Gastrointestinal and hepatobiliary
Dave Maudgil, Anthony Watkinson in The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
False.True.Previous gastric surgery may render a percutaneous approach difficult or impossible. The presence of varices considerably increases the risks of the procedure and may necessitate an endoscopic or combined approach. Interposed bowel should be actively excluded before gastric puncture. True.False.True.False.False.Risk factors for development of cholangiocarcinoma include: primary sclerosing cholangitis, hepatolithiasis, ulcerative colitis, biliary parasites, specific oncogenes and congenital malformations such as choledochal cysts. Cholangiocarcinomas are generally adenocarcinomas and are more common in men. Two-thirds are located at the liver hilum. During treatment, complications occur more commonly via the transhepatic than the endoscopic route. False.False.False.True.True.Capsular invasion occurs in 40% of HCC. There is portal vein invasion in 60% at autopsy, which is an important clue in the diagnosis of HCC, as less than 8% of portal vein tumours are due to other malignancies.
Biliary tract cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2014
The treatment options for cholangiocarcinoma are determined by the stage of the disease in terms of local extent, vascular involvement and presence or absence of metastases.
Biliary Tract Cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2020
However, correlation with the extent of resected cholangiocarcinoma suggests that MRCP underestimates the extent of disease in up to 20% of malignant hilar strictures. In most tertiary referral centers, patients usually undergo combined MRI plus MRCP as well as ceCT. ERCP and percutaneous trans-hepatic cholangiography (PTC) are invasive modalities that allow therapeutic drainage and washings, brushings, and even intraductal biopsies to be obtained for cytopathological analysis. The diagnostic yield is low, although sensitivity may be increased by techniques such as fluorescent in situ hybridization. The choice between PTC and ERCP is usually determined by local expertise, availability, and failure of one or the other technique, usually ERCP. PTC is preferable for more proximal strictures, and at times a combination of both procedures is required. These invasive techniques carry the risk of procedural complications (up to 9%), including bleeding, biliary leakage, pancreatitis, cholangitis, and duodenal perforation. Per-oral cholangioscopy, also called SpyGlass cholangioscopy as well as PTC cholangioscopy, is performed in specialized centers, where biopsy can be obtained under direct vision. Laparoscopy can detect small-volume peritoneal disease or liver secondaries missed in cross-sectional imaging, although it is less accurate for vascular invasion, lymph node involvement, and extent of biliary spread. The combination of laparoscopy with laparoscopic ultrasound may prevent unnecessary laparotomy in up to a third of patients with hilar or gall bladder cancer deemed resectable radiologically, with an accuracy of 48% for hilar cholangiocarcinomas. Histological and cytological confirmation is necessary for the definitive diagnosis of cholangiocarcinoma. Brush cytology is positive only in about 30% of cases, but combining cytology with endoscopic biopsy may enable correct diagnosis in 40–70% of cases of cholangiocarcinoma. Immunohistochemical markers such as CA19-9 and CA50 may distinguish cholangiocarcinoma from hepatocellular carcinoma (positive for HepPar1), and staining with anti-cytokeratin type-1 (monoclonal antibody AE1) could distinguish a biliary tract rather than hepatocyte origin. Histological diagnosis is not mandatory prior to surgical exploration. Positron emission tomography (PET) using the nucleotide tracer 18-F-fluorodeoxyglucose can detect mass-like nodular cholangiocarcinoma lesions as well as the presence of distant metastases. This ability of PET to detect distant metastases may alter surgical management in up to 30% of cases. PET is less useful for patients with infiltrating lesions and those with stents in situ or background primary sclerosing cholangitis. Endoscopic ultrasound (EUS) increasingly plays a role in the diagnosis of cholangiocarcinoma and can detect duct dilatation and lymphadenopathy and also guide fine-needle aspiration for cytological diagnosis. EUS-guided fine-needle aspiration is reported to have greater sensitivity than ERCP brushings for detecting malignancy.
Major liver resection in pregnancy: three cases with different etiologies and review of the literature
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2019
Niv Pencovich, Muhammad Younis, Yonatan Lessing, Lilach Zac, Joseph B. Lessing, Yariv Yogev, Michael J. Kupferminc, Ido Nachmany
Background: Major liver resection during pregnancy is extremely rare. When required, the associated physiologic and anatomic changes pose specific challenges and greater risk for both mother and fetus Materials and methods: Three cases of major liver resection during pregnancy due to different etiologies are presented. The relevant literature is reviewed and discussed. Results: We present three cases of major liver resection due to giant liver hemangioma with Kasabach–Merrit syndrome, giant hydatid cyst, and intrahepatic cholangiocarcinoma, at gestational week (GW) 17, 19, and 30, respectively. All patients had an uneventful postoperative course, continued the pregnancy and gave birth at GW 38. Conclusion: Major liver resection can be performed safely during pregnancy. A multidisciplinary team of surgeons, anesthesiologists and gynecologists, in a highly experienced tertiary hepatobiliary center, should be involved.
Bile Acids Affect the Growth of Human Cholangiocarcinoma via NF-kB Pathway
Published in Cancer Investigation, 2013
Jiaqi Dai, Hongxia Wang, Ying Dong, Yinxin Zhang, Jian Wang
We observed that free bile acids (CA, DCA, and CDCA) inhibited the growth of cholangiocarcinoma cells by promoting cell apoptosis, while the conjugated bile acids (GCA, GDCA, and GCDCA) stimulated cell growth. Consistently, we found that GDCA stimulated tumor growth and CDCA decreased tumor growth in xenografted mice. Further, the phosphorylated IkB was downregulated by free bile acids, and was upregulated by the conjugated bile acids. IL-6 and COX-2 were decreased by the free bile acids and increased by the conjugated bile acids. Collectively, these results suggest that the bile acids regulate the growth of cholangiocarcinoma by modulating NF-kB pathway.
New concept: cellular senescence in pathophysiology of cholangiocarcinoma
Published in Expert Review of Gastroenterology & Hepatology, 2016
Motoko Sasaki, Yasuni Nakanuma
Cholangiocarcinoma, a malignant tumor arising in the hepatobiliary system, presents with poor prognosis because of difficulty in its early detection/diagnosis. Recent progress revealed that cellular senescence may be involved in the pathophysiology of cholangiocarcinoma. Cellular senescence is defined as permanent growth arrest caused by several cellular injuries, such as oncogenic mutations and oxidative stress. “Oncogene-induced” and/or stress-induced senescence may occur in the process of multi-step cholangiocarcinogenesis, and overexpression of a polycomb group protein EZH2 may play a role in the escape from, and/or bypassing of, senescence. Furthermore, senescent cells may play important roles in tumor development and progression via the production of senescence-associated secretory phenotypes. Cellular senescence may be a new target for the prevention, early diagnosis, and therapy of cholangiocarcinoma in the near future.
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