Cases reported "Bile Duct Neoplasms"

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1/105. Hepatic arterial infusion chemotherapy of cisplatin for biliary cystadenocarcinoma.

    Biliary cystadenocarcinoma is a rare tumor which has a better prognosis after complete surgical removal. However, since there is no other effective therapeutic option instead of surgery, the prognosis is very poor if surgical resection is impossible. We report the case of a 78 year-old woman who was treated only by hepatic arterial infusion (HAI) chemotherapy of cisplatin (85 mg) because liver functional reserve was too bad to perform a major hepatectomy. Huge biliary cystadenocarcinoma occupying the right lobe of the liver measuring 12 cm in size before chemotherapy was drastically decreased to 2 cm in size 8 months after chemotherapy. Although she had abdominal pain and anorexia before chemotherapy, she is doing well and has no complaints 9 months after chemotherapy. In conclusion, an effective therapy may be possible using hepatic arterial infusion chemotherapy of cisplatin in patients with biliary cystadenocarcinoma for whom surgical treatment is not suitable.
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ranking = 1
keywords = abdominal pain, pain
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2/105. Intrahepatic cholangiocarcinoma with extensive sarcomatous change: report of a case.

    A 77-year-old woman was admitted to our hospital with severe upper abdominal pain. ultrasonography showed a well-defined hypoechoic mass with heterogeneity in the left lobe of the liver, and computed tomography demonstrated a low-density mass with enhanced peripheral areas. magnetic resonance imaging revealed a mass with iso- to low signal intensity on T1-weighted images (WI) and heterogeneous high and low signal intensity on T2 WI. The tumor was found to be hypovascular by angiography. During 5 months of observation, the tumor increased in size, which strongly suggested malignancy. A laparotomy was performed under the provisional diagnosis of a neoplasm other than hepatocellular carcinoma, revealing that the hepatic mass had invaded the gastric wall. Therefore, a left hepatic lobectomy with dissection of the lymph nodes and hemigastrectomy was carried out. Histologically, the tumor was found to be composed of a large amount of sarcomatous elements and a small amount of adenocarcinomatous elements, both of which were partly intermingled. Immunohistochemically, the sarcomatous element demonstrated the features of malignant fibrous histiocytoma (MFH). Thus, a diagnosis of intrahepatic cholangiocarcinoma with MFH-like sarcomatous change was confirmed.
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ranking = 434.10269502012
keywords = upper abdominal pain, abdominal pain, pain, upper
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3/105. carcinoid tumor of the cystic duct.

    A 69-year-old male was admitted to an outside institution for severe right abdominal pain radiating to the flank. An extensive work-up, including lower GI series, IVP, and ultrasound of the kidneys were normal. Ultrasound of the liver demonstrated a thickened gallbladder as well as cholelithiasis. Despite some improvement, his symptoms returned intermittently and cholecystectomy was performed. Pathologic examination of the gallbladder showed a carcinoid tumor, 5.4 mm in maximum diameter, in the cystic duct. A small metastatic focus was also found in the cystic duct lymph node. In this paper we compare the clinical presentation, pathological findings and outcome of this case to the previously reported six cases of cystic duct carcinoid. A comparison is also made between the general features of carcinoid at this rare location and the more common gastrointestinal carcinoid.
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ranking = 1
keywords = abdominal pain, pain
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4/105. Synchronous carcinoma of the gallbladder in a patient with intrahepatic bile duct carcinoma.

    An 83-year-old woman, diagnosed as having cholelithiasis, was admitted to the Department of Surgery, Nippon Medical School, with right hypochondrial pain. ultrasonography and computed tomography revealed a mass in the gallbladder fundus and a hypovascular tumor in the anterior segment of the liver. magnetic resonance imaging showed stenosis of the intrahepatic bile duct and dilatation of its proximal portion. She was diagnosed as having intrahepatic bile duct carcinoma combined with gallbladder carcinoma. At laparotomy, there was evidence of multiple peritoneal metastases and intraoperative histological examination of the gallbladder tumor revealed adenocarcinoma. Accordingly, only cholecystectomy and needle biopsy of the liver tumor was performed. Histological examination of the gallbladder revealed papillary adenocarcinoma invading the muscularis propria with medullary growth or intermediate stroma. There was no microvessel invasion, no perineural invasion and no lymph node involvement. On the other hand, the liver tumor was a cholangiocarcinoma with a well-differentiated tubular pattern. Therefore, this was a rare case of synchronous carcinoma of the gallbladder associated with intrahepatic bile duct carcinoma.
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keywords = pain
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5/105. Foreign body reaction to a metal clip causing a benign bile duct stricture 16 years after open cholecystectomy: report of a case.

    We present herein a case where a benign bile duct stricture developed 16 years after an open cholecystectomy and without any prior symptoms. The patient was thought to have a Klatskin tumor both pre- and intraoperatively and was treated with a resection of the mass and bile duct confluence, while hepaticojejunostomies were also performed to both ducts separately. A pathologic examination of the specimen revealed extensive fibrosis, chronic inflammation, and a nonnecrotizing granulomata. Any hilar mass presenting after upper abdominal surgery should therefore be considered to be potentially a benign bile duct stricture, even with a long symptom-free interval.
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ranking = 0.026037934321686
keywords = upper
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6/105. Biliary cystadenoma: rare variant of intrahepatic cystic disease.

    Intrahepatic nonparasitic cystic disease is rare and may be of congenital or neoplastic origin. The most frequent symptoms and signs are nonspecific and include pain, nausea, fullness, increased girth, and palpable mass. Interventional therapy is reserved for symptomatic patients, which usually corresponds to cysts >5 cm in diameter. Retrospective analysis revealed 26 cases of intrahepatic cystic disease over 15 years at our institution. We discuss the case of a patient who had bilobular biliary cystadenomatous disease, a rare, benign variant of intrahepatic nonparasitic cystic disease.
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ranking = 0.098207793627456
keywords = pain
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7/105. Hepatic duct stones masquerading as Klatskin tumour.

    We report woman who presented with painless progressive jaundice following cholecystectomy. Radiological investigations indicated proximal bile duct obstruction suggestive of hilar malignancy. Exploratory laparatomy revealed bilateral hepatic duct stone causing obstruction.
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ranking = 0.098207793627456
keywords = pain
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8/105. Medial indentation of the duodenal sweep by common bile duct dilatation.

    The dilated common bile duct has long been recognized as a cause for a smooth, tubular impression across the duodenal bulb or immediate postbulbar duodenum. Only scattered references suggest that a smooth indentation on the medial aspect of the descending duodenum might also be due to an enlarged, tortuous common duct. Three cases of this condition are reported. The dilated common duct impression can mimic a pancreatic mass. While computed tomography, ultrasonography, or transhepatic cholangiography readily suggest the true diagnosis, potential pitfalls in patient management are possible when the first radiographic procedure is an upper gastrointestinal series.
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ranking = 0.026037934321686
keywords = upper
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9/105. Combined hepatocellular-cholangiocarcinoma presented with massive pulmonary embolism.

    A 30-year-old HBsAg-positive woman was admitted to the hospital because of 6 days of progressive shortness of breath. She was in severe respiratory distress with circulatory collapse. She had an enlarged liver but no stigmata of chronic liver disease or signs of cirrhosis. She had rapidly developed respiratory arrest and was transferred to intensive care unit. heart ultrasonography and Doppler scan showed right heart straining and high pulmonary artery pressure. Despite cardiovascular and respiratory support she died a few hours after admission. autopsy revealed combined hepatocellular-cholangiocarcinoma infiltrating the entire liver, metastatic invasion of lung blood vessels and absence of right ventricular hypertrophy. The incidence of hepatocellular-cholangiocarcinoma, a variant of hepatocellular carcinoma, is roughly 2-3% and the presenting symptoms are abdominal pain, weight loss, jaundice, fever or decompensation of liver disease. Associated HBsAg positivity and cirrhosis are reported in 20-30% and 60% of patients, respectively. Metastases to lungs are relatively frequent but this is the first report of hepatocellular-cholangiocarcinoma presented with acute respiratory distress due to massive pulmonary embolism.
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ranking = 1
keywords = abdominal pain, pain
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10/105. cholangiocarcinoma occurring in a liver with multiple bile duct hamartomas (von Meyenburg complexes).

    A 59-year-old woman presented with epigastric pain and weight loss. Ultrasound, computed tomography, and magnetic resonance imaging scans of the abdomen showed a tumor in segments 6 and 7 of the right liver lobe, measuring 8 cm in greatest diameter. The tumor was subsequently resected, and histopathology showed a poorly differentiated adenocarcinoma immunoreactive for CA 19-9 and cytokeratin 19. In the absence of any other clinically detectable primary tumor, the lesion was diagnosed as a peripheral intrahepatic cholangiocarcinoma. In addition, multiple bile duct hamartomas were found in the surrounding parenchyma. The tumor was unrelated to caroli disease, primary sclerosing cholangitis, ulcerative colitis, or nonbiliary cirrhosis, as demonstrated by further clinical and histopathologic investigations, but probably was associated with the presence of multiple bile duct hamartomas. To our knowledge, this is the eighth reported case of a cholangiocarcinoma associated with multiple bile duct hamartomas.
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ranking = 0.098207793627456
keywords = pain
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