Metastatic tumors to the ovaries: a study of 170 cases in northern Thailand

The cases of malignant ovarian tumors treated at Chiang Mai University hospital between 1992 and 2003 were histologically reviewed. The medical records, the radiologic findings, and the follow-up outcome in the cases suspicious or diagnostic of metastases were reviewed to confirm the diagnosis and to determine the primary sites. Metastatic tumors accounted for 30% of malignant ovarian tumors. A total of 170 cases of metastatic tumors included 117 cases with nongynecologic origin and 53 cases with gynecologic origin. Nongynecologic metastatic tumors were from large intestine (31%), stomach (14%), intrahepatic bile duct (10%), breast (9%), extrahepatic bile duct/gallbladder (7%), appendix (5%), hematologic tumors (3%), others (4%), and unknown primary site (16%). Metastatic gynecologic tumors were from cervix (53%), corpus (34%), fallopian tube (11%), and gestational trophoblastic disease (2%). The proportion of metastatic tumors to malignant ovarian tumors in northern Thailand was comparable to those of the Western or Japanese studies. However, the distribution of the primary sites was different and was correlated with the cancer incidence in Thai women. The majority of mucin-producing adenocarcinomas involving the ovaries were metastatic tumors.

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Smoking, Alcohol, and Biliary Tract Cancer Risk: A Pooling Project of 26 Prospective Studies

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz103 ◽

2019 ◽

Vol 111 (12) ◽

pp. 1263-1278 ◽

Cited By ~ 5

Author(s):

Emma E McGee ◽

Sarah S Jackson ◽

Jessica L Petrick ◽

Alison L Van Dyke ◽

Hans-Olov Adami ◽

...

Keyword(s):

Bile Duct ◽

Alcohol Consumption ◽

Gallbladder Cancer ◽

Biliary Tract ◽

Bile Duct Cancer ◽

Extrahepatic Bile Duct ◽

Intrahepatic Bile Duct ◽

Ampulla Of Vater ◽

Biliary Tract Cancers ◽

Duct Cancer

Abstract Background Tobacco and alcohol are well-established risk factors for numerous cancers, yet their relationship to biliary tract cancers remains unclear. Methods We pooled data from 26 prospective studies to evaluate associations of cigarette smoking and alcohol consumption with biliary tract cancer risk. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with smoking and alcohol consumption were calculated. Random-effects meta-analysis produced summary estimates. All statistical tests were two-sided. Results Over a period of 38 369 156 person-years of follow-up, 1391 gallbladder, 758 intrahepatic bile duct, 1208 extrahepatic bile duct, and 623 ampulla of Vater cancer cases were identified. Ever, former, and current smoking were associated with increased extrahepatic bile duct and ampulla of Vater cancers risk (eg, current vs never smokers HR = 1.69, 95% CI = 1.34 to 2.13 and 2.22, 95% CI = 1.69 to 2.92, respectively), with dose-response effects for smoking pack-years, duration, and intensity (all Ptrend < .01). Current smoking and smoking intensity were also associated with intrahepatic bile duct cancer (eg, >40 cigarettes per day vs never smokers HR = 2.15, 95 % CI = 1.15 to 4.00; Ptrend = .001). No convincing association was observed between smoking and gallbladder cancer. Alcohol consumption was only associated with intrahepatic bile duct cancer, with increased risk for individuals consuming five or more vs zero drinks per day (HR = 2.35, 95%CI = 1.46 to 3.78; Ptrend = .04). There was evidence of statistical heterogeneity among several cancer sites, particularly between gallbladder cancer and the other biliary tract cancers. Conclusions Smoking appears to increase the risk of developing all biliary tract cancers except gallbladder cancer. Alcohol may increase the risk of intrahepatic bile duct cancer. Findings highlight etiologic heterogeneity across the biliary tract.

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Biliary Peritonitis Due to Spontaneous Perforation of the Left Intrahepatic Bile Duct in an Adult: A Case Report and Review of Literature

International Surgery ◽

10.9738/intsurg-d-14-00264.1 ◽

2018 ◽

Vol 103 (7-8) ◽

pp. 339-343

Author(s):

Wenwu Cai ◽

Ke Pan ◽

Qinglong Li ◽

Xiongying Miao ◽

Chang Shu

Keyword(s):

Abdominal Pain ◽

Bile Duct ◽

Common Bile Duct ◽

Extrahepatic Bile Duct ◽

Intrahepatic Bile Duct ◽

Bile Leakage ◽

Common Bile Duct Exploration ◽

Good Prognosis ◽

Spontaneous Perforation ◽

Repair Operation

Spontaneous perforation of the left intrahepatic bile duct is extremely rare, especially in adults. Here, we report on a case of a 64-year-old woman who had a complaint of right upper abdominal pain for 10 days, which gradually progressed to entire abdominal pain for 3 days, and was admitted to our hospital. Relevant examinations revealed she had a normal cardiac and lung workup, but an obvious abnormal abdominal computed tomography examination, which revealed an enlarged gallbladder, choledocholithiasis with dilatation of the common bile duct (1.8 cm) and intrahepatic bile duct, and a lot of encapsulated ascites. After being given adequate fluid resuscitation and active preoperative preparation, cholecystectomy and common bile duct exploration and perforation repair operation were then performed. The postoperative course was uneventful, and she was discharged with the T-tube in situ. A choledochoscopy examination at week 6 showed the conditions of the intrahepatic and extrahepatic bile duct were good. For these patients, early diagnosis and surgical treatment are essential for good prognosis. The goal of our surgery is to stop bile leakage, resolve choledocholithiasis and cholangitis, and reconstruct the bile duct.

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A Proposed Algorithm for Endoscopic Ultrasound-Guided Rendezvous Technique in Failed Biliary Cannulation

Journal of Clinical Medicine ◽

10.3390/jcm9123879 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3879

Author(s):

Saburo Matsubara ◽

Keito Nakagawa ◽

Kentaro Suda ◽

Takeshi Otsuka ◽

Hiroyuki Isayama ◽

...

Keyword(s):

Bile Duct ◽

Endoscopic Ultrasound ◽

Extrahepatic Bile Duct ◽

Intrahepatic Bile Duct ◽

Duodenal Bulb ◽

Ultrasound Guided ◽

Biliary Cannulation ◽

Rendezvous Technique ◽

Selection Of ◽

Approach Route

Background: The selection of an approach route in endoscopic ultrasound-guided rendezvous (EUS-RV) for failed biliary cannulation is complicated. We proposed an algorithm for EUS-RV. Methods: We retrospectively evaluated consecutive EUS-RV cases between April 2017 and July 2020. Puncturing the distal extrahepatic bile duct (EHBD) from the duodenal second part (D2) (DEHBD/D2 route) was attempted first. If necessary, puncturing the proximal EHBD from the duodenal bulb (D1) (PEHBD/D1 route), puncturing the left intrahepatic bile duct (IHBD) from the stomach (LIHBD/S route), or puncturing the right IHBD from the D1 (RIHBD/D1 route) were attempted in this order. Results: A total of 16 patients were included. The DEHBD/D2 route was used in 10 (62.5%) patients. The PEHBD/D1 route was attempted in five (31.3%) patients, and the biliary puncture failed in one patient in whom the RIHBD/D1 route was used because of tumor invasion to the left hepatic lobe. The LIHBD/S route was applied in one (6.3%) patient. Successful biliary cannulation was achieved in all patients eventually. The time from the puncture to the guidewire placement in the DEHBD/D2 route (3.5 min) was shorter than that in other methods (14.0 min) (p = 0.014). Adverse events occurred in one (6.3%) patient with moderate pancreatitis. Conclusions: The proposed algorithm might be useful for the selection of an appropriate approach route in EUS-RV.

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A randomized study of gemcitabine/cisplatin versus single-agent gemcitabine in patients with biliary tract cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.4579 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 4579-4579 ◽

Cited By ~ 1

Author(s):

J. Furuse ◽

T. Okusaka ◽

M. Miyazaki ◽

H. Taniai ◽

Y. Nimura ◽

...

Keyword(s):

Bile Duct ◽

Biliary Tract ◽

Bile Duct Cancer ◽

Extrahepatic Bile Duct ◽

Performance Status ◽

Single Agent ◽

Intrahepatic Bile Duct ◽

Extrahepatic Bile Duct Cancer ◽

Duct Cancer ◽

Grade 3

4579 Background: Biliary tract cancers (BTC) are not common but increasing in the US and Europe, and more prevalent in South America and Asia including Japan. Gemcitabine (G) and cisplatin (C) are now deemed as key drugs based on the accumulated literature. This is the first study to compare GC combination with G alone in Japan, even though one phase 3 trial (ABC-02) is ongoing in UK. Methods: 84 Japanese pts, aged ≥ 20 years, with histologically or cytologically confirmed advanced BTC, Performance Status 0 - 1, with adequate bone-marrow, hepatic and renal function were randomized. 83 pts received either C 25 mg/m2 plus G 1000 mg/m2 on days 1, and 8 of each 21-day cycle (GC-arm) or G 1000 mg/m2 on days 1, 8 and 15 of each 28-day cycle (G-arm). Treatments were repeated up to a maximum of 16 cycles of GC or 12 of G until disease progression or unacceptable toxicity occurred. Tumor response was evaluated using RECIST criteria by an independent review committee. The primary end-point of the study was 1- year survival rate. Safety, response rate, duration of progression-free survival were also evaluated. Results: A total of 83 pts (19 extrahepatic bile duct cancer, 28 intrahepatic bile duct cancer, 32 gallbladder cancer and 4 ampullary carcinoma) were eligible for the study protocol defined analysis set (Full Analysis Set, FAS); GC-arm n=41 and G-arm n=42. Baseline characteristics were similar between the two arms: median ages were 65.0 vs 66.5, females were 56.1 vs 50.0%. All pts completed at least one cycle of therapy, yielding a total of 247 cycles (median 6) in GC vs 203 (median 4) in G. The overall response rates were 19.5% (95% CI: 8.8, 34.9) vs 11.9 (95% CI: 4.0, 25.6). The results on survival will be determined and presented at the meeting. The most commonly reported grade 3 or 4 toxicities were: neutropenia (56.1 vs 38.1%), thrombocytopenia (39.0 vs 7.1%), leukopenia (29.3 vs 19.0%), hemoglobin decrease (36.6 vs 16.7%) and γ-GTP increase (29.3 vs 35.7%). Grade 3 acute renal failure was reported in 1 pt on GC. Conclusions: The combination therapy of GC would be an effective and well-tolerated chemotherapy regimen for Japanese pts with advanced BTC. [Table: see text]

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Isolated Liver Hilar Infiltration by IgG4 Inflammation Mimicking Cholangiocarcinoma

Case Reports in Gastroenterology ◽

10.1159/000448989 ◽

2016 ◽

Vol 10 (3) ◽

pp. 512-517 ◽

Cited By ~ 1

Author(s):

Laurent Bochatay ◽

Pietro Majno ◽

Emiliano Giostra ◽

Jean Louis Frossard

Keyword(s):

Bile Duct ◽

Extrahepatic Bile Duct ◽

Immunosuppressive Treatment ◽

Intrahepatic Bile Duct ◽

Klatskin Tumor ◽

Mr Cholangiography ◽

Igg4 Related Disease ◽

Left And Right ◽

Biliary Cytology ◽

Isolated Liver

IgG4-related disease represents a heterogeneous group of disease characterized by infiltration of various tissues by IgG4 plasmocytes. In case of liver infiltration, this condition classically mimics primary sclerosing cholangitis or multifocal cholangiocarcinoma due to inflammation that preferentially affects the intra- and extrahepatic bile duct. Diagnostic criteria have recently been reviewed in order to better define the disease and help physicians make the diagnosis. Herein, we present the case of a patient who died after liver surgery for suspected cholangiocarcinoma that finally turned out to be IgG4-associated liver disease, a condition being out of current consensual criteria. The patient presented with progressive cholestasis identified by MR cholangiography as an isolated hilar mass responsible for dilatation of the left and right intrahepatic bile duct suspicious for a Klatskin tumor. The IgG4 blood level was normal as was biliary cytology. The patient underwent right portal embolization followed by right extended hepatectomy. Pathologic examination found no tumor but intense fibrosclerotic infiltration with a marked inflammatory infiltrate characterized by IgG4-positive plasmocytes. Despite immunosuppressive treatment, cholestasis was never controlled and successive biopsies of the remaining liver showed progressive cholestasis, liver infiltrate and no bile duct regeneration. The patient finally presented an upper gastrointestinal hemorrhage leading to death 4 months after hepatectomy and appropriate immunosuppressive therapy.

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Efficacy of the bile leak test using contrast-enhanced intraoperative ultrasonic cholangiography in liver resection: a study protocol for a non-randomised, prospective, off-label, single-arm trial

BMJ Open ◽

10.1136/bmjopen-2019-029330 ◽

2019 ◽

Vol 9 (6) ◽

pp. e029330

Author(s):

Motofumi Tanaka ◽

Masahiro Kido ◽

Kaori Kuramitsu ◽

Shohei Komatsu ◽

Masahide Awazu ◽

...

Keyword(s):

Liver Resection ◽

Bile Duct ◽

Intrahepatic Bile Duct ◽

Bile Leak ◽

University Hospital ◽

Institutional Review Boards ◽

Leak Test ◽

Off Label ◽

Contrast Enhanced ◽

Cut Surface

IntroductionBile leak is still a major complication after liver resection to be improved. To intraoperatively detect this adverse complication, leak test is commonly performed after hepatic resection. However, by the conventional leak test, it is often difficult to know whether the test reagent reaches to intrahepatic bile duct near cut surface of liver with adequate volume and pressure to identify the existence of bile leak. Thus, in order to perform leak test more accurately, this study aims to evaluate the efficacy and safety of the leak test using contrast-enhanced intraoperative ultrasonic cholangiography (CE-IOUSC), which was reported by our group as a procedure for detection of bile duct.Methods and analysisThe current study is a non-randomised, prospective, off-label, single-arm clinical trial for patients who undergo liver resection. A total of 100 patients will be enrolled. After completion of liver resection, the leak test is performed with CE-IOUSC using Sonazoid as a contrast agent to visualise dye injection into the intrahepatic bile duct. The primary endpoint is the success of the leak test, defined as clear visualisation of intrahepatic bile duct around cut surface by ultrasonography that indicates enough volume of dye injection. Secondary endpoints are postoperative bile leak and all adverse events related to CE-IOUSC. The findings obtained through this study will establish this procedure to assist surgeons for adequately performing the leak test, precisely detecting intraoperative biliary leak strictly and reducing postoperative bile leak.Ethics and disseminationThe protocol is approved by Institutional Review Boards of Kobe University Hospital (No.290069). Our findings will be widely disseminated through conference presentations and peer-reviewed publications.Trial registration numberUMIN000031236 and jRCTs051180027.

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Paucity of intrahepatic bile ducts in infancy: experience of a tertiary center

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032004000300010 ◽

2004 ◽

Vol 41 (3) ◽

pp. 190-192 ◽

Cited By ~ 6

Author(s):

Adriana Maria Alves De Tommaso ◽

Agnes Sumi Kawasaki ◽

Gabriel Hessel

Keyword(s):

Bile Duct ◽

Bile Ducts ◽

Portal Tract ◽

Intrahepatic Bile Duct ◽

University Hospital ◽

Intrahepatic Bile Ducts ◽

Tertiary Center ◽

Antitrypsin Deficiency ◽

Alpha 1 Antitrypsin Deficiency ◽

Alpha 1 Antitrypsin

BACKGROUND: Intrahepatic cholestasis secondary to paucity of bile duct is an alteration of the anatomic integrity of the biliary tract. Can be defined only histologically and, clinically, two categories are recognized: syndromic and non-syndromic, where the prognosis is generally more severe. AIM: To evaluate the history, clinical and biochemical characteristics, etiology and improvement of children who have paucity of intrahepatic bile duct followed at tertiary center. PATIENTS AND METHODS: Eleven children with paucity of intrahepatic bile duct, followed at the Pediatric Hepatology Service of the University Hospital, Campinas, SP, Brazil, were evaluated in the period from 1986 to 2001. RESULTS: Among the patients, three presented the syndromic and eight the non-syndromic form (two with alpha-1-antitrypsin deficiency, one with lues, one secondary to sepsis, three with probable etiology by cytomegalovirus and one without a definite etiology). Referral ranged from 31 to 1185 days. Birth weights ranged from 1920 g to 3590 g. Most of the patients presented pale stools. The median bile duct/portal tract ratio was 0.14. The majority of the children presented a favorable follow-up, regardless of the form of presentation. CONCLUSION: Paucity of intrahepatic bile ducts should be considered in children with cholestasis and its differentiation from extrahepatic causes of neonatal cholestasis is important in order to avoid surgery. Diagnosis of non-syndromic form should not be regarded as unfavorable prognosis, as the evolution is probably related to the etiology in this form of presentation.

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Laparoscopic surgery for lithiasis local choledochal dilatation diagnosed a cyst: Case report and literature reviews

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2021.2.7 ◽

2021 ◽

Vol 11 (2) ◽

Author(s):

Tuấn Anh Đỗ ◽

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Choledochal Cyst ◽

Frozen Section ◽

Extrahepatic Bile Duct ◽

Intrahepatic Bile Duct ◽

Term Outcome ◽

Long Term Outcome ◽

Proper Diagnosis ◽

The Common

Abstract Biliary dilation is common in clinical practice and originates from many pathologies; among them, choledocholithiasis, chronic pancreatitis and periampullary diverticula (PAD) are the most common. Popular signs of cholelithiasis is diffuse dilatation of the intra- and extrahepatic bile duct, however, in some cases, it might be local dilatation of the common bile duct without intrahepatic bile duct dilatation. The long-term outcome is favorable, however, it is necessary to rule out other causes such as choledochal cyst, pancreatitis by frozen section in order to have a proper diagnosis and treatment. We describe a 19-year-old female patient with local dilation of the common bile duct due to choledocholithiasis that was operated laparoscopically with success. Key word: Local common bile duct dilation, gallstones, choledochal cyst, laparoscopy. Tóm tắt Giãn đường mật là một hình thái tổn thương hay gặp trên lâm sàng, do nhiều bệnh lý khác nhau, hay gặp nhất là sỏi ống mật chủ (OMC), viêm tụy mạn và túi thừa Vater 1. Dấu hiệu phổ biến của sỏi mật là giãn đường mật trong và ngoài gan lan tỏa, tuy nhiên có trường hợp OMC giãn đơn thuần không kèm theo giãn đường mật trong gan. Tiên lượng của bệnh này là tốt, tuy nhiên cần loại trừ các nguyên nhân như nang OMC, viêm tụy bằng sinh thiết tức thì để có chẩn đoán và điều trị phù hợp nhất. Chúng tôi xin báo cáo một trường hợp người bệnh (NB) nữ, 19 tuổi mắc sỏi mật gây giãn OMC khu trú dạng nang được phẫu thuật nội soi thành công. Từ khóa: Giãn đường mật khu trú, sỏi mật, nang ống mật chủ, phẫu thuật nội soi.

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Gastrointestinal Cancers: Racial and Ethnicity Differences

10.21203/rs.3.rs-546907/v1 ◽

2021 ◽

Author(s):

Maharaj Singh ◽

Santhi Konduri ◽

Samit Datta ◽

Wesley Papenfuss ◽

Geoffrey Belini ◽

...

Keyword(s):

Small Intestine ◽

Bile Duct ◽

Race And Ethnicity ◽

Lower Risk ◽

Extrahepatic Bile Duct ◽

Survival Rates ◽

Intrahepatic Bile Duct ◽

Lower Mortality ◽

Gi Cancers ◽

Race Category

Abstract Objective: The purpose of this study was to examine race and ethnicity for overall survival (OS) and percent survival after 5- and 10-years for patients diagnosed with one of the gastrointestinal (GI) cancers.Method: We used national data for 12 types of GI cancers (esophagus, stomach, gallbladder, intrahepatic bile duct, extrahepatic bile duct, liver, pancreas, small intestine, colon, rectosigmoid, rectum, and anal) for the years 2004-2016. Results: A total of 2,249,213 patients diagnosed with one of the GI tract cancers with median age of 67 years were included in this study. There were 55% male, 77% non-Hispanic White (NHW), 12% were non-Hispanic Black (NHB), 6% were Hispanic, and the rest were classified as ‘Other’ race (4%). OS was higher for the Hispanics, followed by the ‘Other’, NHW and NHB (P <0.001). After adjusting for sex, income, insurance status, grade differentiation, age, and for Charlson-Dayo index, Hispanics and ‘Other’ race category had lower mortality compared to NHW (HR=0.93, 0.92-0.94, p <0.001; HR=0.92, 0.91-0.93, p <0.001), whereas NHB had higher risk compared to NHW (HR=1.09,1.08-1.09 p <0.001). Hispanics had lower mortality than NHW for 11 or 12 types (except esophagus), and ‘Other’ race category had lower risk for 10 of 12 types (except anal and small intestine). Five- and 10-year survival rates were higher for Hispanic patients (47%, 36%) followed by ‘Other’ (42%, 31%), NHW (40%, 28%), and for NHB (38%, 28%).Conclusion: Hispanics and the patients from ‘Other’ race category diagnosed with one of the GI cancers had longer survival probability and lower risk of mortality compared to NHW and NHB.

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Multimodal profiling of biliary tract cancers to detect potentially actionable biomarkers and differences in immune signatures between subtypes.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.4023 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 4023-4023

Author(s):

Kabir Mody ◽

Nilofer Saba Azad ◽

Prerna Jain ◽

Sherif El-Refai ◽

Rachna T. Shroff ◽

...

Keyword(s):

Bile Duct ◽

Biliary Tract ◽

Extrahepatic Bile Duct ◽

Intrahepatic Bile Duct ◽

Relative Increase ◽

Biliary Tract Cancers ◽

Cancer Subtypes ◽

Immune Biomarkers ◽

The Relationship ◽

Immune Profiling

4023 Background: Biliary tract cancers (BTC) are increasingly subtyped by molecular alterations, but little is known about the relationship between gain-of-function mutations and the RNA transcript expression of immune-related pathways. Methods: A sample of retrospective, clinicogenomic and transcriptomic data from de-identified records of patients with BTC in the Tempus database was selected. We then investigated the relationship between the mutational landscape and immune-related RNA signatures of different anatomic and genomic BTC subtypes. Results: The cohort included 455 samples of intrahepatic bile duct (IH) (n=267), gallbladder (GB) (n=153), and extrahepatic bile duct (EH) (n=35) cancer subtypes. Across all subtypes, we detected alterations in TP53 (43.8%), ARID1A (19.8%), KMT2C (18.2%), BAP1 (14.6%), KRAS (12.7%), TERT (12.0%), IDH1 (11.4%), KMT2D (11.0%), LRP1B (11.0%), and PBRM1 (10.7%), along with FGFR2 fusions (2.6%). Potentially actionable biomarkers ( FGFR2 and NTRK1-3 fusions, IDH1 and BRAFV600E mutations, tumor mutational burden [TMB]>10, HER2 expression, and/or microsatellite instability) were identified in 21.1% of all BTC and 28.6% of IH samples. Mutually exclusive alterations observed between subtypes were TP53 & BAP1, KRAS & BAP1, TP53 & IDH1, KRAS & IDH1, and SMAD4 & BAP1 ( P < 0.001 for all). GB was more inflamed based on RNA signatures and classical immune biomarkers, including PD-L1 and TMB. RNA signature analyses revealed a higher expression of immune-related pathways in GB than IH ( P = 0.001) with no differences in comparison with EH. PD-L1 expression and continuous TMB were elevated in GB versus the other anatomical subtypes. Significant associations were noted between particular genetic mutations and immune profiling features (table). Conclusions: BTC subtypes are diverse in DNA alterations, RNA inflammatory signatures, and immune markers. Notably, potentially actionable biomarkers were identified in a sizable portion of the cohort and varied significantly between subtypes. These results provide guidance for targeted therapy development and support the use of multimodal immune profiling for BTC. For example, GB-specific clinical trials may be considered due to the relative increase in immune-related biomarkers observed in GB and the historically limited success of BTC trials.[Table: see text]

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