11/105. Undifferentiated spindle cell carcinoma of the extrahepatic bile ducts: a case report.Spindle cell carcinoma is a rare tumor that generally occurs in the upper digestive tract. We report an 81-year-old man with spindle cell carcinoma located in the extrahepatic bile ducts, resulting in obstructive jaundice. The patient died 10 months after operation due to local recurrence. The literature on this rare disease is reviewed and discussed.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
12/105. Hepatobiliary cystadenoma with mesenchymal stroma mimicking hydatid cyst. Report of a case.We report on a case of hepatobiliary cystadenoma with mesenchymal stroma in a 44-year-old Caucasian woman who presented with upper abdominal discomfort. Ultrasound (US) and computed tomography (CT) showed a cystic mass resembling hydatid cyst. Endoscopic retrograde cholangiography (ERC) demonstrated communication with the left hepatic duct. At surgery, a cystic mass with communication to the left hepatic duct was found and resected en bloc with a margin of normal liver tissue. Histological examination showed a hepatobiliary cystadenoma with mesenchymal stroma.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
13/105. Intrahepatic cholangiocarcinoma with lymphoepithelioma-like component.We present two cases of intrahepatic cholangiocarcinoma with lymphoepithelioma-like component. The patients included one woman and one man, aged 67 and 41 years, respectively. They presented with right upper quadrant pain and epigastralgia. Histologically, both tumors showed two distinct histological patterns with dense lymphoplasma cell infiltration. The first pattern was a well to moderately differentiated adenocarcinoma; the second component showed a feature similar to lymphoepithelioma-like carcinoma. Granulomatous reaction was noted in one case. Immunohistochemical study revealed that both tumors were immunoreactive with AE1/AE3, cytokeratin 7, and cytokeratin 19 but negative for carcinoembryonic antigen and cytokeratin 20. The stromal lymphocytes were composed of predominantly CD3( ) T cells. in situ hybridization for Epstein-Barr virus (EBV)-encoded rna (EBER) showed positive nuclear signal in tumor cells but not in inflammatory cells in one case. The presence or absence of EBV genome was confirmed by polymerase chain reaction of LMP-1 gene in both cases. The LMP-1 gene also had a 30-bp deletion in Exon 3 as compared with the products from B95-8 cells. We further sequenced the PCR product and confirmed a 30-bp deletion between Nucleotide (nt) 168,282 and nt 168,253 corresponding to the B95-8 sequence. The clinical significance of 30-bp deletion in Exon 3 of the LMP-1 gene in lymphoepithelioma-like carcinoma of the liver warrants further investigation.- - - - - - - - - - ranking = 4.7717198459043keywords = pain, upper (Clic here for more details about this article) |
14/105. Peripheral cholangiocarcinoma with thoracic spine metastasis: a successful surgically treated case.In this study we present a rare case of cholangiocarcinoma with metastasis to the thoracic spine. A 63-year-old female with peripheral cholangiocarcinoma associated with hepatolithiasis presented low back pain as a result of a thoracic spine (T12) compression fracture. spine surgery and pathological examination revealed a metastatic mucinous adenocarcinoma of unknown origin. Two weeks after the spine surgery, a nontender palpable abdominal mass was found at the epigastric area. Abdominal sonography (US), abdominal computed tomography (CT), and magnetic resonance cholangiopancreaticogram (MRCP) revealed a hepatic tumor, hepatolithiasis, and gallbladder empyema. The patient underwent hepatic resection, cholecystectomy, and choledocholithotomy with T-tube stent. Pathological examination with immunohistochemical stain revealed hepatolithiasis concurrent with mucinous cholangiocarcinoma. Postoperative course was uneventful and no recurrence was noted during a 1-year follow-up period.- - - - - - - - - - ranking = 3.7717198459043keywords = pain (Clic here for more details about this article) |
15/105. Acute necrotizing esophagitis: a case report.Acute necrotizing esophagitis is rare. The exact etiology is unknown in most cases. The esophagus appears black, necrotic and ulcerated on the upper endoscopy, thus the term "black esophagus" is used. Histologically, there is necrosis of the esophageal mucosa and submucosa. Here, we present a patient with cholangiocarcinoma who had upper gastrointestinal bleeding and was found to have acute necrotizing esophagitis on the upper endoscopy.- - - - - - - - - - ranking = 3keywords = upper (Clic here for more details about this article) |
16/105. Intraductal papillary cholangiocarcinoma with aneurismal dilation: a case of the mimicking abscess.A case of cystic intraductal papillary cholangiocarcinoma is presented. A 58-year-old male patient presented with fever, chills, epigastric and right upper quadrant pain for 15 days. Clinically and radiologically, he was diagnosed as having liver abscess. After ultrasonography and abdominal computed tomography were taken, percutaneous drainage was performed and pus was drained. Computed tomography revealed a huge, multiloculated, septated cystic lesion in the right lobe of the liver. On the pathologic exam, the cystic lesion was an aneurismally dilated tumor, which spread diffusely and contiguously along the intrahepatic bile duct and microscopically the lesion was composed of a single layer of tall columnar tumor cells with short intraluminal papillary projections. We present the unusual case of intraductal papillary cholangiocarcinoma with aneurismal dilation and with superimposed infection.- - - - - - - - - - ranking = 4.7717198459043keywords = pain, upper (Clic here for more details about this article) |
17/105. reoperation for amputation neuroma of the cystic duct.Two cases of amputation neuroma of the cystic duct are reported. In both instances, significant symptoms were totally relieved by excision of the neuroma. review of the literature reveals at least twenty similar cases with the same results. Emphasis is placed on the importance of considering this diagnosis in postcholecystectomy patients after all the usual causes of right upper quadrant symptoms have been ruled out.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
18/105. Follicular lymphoma of the gallbladder and extrahepatic bile ducts.We report a case of a 63-year-old female, who presented with symptoms and signs of an acute biliary tract obstruction with jaundice and pain. Ultrasound together with intraoperative examination suggested a Klatskin tumour. Following radical resection, a tumour located predominantly in the wall of gallbladder, but infiltrating extensively also the walls of cystic, common hepatic and choledochus duct, was found. On the basis of cell morphology and the results of immunohistochemical analysis, the tumour was classified as an extranodal follicular lymphoma, grade II of the gallbladder, involving also hilar extrahepatic bile ducts. To the best of our knowledge, this is the first report of an extranodal follicular lymphoma in this location. A postoperative follow-up of more than 3 years has been completely uneventful without any symptoms or signs of disease recurrence.- - - - - - - - - - ranking = 3.7717198459043keywords = pain (Clic here for more details about this article) |
19/105. Advanced intrahepatic cholangiocarcinoma in hepatitis c virus-related decompensated cirrhosis: case report and review of the literature.A 75-year-old man with no known previous liver disease was admitted to our institution because of right pleural effusion, backache, and pain in the upper right quadrant. Physical and laboratory work-up revealed decompensated liver cirrhosis. Spiral computed tomography (CT) showed a 6-cm tumour in the right liver lobe. serum levels of aminotransferases, prothrombin time, total bilirubin, alphafetoprotein and carcinoembryonic antigen were within normal limits. However, the patient had elevated cholestatic enzymes, diffuse hypergammaglobulinaemia, a six-fold increase in carbohydrate antigen 19-9 (CA 19-9), cryoglobulinaemia, and reactivity against hepatitis c virus (anti-HCV). Although hepatocellular carcinoma is the most common cancer in a cirrhotic patient with chronic viral hepatitis, the investigation revealed the presence of intrahepatic cholangiocarcinoma (ICC). This is a less frequently occurring primary liver tumour, the aetiology and pathogenesis of which remain unclear in the majority of cases. The coexistence of HCV liver disease and ICC might be an incidental finding, but recently some reports have shown a relatively high incidence of this tumour in patients with HCV-related cirrhosis. The current aspects regarding ICC prevalence in HCV patients, the possible aetiopathogenetic links between this tumour and HCV, and the importance for ICC detection and characterization using the enhancement patterns with quadruple-phase spiral CT scan are also discussed.- - - - - - - - - - ranking = 4.7717198459043keywords = pain, upper (Clic here for more details about this article) |
20/105. Biliary adenofibroma: a rare neoplasm of bile duct origin with an indolent behavior.We report a case of biliary adenofibroma in a 47-year-old woman, who presented with right upper quadrant pain for several months. Abdominal imaging revealed a 16-cm solid and cystic mass in the left hepatic lobe. Histologically, the tumor showed two distinct components: 1) cystic and tubular structures lined by low columnar to cuboidal biliary-type epithelium, and 2) a dense fibrous stroma composed of spindle-shaped cells with only mild nuclear pleomorphism and inconspicuous nucleoli. Mitoses and stromal invasion were absent. The glandular epithelium stained positively for keratin AE.3/Cam 5.2, cytokeratin 7, cytokeratin 19, carcinoembryonic antigen, and epithelial membrane antigen and had a low Ki-67 proliferative index. In addition, the epithelium was positive for D10 but did not stain for 1F6 or acid mucin with alcian blue stain. This staining pattern, similar to bile duct hamartoma (von Meyenburg complex) with which this tumor shares morphologic similarity, suggests that biliary adenofibroma originates from interlobular or larger bile ducts. Three years after a subtotal resection no metastasis or significant tumor growth was noted. However, given the marked nuclear p53 immunoreactivity and tetraploidy status observed in this tumor, we cannot exclude that biliary adenofibroma may represent a premalignant process that warrants complete resection and thorough histopathologic examination.- - - - - - - - - - ranking = 4.7717198459043keywords = pain, upper (Clic here for more details about this article) |
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