papilla, and the remaining cases were localized in the duodenum throughout the duodenal papilla only in Case 3. Expression of CK7, CK20, and CD10 was observed by staining of the resected tissues in Cases 1, 2, and 4, while only CK20 and CD10 expression were observed in Case 3. In preoperative biopsy tissues, only the results of CK7 staining in Case 4 were significantly different from the resected tissue. Other preoperative biopsy tissues were consistent with the staining behavior of resected tissues. MUC1 and MUC2 staining indicated intestinal type with better prognosis in all cases. In conclusion, CK7, CK20, CD10, MUC1, and MUC2 staining in preoperative biopsy tissues could provide information on the tumor location, subtypes, and malignancy potential in pAC.
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Review Articles
  • Liver Transplantation for Cholangiocarcinoma
    Tomoharu Yoshizumi, Ken Shirabe, Yoshihiko Maehara
    2014 Volume 28 Issue 5 Pages 756-762
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.756
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    Neoadjuvant chemoradiotherapy followed by liver transplantation (LT) is reported as an effective treatment for patients with unresectable hilar cholangiocarcinoma, with 5-year survival is around 70%. Historically, liver transplantation alone is equally poor treatment in multiple reports. Success requires careful patient selection to exclude patients with advanced disease and regional lymph node metastasis that are destined to develop distant metastasis. Due to cadaveric donor shortage, cadaveric liver transplantation is permitted for liver cancer within Milan criteria in Japan. Therefore, living donor liver transplantation (LDLT) is required for patients with known unresectable hilar cholangiocarcinoma. Primary sclerosing cholangitis (PSC) is accompanied by an increased risk of cholangiocarcinoma. The problem is high recurrence rate of PSC is known after LDLT compared to cadaveric LT. Further discussion is needed whether indication of LDLT should be widened for patients with cholangiocarcinoma in Japan. We herein review recent reports from western countries, and summarize our data of LDLT for cholangiocarcinoma.
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  • Outbreak of cholangiocarcinoma developing in printing company workers: new occupational disease
    Shoji Kubo, Shigekazu Takemura, Chikaharu Sakata, Shogo Tanaka, Yasuni ...
    2014 Volume 28 Issue 5 Pages 763-771
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.763
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    An outbreak of cholangiocarcinoma occurred among young adult workers in the offset color proof-printing department at a printing company in Japan. They were exposed to chemicals, including dichloromethane and 1,2-dichloropropane. The measurement of liver function tests and tumor markers, and ultrasonography was useful to detect the cholangiocarcinoma in a regular health examination. Dilated intrahepatic bile ducts without tumor-induced obstruction as well as a space-occupying lesion, bile duct stenosis, and dilatation of bile duct due to main tumor were observed in diagnostic imaging. The cholangiocarcinomas arose from the large bile ducts. The precancerous or early cancerous lesions, such as biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile ducts, as well as non-specific bile duct injuries, such as fibrosis, were observed in various sites of the bile ducts. The cholangiocarcinoma are now recognized as a new occupational disease.
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Case Reports
  • A case of xanthogranulomatous cholecystitis distinguished from hepatic invasion of gallbladder cancer using contrast-enhanced ultrasonography
    Tomoaki Takeyama, Hiroshi Matsubara, Fumihiro Urano, Motokazu Fujita, ...
    2014 Volume 28 Issue 5 Pages 772-777
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.772
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    A 49-year-old male was admitted with right upper quadrant pain. CT, US, and MRI showed abnormal thickening of gallbladder wall with multiple cystic components. The border between gallbladder wall and liver was unclear. We suspected xanthogranulomatous cholecystitis (XGC), but cannot deny gallbladder carcinoma with hepatic invasion. To confirm tentative diagnosis, we performed contrast-enhanced US (CE-US). In the early phase of the CE-US, the gallbladder wall was homogenously enhanced, and all the cystic components were in the thickened wall. And then, in the later phase of the CE-US, the border between gallbladder wall and liver became clear. On the basis of these examinations, we diagnosed as XGC, rather than gallbladder carcinoma with hepatic invasion. Open cholecystectomy was performed and histopathological diagnosis was XGC.
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  • Late biliary stricture after laparoscopic right hepatectomy
    Yusuke Ome, Kazuki Hashida
    2014 Volume 28 Issue 5 Pages 778-784
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.778
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    A 77-year-old female had undergone laparoscopic right hepatectomy for a hepatocellular carcinoma of 9 cm following right portal embolization. Fifteen months later, she was hospitalized with obstructive jaundice. Since examinations showed no evidence of tumor recurrence, we diagnosed it as jaundice caused by late benign postoperative stricture. We performed intrahepatic cholangiojejunostomy with partial hepatectomy of segment IVa after endoscopic nasobiliary drainage, which successfully made normal intrahepatic duct clearly exposed. She has not experienced obstructive jaundice since then, and no signs of recurrence of hepatocellular carcinoma have been found. The late biliary stricture after laparoscopic right hepatectomy has been rarely reported, however, it could be well managed by intrahepatic cholangiojejunostomy.
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  • Cholangiocellular carcinoma developed in a patient with autoimmune pancreatitis and IgG4-related sclerosing cholangitis during long follow-up periods
    Osamu Hasebe, Yasuhide Ochi, Tetsuya Ito, Soichi Narumoto, Noriko Hosa ...
    2014 Volume 28 Issue 5 Pages 785-793
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.785
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    A 81-year-old male who had been followed up with autoimmune pancreatitis and diabetes mellitus for fifteen years admitted to our hospital due to abnormal liver function test and hepatic mass. US, CT, MRI, ERCP and IDUS revealed a low density mass in 40 mm diameter at segment 4 of the liver, dilatation of biliary tract and wall thickness of hilar bile duct. As transpapillary bile duct biopsy showed poorly differentiated adenocarcinoma, he was clinically diagnosed as cholangiocellular carcinoma extended to hepatic hilum. Surgical resection could not be done because of delirium and his rejection. Biliary stenting was performed via PTBD route, but he died suddenly nine months after clinical onset. When we encounter with hepatic mass or stenosis of hilar bile duct mimicking IgG4-SC in patients with autoimmune pancreatitis, it is important to perform histological examinations to rule out malignancy.
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  • A case of intraductal papillary-mucinous neoplasm of the pancreas combined with pancreatobiliary fistula
    Masato Kayahara, Ichirou Ohnishi, Hisatoshi Nakagawara, Hirohisa Kitag ...
    2014 Volume 28 Issue 5 Pages 794-799
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.794
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    Fistula formation associated with an IPMN was rarely reported. It is difficult to control obstructive cholangitis for patients with pancreatobiliary fistula because of the massive mucin production. A 76-year-old man was admitted to the Kanazawa University Hospital for the treatment of obstructive jaundice and septic shock caused by fistula formation associated with an IPMN. Because of the unsatisfactory effect of biliary drainage by ENBD, PTBD was performed. In spite of the frequent IC of treatment, he did not accept surgical resection. Therefore, double-bypass method which consisted of hepaticojejunostomy, distal choledocojejunostomy, and Braun anstomosis was performed. His postoperative course was uneventful. Nutritional status was poor because of the insufficient pancreatic enzyme. After administration of enteric coated pancrealipase, the level of albumin has increased until 4 g/dL. His nutritional status has been good and no re-admission for cholangitis was experienced 5 years after surgery. Double-bypass method is one of the useful surgical procedure for patients with pancreatobiliary fistula formation by IPMN.
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  • B-cell type lymphoblastic leukemia/lymphoma mimicking of autoimmune pancreatitis with sclerosing cholangitis
    Shinya Kawaguchi, Rei Yamamoto, Mitsuhiro Yamamura, Jun Oyamada, Tadas ...
    2014 Volume 28 Issue 5 Pages 800-807
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.800
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    A 70-year-old female was admitted to our hospital with the complaint of upper abdominal pain in August 2011. Diffuse swelling of the pancreas, diffuse irregular narrowing of the main pancreatic duct, lower bile duct stenosis and bile duct wall thickness were observed. Although these findings suggested that she was suffering from autoimmune pancreatitis (AIP) with sclerosing cholangitis, neither anti-nuclear antigen nor an increased serum level of IgG-IgG4 was detected. The biopsy specimens obtained by EUS-FNA revealed no malignancy. The patient was diagnosed as AIP with sclerosing cholangitis. Steroid therapy improved the swelling of pancreas and narrowing of the main pancreatic duct. But, the patient was relapsed, and at last she was diagnosed as B-cell type lymphoblastic leukemia according to several immunohistochemical stainings. After 2 years of chemotherapy, Diffuse swelling of the pancreas was improved, showing complete remission. This patient has no recurrence for over 2 years.
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  • A Case of Hemorrhagic Cholecystitis during Anticoagulant Therapy after Cerebral Infarction
    Hiroshi Matsukiyo, Manabu Watanabe, Koji Asai, Tomoaki Saito, Hajime K ...
    2014 Volume 28 Issue 5 Pages 808-814
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.808
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    A 68-year-old woman was admitted to our hospital with cerebral infarction. Anticoagulant therapy was initiated following thrombolytic therapy. Although the patient initially responded well to treatment, she suddenly developed abdominal pain after eating. Laboratory data indicated inflammation as well as severe and rapid liver dysfunction. Therefore, we made a diagnosis of acute hemorrhagic cholecystitis with hemobilia. Firstly endoscopic therapy was undergone for hemobilia and obstruction of bile duct with liver dysfunction during anticoagulant therapy. However, it was very difficult to perform the endoscopic therapy. Hence, we suspected perforation of the bile duct and duodenum and performed an emergency laparotomy. A region of the perforation could not be clearly observed; therefore, we finally chose cholecystectomy and placed a drainage tube in the bile duct for intraperitoneal drainage. The patient's postoperative course was uneventful. We emphasize that early diagnosis of hemorrhagic cholecystitis is very important and therapy should be initiated without delay.
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  • A case report of rapidly progressive gall bladder cancer that showed differentiation to the choriocarcinoma
    Takehiko Hanaki, Teruhisa Sakamoto, Joji Watanabe, Naruo Tokuyasu, Tak ...
    2014 Volume 28 Issue 5 Pages 815-820
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.815
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    A 60-year-old woman was referred to our department after a gall bladder tumor was identified by ultrasonography. While she was undergoing tests for general anesthesia, sudden abdominal pain became evident, followed by decrease in blood pressure and progressive anemia. Emergency computed tomography led to a diagnosis of intraperitoneal hemorrhage due to the rupture of an intrahepatic lesion, and hemostasis was performed by emergency interventional radiology. For the reason of imminent re-rupture risk, central hepatectomy (segment IV, V and VIII resection) en-blocking with gallbladder and extra-hepatic bile-duct resection was performed. On histopathological examination, tissue showing the morphological characteristics of choriocarcinoma was widespread in the area of hepatic infiltration and also was seen in the metastatic area in the liver and lymph node. Occurrence of choriocarcinoma in the gall bladder is extremely rare. Here, we summarize this case along with five previously reported cases and provide a short discussion of the literature.
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  • A case of gallstone ileus of colon with cholecystcolic fistula
    Takayuki Shimizu, Masato Kato, Azusa Terasaki, Takayuki Kosuge, Mitsug ...
    2014 Volume 28 Issue 5 Pages 821-826
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.821
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    A gallstone ileus with cholecystocolic fistula is very rare. An 81-year-old woman was introduced to our hospital for gallstone ileus. She was admitted to the previous hospital, complaining of vomit and abdominal pain. An abdominal CT showed ileus and a gallstone in the sigmoid colon. Transanal discharge was expected, but the stone was not defecated and she was introduced to our hospital for operation. Cholecystotransversecolic fistula and impacted gallstone in sigmoid colon were confirmed. We performed cholecystectomy, closure of fistula, partial sigmoidectomy, and colostomy. Her postoperative course was uneventful. We report this rare case with review of the literature.
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  • A case of gallbladder cancer which was diagnosed in the follow-up term for post acute cholecystitis
    Isamu Yamada, Hirohiko Onoyama, Toshiya Inoue, Tetsuya Yamaguchi, Tets ...
    2014 Volume 28 Issue 5 Pages 827-832
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.827
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    A 78-year old man with fever and abdominal pain was admitted to our hospital with acute cholecystitis. Conservative treatment did not improve his condition. We performed PTGBD, and he recovered immediately. Diagnostic imaging did not reveal the cause of the cystic duct obstruction and he declined a cholecystectomy. After six months, US and CT showed not only continued wall thickness, but also an elevated (timorous) lesion of the gallbladder. The tumor marker CA19-9 was continuously elevated and we diagnosed carcinoma of the gallbladder. However, he declined to undergo surgery. One year after the onset of acute cholecystitis, he finally underwent wedge resection of the gallbladder bed and regional lymphadenectomy. The pathologic findings showed; adenocarcinoma, tub1, pHinf2, pN1, stage IVa and he underwent chemotherapy with gemcitabine. However, liver and lymph node metastases were detected three months after the operation and he died from the disease ten months after surgery.
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Specialized Course for Biliary Expert
Carcinoma of the Major Papilla
  • Surgical treatment for carcinoma of the Ampulla of Vater
    Yoshiyuki Matsumura, Satoshi Hirano
    2014 Volume 28 Issue 5 Pages 833-839
    Published: December 31, 2014
    Released on J-STAGE: January 28, 2015
    DOIhttps://doi.org/10.11210/tando.28.833
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    Patients with carcinoma of the ampulla of Vater have high rate of curative resectability and relatively good prognosis. They are generally treated by pancreatoduodenectomy (PD) with systematic lymphadenectomy. The safety of PD for ampullary cancer has gradually increased, however, postoperative morbidity and mortality have still remind in high range. Therefore some procedures of local resection including transduodenal papillectomy has been attempted as an alternative to PD for patients with carcinoma in adenoma and T1 cancers without lymph node metastasis. However, it is difficult to select the patient who could be treated adequately with local resection because the precise diagnostic procedures for malignancy, depth of invasion of the tumor, and lymph node metastasis have been under investigation. Further improvement of the preoperative diagnostic accuracy could lead to perform more appropriate treatment for each patient.
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Commentary of Imagings
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