Radiation Stricture of the Biliary Ducts: An Emerging New Entity?

Two patients with stricture of the extrahepatic biliary tree are described. Both patients presented with a clinical picture of obstructive jaundice one to two years following radiotherapy for a malignant condition. As no recurrent tumour was detected in either of the patients the strictures were considered to be the result of radiation therapy. Bilio-enteric decompression was performed in both patients who are well at follow up one and ten years after the procedure.

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Anatomic variation of extrahepatic biliary tree structures: importance in treatment planning for radiation therapy.

Radiology ◽

10.1148/radiology.201.1.8816557 ◽

1996 ◽

Vol 201 (1) ◽

pp. 271-273 ◽

Cited By ~ 1

Author(s):

R G Smith ◽

J W Keller ◽

J C Landry ◽

K Tsujino ◽

W E Torres ◽

...

Keyword(s):

Radiation Therapy ◽

Treatment Planning ◽

Anatomic Variation ◽

Biliary Tree ◽

Tree Structures ◽

Extrahepatic Biliary Tree

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BILIARY ATRESIA: evaluation on two distinct periods at a reference pediatric service

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032014000100011 ◽

2014 ◽

Vol 51 (1) ◽

pp. 53-58 ◽

Cited By ~ 1

Author(s):

Thais Costa Nascentes QUEIROZ ◽

Alexandre Rodrigues FERREIRA ◽

Eleonora Druve Tavares FAGUNDES ◽

Mariza Leitão Valadares ROQUETE ◽

Francisco José PENNA

Keyword(s):

Biliary Atresia ◽

Waiting Time ◽

Neonatal Period ◽

Biliary Tree ◽

Probability Of Survival ◽

Age At Surgery ◽

Pediatric Service ◽

Extrahepatic Biliary Tree ◽

Observation Period

Context Biliary atresia is a progressive, idiopathic, fibro-obliterative disease of the extrahepatic biliary tree that presents with biliary obstruction exclusively in the neonatal period. Objectives To assess the differences regarding age at referral, age at surgery, duration of propaedeutics and waiting time for surgery between two groups of infants in different periods. Methods Retrospective study of infants diagnosed with biliary atresia on two periods: 1983-1993 and 1998-2011. Results Biliary atresia was diagnosed in 129 infants, being 48 in casuistic I and 81 in casuistic II. The median age at admission was 94 and 60 days, respectively (P = 0.0001). On evaluating patients who had undergone portoenterostomy before 120 days of age, no difference was observed regarding the duration of propaedeutics or waiting time for surgery (P = 0.15), but difference was found when comparing the age at surgery (P = 0.002). Among those infants with no biliary flow and without liver transplantation or death after 18 post-operative months, the estimated probability of survival was 44.6% and 38.7% in casuistics I and II, respectively. In casuistic I, all infants who showed biliary flow were alive during the observation period and, in casuistic II, 80.3% were alive after 7 years of follow-up. Conclusions Even though patients were admitted and treated earlier, it is clear that surgery could be done sooner. Delay in referral and timely propaedeutics were the main contributors.

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The Difficult Path to Correct Diagnosis of Hepatolithiasis: A Case Report

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2021.21 ◽

2021 ◽

Vol 64 (2) ◽

pp. 125-128

Author(s):

Peter Mikolajčík ◽

Alexander Ferko ◽

Michal Demeter ◽

Martin Vorčák ◽

Ľudovít Laca

Keyword(s):

Clinical Picture ◽

Correct Diagnosis ◽

Magnetic Resonance Cholangiopancreatography ◽

Good Prognosis ◽

Definitive Treatment ◽

Stone Extraction ◽

Laboratory Findings ◽

Biliary Ducts ◽

Obstructive Cholangitis

Hepatolithiasis is a benign disease, where stones are localized proximal to the confluence of hepatic ducts. The clinical picture may differ depending on whether the stones cause complete, partial, or intermittent biliary obstruction. The course can vary from asymptomatic to fatal, thus, early diagnosis and treatment is critical for a good prognosis. The gold standard in imaging is magnetic resonance cholangiopancreatography (MRCP). However, correct diagnosis can be challenging due to atypical clinical picture and laboratory findings. We present a case where hepatolithiasis was misdiagnosed initially due to incomplete reporting and documentation of MRCP. Choledocholithiasis was diagnosed based on initial MRCP, and endoscopic stone extraction was indicated. However, an unusual post-interventional course and signs of obstructive cholangitis led to an endoscopic re-intervention, which confirmed absence of pathology in extrahepatic biliary ducts. The cholangitis recurrence required intensive antibiotic treatment, and CT examination revealed intrahepatic S3 bile duct dilatation. Thus, a re-evaluation of initial MRCP and repeated MRCP confirmed hepatolithiasis. Further, laparoscopic bisegmentectomy was chosen as the definitive treatment due to the location of the lesion. The patient recovered and remained symptom free upon a 12 month follow up.

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Fatigue in patients with adjuvant radiation therapy for breast cancer: long-term follow-up

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-003-0540-9 ◽

2004 ◽

Vol 130 (6) ◽

pp. 327-333 ◽

Cited By ~ 59

Author(s):

Hans Geinitz ◽

Frank B. Zimmermann ◽

Reinhard Thamm ◽

Monika Keller ◽

Raymonde Busch ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Adjuvant Radiation ◽

Adjuvant Radiation Therapy ◽

Long Term Follow Up

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RONC-19. TWO CASES OF RE-IRRADIATION FOR LATE RECURRENT OR RADIATION-INDUCED TUMOR AFTER RADIATION THERAPY FOR PEDIATRIC BRAIN TUMORS

Neuro-Oncology ◽

10.1093/neuonc/noaa222.788 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii459-iii459

Author(s):

Takashi Mori ◽

Shigeru Yamaguchi ◽

Rikiya Onimaru ◽

Takayuki Hashimoto ◽

Hidefumi Aoyama

Keyword(s):

Radiation Therapy ◽

Brain Tumors ◽

Tumor Resection ◽

Intensity Modulated Radiation Therapy ◽

Late Recurrence ◽

Pediatric Brain Tumors ◽

Suprasellar Region ◽

Radiation Induced ◽

Pediatric Brain

Abstract BACKGROUND As the outcome of pediatric brain tumors improves, late recurrence and radiation-induced tumor cases are more likely to occur, and the number of cases requiring re-irradiation is expected to increase. Here we report two cases performed intracranial re-irradiation after radiotherapy for pediatric brain tumors. CASE 1: 21-year-old male. He was diagnosed with craniopharyngioma at eight years old and underwent a tumor resection. At 10 years old, the local recurrence of suprasellar region was treated with 50.4 Gy/28 fr of stereotactic radiotherapy (SRT). After that, other recurrent lesions appeared in the left cerebellopontine angle, and he received surgery three times. The tumor was gross totally resected and re-irradiation with 40 Gy/20 fr of SRT was performed. We have found no recurrence or late effects during the one year follow-up. CASE 2: 15-year-old female. At three years old, she received 18 Gy/10 fr of craniospinal irradiation and 36 Gy/20 fr of boost to the posterior fossa as postoperative irradiation for anaplastic ependymoma and cured. However, a anaplastic meningioma appeared on the left side of the skull base at the age of 15, and 50 Gy/25 fr of postoperative intensity-modulated radiation therapy was performed. Two years later, another meningioma developed in the right cerebellar tent, and 54 Gy/27 fr of SRT was performed. Thirty-three months after re-irradiation, MRI showed a slight increase of the lesion, but no late toxicities are observed. CONCLUSION The follow-up periods are short, however intracranial re-irradiation after radiotherapy for pediatric brain tumors were feasible and effective.

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Percutaneous transhepatic biliary puncture simulator: a cord network prototype

Advances in Simulation ◽

10.1186/s41077-021-00178-w ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Rubén Lopez Benítez ◽

Tomás Reyes del Castillo ◽

David Benz ◽

Carsten Fechner ◽

Lorant Szabo ◽

...

Keyword(s):

Training Session ◽

Lower Lobe ◽

Biliary Tree ◽

Training Model ◽

Polystyrene Foam ◽

Wooden Frame ◽

Biliary Ducts ◽

Hand Coordination ◽

Radiology Residents ◽

Positive Results

Abstract Background The aim of this study was to present a percutaneous transhepatic biliary puncture simulator that can be used without radiation exposure and that reflects the conventional anatomy of the biliary ducts and its vicinity structures. Methods An anatomically based model of the biliary tree was developed using a cord network fixed to a wooden frame. The skin, ribs, intercostal muscles, and right lower lobe pleura were simulated using foam sponge, plastic tubes, a polystyrene foam panel, and an air pad, respectively. For the puncture, we used a 20-G Chiba needle and a wire with distal double arches; these were used to troll a cord, simulating the successful puncture of a bile duct. A camera was also placed above the model to allow the trainees to train eye-hand coordination while viewing the image on a monitor in real time. The simulator was tested with 60 radiology residents to evaluate the confidence and skills transferability of the training model. Results After receiving an introduction of the system and 5 min of training under tutor surveillance, all participants were able to troll a cord of the biliary simulator by themselves in less than 4 min. Only one participant punctured the simulated pleura. The participants’ evaluations showed positive results, with increased user confidence and skills transferability after the training session. Conclusions This proposed simulator can be an effective tool to improve a trainee’s confidence and competence while achieving procedural and non-procedural interventional radiology skills related to the liver. Trial registration Retrospectively registered

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IMG-18. ASSESSMENT OF SUSPECTED DISEASE PROGRESSION USING MULTIPARAMETRIC 18F-CHOLINE PET/MRI IN CHILDHOOD AND TEENAGE-YOUNG ADULT GLIOMAS

Neuro-Oncology ◽

10.1093/neuonc/noaa222.353 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii358-iii358

Author(s):

Valentina Ferrazzoli ◽

Ananth Shankar ◽

Julia Cockle ◽

Christine Tang ◽

Ahmed Al-khayfawee ◽

...

Keyword(s):

Disease Progression ◽

Posterior Fossa ◽

Cerebral Blood Volume ◽

Posterior Fossa Tumour ◽

Recurrent Tumour ◽

Normal Appearing White Matter ◽

Conventional Mri ◽

Apparent Diffusion ◽

Teenagers And Young Adults

Abstract OBJECTIVES Evaluation of post-treatment glioma burden remains a significant challenge in children, teenagers and young adults (TYA). The aim of this study was to evaluate the utility of ChoPET/MRI for evaluation of suspected disease progression in childhood and TYA gliomas. METHODS 27 patients (mean age 14 years, range 6–21 years) with suspected glioma disease progression were evaluated with ChoPET/MRI (n=59). Relative cerebral blood volume (rCBV), apparent diffusion coefficient (ADC) and maximum standardised uptake values (SUVmax) in enhancing (enh) and non-enhancing (ne) tumour and normal-appearing white matter (wm) were calculated (rCBVenh, rCBVne, rCBVwm, ADCenh, ADCne, ADCwm, SUVenh, SUVne, SUVwm). 2 blinded radiologists scored tumour probability (1 = unlikely; 5 = definitely). Sensitivity and specificity calculated with gold standard histopathology or clinical follow-up. RESULTS Accuracy for the detection of residual/recurrent tumour on conventional MRI was 96.3% (91.7% ≤14 years, 100% ≥15 years) and ChoPET was 73.1% (66.7% ≤14 years, 80.0% ≥15 years). Lack of agreement was observed in 9/27 patients, with ChoPET superior to MRI in 1 case of a posterior fossa tumour. Tumour component analysis demonstrated significantly higher SUVenh and SUVne than SUVwm (SUVenh: p<0.001; SUVne: p=0.004, equivalent to results were observed for ADV and rCBV (ADCenh, ADCne: p<0.001 vs ADCwm; rCBVenh, rCBVne: p<0.001 vs rCBVwm). CONCLUSIONS MRI is more sensitive than ChoPET in the evaluation of suspected disease progression in TYA gliomas. However, quanititative ChoPET is able to detect enhancing and non-enhancing tumour and may be helpful in evaluating posterior fossa disease where MRI is equivocal.

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The case of the disappearing bullet: An extraluminal compression of the biliary tree

Trauma ◽

10.1177/14604086211000914 ◽

2021 ◽

pp. 146040862110009

Author(s):

M Mihalik ◽

N Allopi

Keyword(s):

Obstructive Jaundice ◽

South African ◽

Surgical Intervention ◽

Biliary Tree ◽

Common Occurrence ◽

Abdominal Injuries ◽

Gun Shot ◽

Shot Wounds

Penetrating abdominal injuries, especially from gun shot wounds, are a common occurrence in South African hospitals, and a vast majority of these patient receive surgical intervention for suspected intra-abdominal injuries. Not all bullets are found and removed however, and we detail the case of a gentleman who presented to our institution with obstructive jaundice secondary to an extraluminal compression of his biliary tree by a retained migrated bullet, that spontaneously resolved, without any surgical intervention.

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MBCL-14. A STUDY OF LOW-DOSE CRANIOSPINAL RADIATION THERAPY IN PATIENTS WITH NEWLY DIAGNOSED AVERAGE-RISK MEDULLOBLASTOMA

Neuro-Oncology ◽

10.1093/neuonc/noaa222.490 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii390-iii391

Author(s):

Aaron Mochizuki ◽

Anna Janss ◽

Sonia Partap ◽

Paul Fisher ◽

Yimei Li ◽

...

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Treatment Modalities ◽

Average Risk ◽

Craniospinal Radiation ◽

Grade 5 ◽

Therapy Studies ◽

Do So

Abstract INTRODUCTION Medulloblastoma is one of the most common malignant brain tumors in children. To date, the treatment of average-risk (non-metastatic, completely resected) medulloblastoma includes craniospinal radiation therapy and adjuvant chemotherapy. Modern treatment modalities and now risk stratification of subgroups have extended the survival of these patients, exposing the long-term morbidities associated with radiation therapy. METHODS We performed a single-arm, multi-institution study, seeking to reduce the late effects of treatment in patients with average-risk medulloblastoma prior to advances in molecular subgrouping. To do so, we reduced the dose of craniospinal irradiation by 25% to 18 gray with the goal of maintaining the therapeutic efficacy as described in CCG 9892 with maintenance chemotherapy. RESULTS 28 patients aged 3–30 years were enrolled across three institutions between April 2001 and December 2010. Median age at enrollment was 9 years with a median follow-up time of 11.7 years. The 3-year relapse-free (RFS) and overall survival (OS) were 78.6% (95% CI 58.4% to 89.8%) and 92.9% (95% CI 74.4% to 98.2%), respectively. The 5-year RFS and OS were 71.4% (95% CI 50.1% to 84.6%) and 85.7% (95% CI 66.3% to 94.4%), respectively. Toxicities were similar to those seen in other studies; there were no grade 5 toxicities. CONCLUSIONS Given the known neurocognitive adverse effects associated with cranial radiation therapy, studies to evaluate the feasibility of dose reduction are needed. In this study, we demonstrate that select patients with average-risk medulloblastoma may benefit from reduced craniospinal radiation dose of 18 gray without impacting relapse-free or overall survival.

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Clinical and in Vivo Response Following Surgery or Surgery Plus Adjuvant Chemotherapy or Immunotherapy for Colorectal Carcinoma in a Rat Model

Journal of the Royal Society of Medicine ◽

10.1177/014107688307601007 ◽

1983 ◽

Vol 76 (10) ◽

pp. 833-840 ◽

Cited By ~ 6

Author(s):

A K House ◽

M A L Maley

Keyword(s):

Body Weight ◽

Adjuvant Chemotherapy ◽

Surgical Excision ◽

The Body ◽

Recurrent Tumour ◽

Mesenteric Node ◽

And Control ◽

Tumour Weight

Two cohorts of rats, 240 with colon cancer and 150 controls, were assessed clinically and immunologically for their response to tumour and its management which was either by surgical excision alone or by surgical excision combined with either adjuvant chemotherapy or immunotherapy. The histology and invasion characteristics were observed for similarity with those of human lesions. Metastases were found in liver, lymph nodes, the peritoneum or lungs in 27% of animals during follow up. Significantly fewer adjuvant-treated rats had metastases than those receiving surgery alone ( P < 0.05), and less total tumour weight was found in the adjuvant-treated rats at four ( P < 0.03) and six ( P < 0.001) weeks postoperatively. Animals in the adjuvant immunotherapy group survived longer than in either other group ( P < 0.001). The crude parameters of host response to tumour, body, spleen and mesenteric lymph node weight were recorded and the latter two indexed to body weight. The body weight of tumour and control rats increased significantly with time ( P < 0.04). The spleen and mesenteric node indices were significantly ( P < 0.04) greater in tumour than control rats and were varied by recurrent tumour growth and by the adjuvant treatment administered postoperatively.

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