1/27. Unusual manifestation of an ampullary tumor presenting with severe upper gastrointestinal bleeding.Ampullary tumors can occasionally ulcerate and present as frank gastrointestinal bleeding. The most common clinical presentation is jaundice like in other tumors of the biliary tree. We report on a 68-year-old man who presented with severe upper gastrointestinal hemorrhage secondary to an asymptomatic mass of the ampulla of vater. An endoscopic biopsy specimen revealed a villous adenoma with moderate dysplasia. A curative resection was performed, and pathological work-up revealed the presence of an infiltrating, moderately differentiated ampullary adenocarcinoma.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/27. Mucinous ductal ectasia of the biliary tree secondary to mucous metaplasia. A case report.Mucinous ductal ectasia is an uncommon disorder, characterized by ductal dilatation and filling with thick, viscid mucus, described in the pancreas. We report a case of mucinous ductal ectasia of the biliary tree. The cause of the mucus production was mucous metaplasia in the biliary epithelium. The patient was followed for 16 years, treated with serial saline flushings of the biliary tree whenever he became symptomatic.- - - - - - - - - - ranking = 6keywords = tree (Clic here for more details about this article) |
3/27. Early neoplasias of the gallbladder and bile duct: an "unstable" biliary epithelium?Benign tumours of the biliary tree are rare. In particular, only anecdotal cases of intraductal villous adenomas have been reported. The polyp-cancer sequence has not been observed in the biliary epithelium, in contrast to the paradigm of colorectal carcinogenesis. This report presents the case of a 64-year-old woman with a past history of cholelithiasis who had two early neoplasias involving the biliary epithelium: an adenocarcinoma in situ of the gallbladder and a common bile duct (CBD) villous adenoma with high-grade dysplasia. The tumours presented 4 years apart. The clinical features and combined radiological, cytological, and surgical modalities leading to the diagnosis of intraductal villous adenoma are presented. The endoscopic ultrasound (EUS) characteristics of villous adenoma of the CBD are described. While the prognosis on both occasions appears excellent following curative resections of both tumours detected at an early stage, it is possible that further neoplasia involving the biliary tree may recur. There are currently no data on optimal surveillance modalities. It may be hypothesized that the gallbladder and biliary epithelium share a similar mechanism for carcinogenesis to that observed in the colonic adenomacarcinoma sequence.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
4/27. Pigment polyp in the common bile duct.We report here a case of a young female with sickle cell disease and a past history of open cholecystectomy 10 years ago presenting with intermittent upper abdominal pain and jaundice. Abdominal ultrasonography revealed a dilated biliary tree with the possibility of a stone in the proximal common bile duct, but cholangiopancreatography showed a polypoid lesion at the junction of the common hepatic and common bile ducts. biopsy of the lesion was benign. She underwent bile duct exploration and excision of what proved to be a pigment'polyp arising from the cystic duct stump. This is the first reported case of a pigment polyp encountered in sickle a cell disease population.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/27. Advanced cholangiocarcinoma in a patient with stage I primary sclerosing cholangitis.A 29-year-old woman presented with jaundice and fever in May 2001. cholangiography showed multiple strictures and beading of the biliary tree, with a large stricture in the common bile duct and marked dilatation of the hilar bile ducts. Typical cholangiography findings and elevated hepatobiliary enzymes suggested primary sclerosing cholangitis (PSC). At the same time, computed tomography detected a 2-cm tumor in the common bile duct, and angiography showed an encasement in the portal vein. Tumor markers, cytology, and biopsy were all negative for cancer. Although laparotomy showed a healthy liver and no lymph node metastasis was found, suggesting early-stage PSC and a low likelihood of accompanying cholangiocarcinoma (CCA) reported so far, the tumor in the resected common bile duct was subsequently diagnosed as CCA. Therefore, pancreatoduodenectomy was performed combined with partial resection of the portal trunk. histology also revealed invasion of the wall of the portal vein by cancer cells. The patient had a recurrence 5 months later and died 12 months after her operation. This is a rare case in which stage I PSC was complicated by advanced CCA.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/27. Squamous cell carcinoma of the distal common bile duct.CONTEXT: Squamous cell carcinoma of the biliary tree is rare. Although few cases of squamous cell carcinoma of the intrahepatic bile-duct and gallbladder have been reported, until today, only four cases of squamous cell carcinoma of the extrahepatic bile duct have been reported in the literature. CASE REPORT: We present a case of squamous cell carcinoma of the distal common bile duct presenting with obstructive jaundice in a 60-year-old male which was successfully managed by a Whipple's pancreaticoduodenectomy. CONCLUSION: Squamous cell carcinoma of the distal bile duct without lymph node metastasis can be managed by pancreaticoduodenectomy alone.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/27. Granular cell tumour of the ampulla of vater.Granular cell tumour (GCT) is a rare soft tissue neoplasm commonly encountered in the head and neck region, skin and subcutaneous tissue. GCT of the biliary system is most commonly reported in African-American females and usually presents as abdominal pain and obstructive jaundice. The neoplasm constitutes less than 10% of all benign tumours of the extra-hepatic biliary tree. No case of GCT involving the ampulla of vater has been reported in the literature to date. We report a case of benign GCT involving the ampullary region in a 44-year-old Ethiopian male. Preoperative diagnosis was available on ERCP and deep biopsy. The patient was managed by debulking resection and biliary-enteric bypass and is symptom-free with no evidence of tumour progression after a follow-up of one year.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/27. common bile duct MALT lymphoma: case report and review of the literature.We report a rare case of common bile duct mucosa-associated lymphoid tissue (MALT) lymphoma treated with pancreatico-duodenectomy with a partial gastrectomy. MALT lymphoma involving the biliary tree is extremely rare. diagnosis is difficult and treatment options are controversial. Even though helicobacter pylori treatment is effective in the early stages of the disease, surgery is still helpful especially when obstruction, perforation, or bleeding is present.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/27. Hepatocellular carcinoma in extrahepatic bile ducts.An elongated solid lesion observed on ultrasonography and CT in the biliary tree causing a smooth filling defect on cholangiography was observed in 2 patients. No tumor was observed in the liver parenchyma either on radiography or at operation. Histopathology showed hepatocellular carcinoma. After removal of the intraductal tumors, recurrence was observed in 2 and 6 months, respectively.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/27. Novel approach to iatrogenic bile peritonitis.Bile peritonitis after injury to the biliary tree is a serious complication that requires exploratory laparotomy. Our patient had an obstructing ampullary carcinoma, and generalized bile peritonitis developed from attempted percutaneous transhepatic cholangiography. The patient's condition was managed by peritoneal lavage and endoscopic transampullary stenting, with immediate relief of pain and toxicity. Exploratory laparotomy was avoided, and an eventual pylorus-sparing Whipple resection was the definitive treatment. We believe this to be the first report of successful nonoperative treatment of a patient with bile peritonitis with obstructive jaundice.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
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