Neuroendocrine tumor of distal bile duct

BACKGROUND: Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed. AIM: To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy. METHODS: Between 1992 and 2002 we have treated 89 patients with difficult bile duct stones by endoscopic retrograde cholangiopancreatography and laser lithotripsy. Unsuccessful extracorporeal shock-wave lithotripsy and electrohydraulic were also performed before laser in 35% and 26% of the cases, respectively. RESULTS: Laser was effective in 79.2% of 72 patients guided by cholangioscopy and in 82.4% of 17 cases steered by fluoroscopy. The median number of impulses in the latter was 4,335 and 1,800 with the former technique. Two parameters influenced the manner of laser guidance. In cases of stones situated above a stricture, cholangioscopic control was more effective (64.7% vs. 31.9%). When the stones were in the distal bile duct, fluoroscopic control was more successful. CONCLUSION: In cases of difficult stones in the distal bile duct, laser lithotripsy under fluoroscopic control is very effective and easily performed. Cholangioscopic guidance should be recommended just in cases of intrahepatic stones or in patients with stones situated proximal to a bile duct stenosis. In these cases, cholangioscopy should be performed either endoscopically or percutaneously.

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Reclassification of tumour origin in resected periampullary adenocarcinomas reveals underestimation of distal bile duct cancer

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2012.07.113 ◽

2012 ◽

Vol 38 (11) ◽

pp. 1043-1050 ◽

Cited By ~ 35

Author(s):

E. Pomianowska ◽

K. Grzyb ◽

A. Westgaard ◽

O.P.F. Clausen ◽

I.P. Gladhaug

Keyword(s):

Bile Duct ◽

Bile Duct Cancer ◽

Distal Bile Duct ◽

Duct Cancer ◽

Tumour Origin

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Difficulty Achieving a Preoperative Diagnosis of IgG4-Related Sclerosing Cholangitis

Case Reports in Gastroenterology ◽

10.1159/000490523 ◽

2018 ◽

Vol 12 (2) ◽

pp. 425-431

Author(s):

Kazuhiro Suzumura ◽

Etsuro Hatano ◽

Masaharu Tada ◽

Hideaki Sueoka ◽

Hiroshi Nishida ◽

...

Keyword(s):

Bile Duct ◽

Preoperative Diagnosis ◽

Sclerosing Cholangitis ◽

Wall Thickening ◽

Distal Bile Duct ◽

Obliterative Phlebitis ◽

Bile Duct Stenosis ◽

Storiform Fibrosis ◽

Lymphoplasmacytic Infiltration ◽

Duct Stenosis

A 75-year-old male was admitted to our hospital because of bile duct stenosis. He had no medical history of autoimmune disease. The level of tumor markers, serum IgG, and IgG4 were within normal ranges. Computed tomography showed perihilar and distal bile duct stenosis and wall thickening without swelling or abnormal enhancement of the pancreas. Endoscopic retrograde cholangiopancreatography showed perihilar and distal bile duct stenosis. A biopsy and cytology from the distal bile duct stenosis suggested adenocarcinoma, and cytology from the perihilar bile duct also suggested adenocarcinoma. A preoperative diagnosis of perihilar and distal bile duct cancer was made, and the patient underwent left hepatectomy and pancreaticoduodenectomy. Resected specimens showed wall thickening in the perihilar and distal bile duct; however, tumors were unclear. A histopathological examination revealed lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis in the perihilar and distal bile ducts. Immunohistochemistry revealed diffuse infiltration of IgG4-positive plasma cells in the perihilar and distal bile ducts. Lymphoplasmacytic infiltration, inflammatory change, storiform fibrosis, and obliterative phlebitis were shown in the pancreas. A final diagnosis of IgG4-related sclerosing cholangitis (IgG4-SC) with autoimmune pancreatitis was made. We herein report a case in which a preoperative diagnosis of IgG4-SC was difficult due to normal serum IgG4 levels and no obvious pancreatic lesion.

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