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Biliary Tract Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Hemant M. Kocher, Vincent S. Yip, Ajit T. Abraham
The difficult tumors at the confluence of the right and left ducts are sometimes eponymously referred to as Klatskin tumors, after Klatskin’s report of 13 cases in 1965.31 Intra-hepatic cholangiocarcinomas could be histologically classified as mass-forming, periductal infiltrating, intraductal, or mixed, which may be related to their prognosis as well as getting a R0 resection.32 Bile duct tumors spread to the lymph node groups along the proper and common hepatic arteries; coeliac nodes; and, for distally placed lesions, retropancreatic and superior mesenteric nodes. It is important to sample lymph nodes when considering curative resection and when resecting tumors to skeletonize the hepatic artery and remove all lymphatic tissues and associated neural tissue. These tumors have a propensity for spread along the sub-epithelial planes and for longitudinal perineural and lympho-vascular invasion, both proximally and distally. Such invasion has a negative impact on survival.32,33 This histological feature presents challenges in pre- and intra-operative diagnosis, as choledochoscopic biopsies may underestimate the extent of tumor. Bile duct cancer may give rise to very well-differentiated nests of biliary epithelial cells within lymph nodes. Lymph node metastases have been seen to the left supraclavicular lymph nodes (Virchow’s sign).
The liver, gallbladder and pancreas
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Dina G. Tiniakos, Alastair D. Burt
This is usually associated with ulcerative colitis. There is fibrous obliteration of bile ducts (Figure 11.8). Larger ducts and even extrahepatic bile ducts may be affected. These patients are at risk of developing bile duct cancer – cholangiocarcinoma. In both primary biliary cholangitis and primary sclerosing cholangitis periportal hepatocyte injury occurs and, in the early disease stages, there is often proliferation of poorly formed ductular structures (ductular reaction). This is probably a regenerative phenomenon.
The liver
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Diagnosis of CCA in PSC is greatly facilitated by biliary brush cytology and direct endoscopic inspection (Spyglass, see above), as imaging rarely shows evidence of a mass lesion even in patients with advanced CCA. Further, imaging cannot reliably differentiate between inflammatory and malignant biliary strictures. Serum CA 19-9 level may be increased but the sensitivity of CA 19-9 in detecting CCA in PSC is only 60%. Patients with good liver function, no dominant strictures and negative biliary cytology may simply be monitored for disease progression. The only useful treatment modality is liver transplantation, which is associated with excellent results if carried out before bile duct cancer has developed. Temporary relief of obstructive jaundice due to a dominant bile duct stricture can be achieved by biliary stenting, although there is considerable risk of cholangitis from the introduction of bacteria to the biliary tract.
Second Primary Malignancies following a Diagnosis of Conjunctival Melanoma
Published in Current Eye Research, 2022
Heba Mahjoub, Asad Loya, Talha Ayaz, Christina Y. Weng
Interestingly, there was an increased incidence of second primary non-intrahepatic biliary malignancies observed in our primary CM cohort. This association was statistically significant only in the 65+ age group and only after 10 years from initial diagnosis. One biliary malignancy was extrahepatic bile duct cancer, while the other biliary malignancy was characterized as “biliary tract, not otherwise specified.” Bile duct cancer, also known as cholangiocarcinoma, rarely occurs before the age of 40, and most often arises after the age of 70.51,52 The majority of risk factors for cholangiocarcinoma – parasitic infections, toxins, primary sclerosing cholangitis, hepatolithiasis, and biliary-duct cysts – do not overlap with CM risk factors,53 and this observation may be confounded by a small sample. Larger studies are warranted.
Assessing prognosis in cholangiocarcinoma: a review of promising genetic markers and imaging approaches
Published in Expert Opinion on Orphan Drugs, 2020
Fabio Bagante, Marzia Tripepi, Gaya Spolverato, Diamantis I. Tsilimigras, Timothy M. Pawlik
In a recent review, Louis et al. reported an integrated classification of bile duct cancer (BDC) according to anatomical, histo-morphological, and molecular features (Table 1) [21]. iCCA was characterized by IDH1/2 mutations and FGFR2 gene fusion, which may be a reliable target for innovative treatments; pCCA has been characterized by more frequent KRAS and TP53 mutations [21].Ruzzenente et al. analyzed the molecular profile of 91 bile duct cancers undergoing curative surgery, including 56 pCCA, and 35 iCCA. In this study, pCCA had a higher incidence of mutations in KRAS (47% p < 0.001) and TP53 (23% p = 0.032) genes, while there was a higher incidence of mutation in IDH1 (17%, p = 0.035) and NRAS (17%, p = 0.008) genes among iCCA patients. Of note, mutations in IDH1, BRAF, and TP53 were associated with a poor prognosis [22]. The prognostic role of IDH1 mutations in iCCA has been debated. Zhu Ax et al. examined the mutational tumor profile of 200 patients who underwent surgery for iCCA and reported that IDH1 and KRAS were the most frequent genes mutated with an incidence of 15% and 8%, respectively; yet, these genes were not associated with long-term prognosis [23]. In a separate study, Kipp et al. reported on 94 patients (67 iCCA and 27 pCCA/dCCA patients) who underwent curative surgery and reported an the incidence of IDH1/2 of 28% and 7% among iCCA and pCCA/dCCA patients, respectively; IDH1/2 mutations were not associated with prognosis [24].
Gold nano particles synthesized from Strychni semen and its anticancer activity in cholangiocarcinoma cell (KMCH-1)
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2019
Yuehua Li, Yang Ke, Hao Zou, Kun Wang, Songquan Huang, Thamaraiselvan Rengarajan, Lin Wang
Even though there has been enormous innovation in indicative technique, surgical treatment and the development of new anti-cancer agent, the upshot of patients with bile duct cancer has improved discreetly in the past. In contrast to other metals, gold is environmentally friendly and low cost. Production of nanoparticles from plant extracts is an unsophisticated practice, in which metal salt is departed with plant extract and finishing point of reaction takes place within a short period. Specifically, gold nanoparticles (AuNPs) are non-toxic when compared to other metallic nanoparticles [22,23]. Nanoparticles separation in plants can be flattering over all other organic technique by eradicating the complicated process of preserving cell cultures [24]. In the present study, we recognized the Strychni Semen arbitrates the produced AuNPs by UV-visible absorbance. A mounting reflection of Strychni Semen seed extracts direct towards the improved intensity of absorption.