Challenges in treatment of a patient suffering from neuroendocrine tumor G1 of the hilar bile duct: a case report

Abstract Background Neuroendocrine tumors (NETs) arise from neuroendocrine cells and are extremely rare in the biliary tract. Currently, there are no guidelines for the diagnosis and treatment of biliary NETs. We presented a case with NETs G1 of the hilar bile duct and the challenges for her treatment. Case presentation A 24-year-old woman was presented to our department with painless jaundice and pruritus, and the preoperative diagnosis was Bismuth type II hilar cholangiocarcinoma. She underwent Roux-en-Y hepaticojejunostomy with excision of the extrahepatic biliary tree and radical lymphadenectomy. Unexpectedly, postoperative pathological and immunohistochemical examination indicated a perihilar bile duct NETs G1 with the microscopic invasion of the resected right hepatic duct. Then the patient received 3 cycles of adjuvant chemotherapy (Gemcitabine and tegafur-gimeracil-oteracil potassium capsule). At present, this patient has been following up for 24 months without recurrence or disease progression. Conclusion We know little of biliary NETs because of its rarity. There are currently no guidelines for the diagnosis and treatment of biliary NETs. We reported a case of perihilar bile duct NETs G1 with R1 resection, as far as we know this is the first report. More information about biliary NETs should be registered.

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Challenges in treatment of a patient suffering from neuroendocrine tumor G1 of the hilar bile duct: a case report

10.21203/rs.3.rs-377428/v1 ◽

2021 ◽

Author(s):

Biao Zhang ◽

Zhen Sun ◽

Xu Chen ◽

Bing Qi ◽

Qingkai Zhang ◽

...

Keyword(s):

Bile Duct ◽

Adjuvant Chemotherapy ◽

Biliary Tract ◽

Time Management ◽

Proper Time ◽

Hepatic Duct ◽

Biliary Tree ◽

Neuroendocrine Cells ◽

R1 Resection ◽

Hilar Bile Duct

Abstract Background Neuroendocrine tumors (NETs) arise from neuroendocrine cells and are extremely rare located in the biliary tract. Currently, there are no guidelines for the diagnosis and treatment of biliary NETs. We present a case with NETs G1 of the hilar bile duct and the challenges for her treatment.Case presentation A 24-year-old woman was presented to our department with painless jaundice and pruritus, and the preoperative diagnosis was the perihilar bile duct cholangiocarcinoma. She underwent Roux-en-Y hepaticojejunostomy with excision of the extrahepatic biliary tree and radical lymphadenectomy. Unexpectedly, postoperative pathology showed a perihilar bile duct NETs G1 and microscopic invasion of the resected right hepatic duct. Then the patient received 3 cycles of adjuvant chemotherapy (Gemcitabine and tegafur-gimeracil-oteracil potassium capsule). At present, this patient has been following up for 20 months without recurrence or disease progression.Conclusions NETs of the biliary tract are difficult to diagnose preoperatively. The treatment for NETs G1 with R1 resection is still controversial yet may offer potential positive adjuvant chemotherapy. The diagnosis of NETs should be kept in mind by the surgeon for proper time management and more information about biliary NETs should be registered.

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Proximal Extrahepatic Bile Ducts: Comprehensive Review

Journal of oncology: diagnostic radiology and radiotherapy ◽

10.37174/2587-7593-2021-4-1-74-93 ◽

2021 ◽

Vol 4 (1) ◽

pp. 74-93

Author(s):

M. A. Shorikov ◽

O. N. Sergeeva ◽

M. G. Lapteva ◽

N. A. Peregudov ◽

B. I. Dolgushin

Keyword(s):

Bile Duct ◽

Bile Flow ◽

Bile Ducts ◽

Extrahepatic Bile Duct ◽

Hepatic Duct ◽

Biliary Tree ◽

Comprehensive Review ◽

Extrahepatic Bile Ducts ◽

And Function ◽

Variant Anatomy

Proximal extrahepatic bile ducts are the biliary tree segment within formal boundaries from cystic ductcommon hepatic duct junction to sectoral hepatic ducts. Despite being a focus of attention of diagnostic and interventional radiologists, endoscopists, hepatobiliary surgeons and transplantologists they weren’t comprehensively described in available papers. The majority of the authors regard bile duct confluence as a group of merging primitively arranged tubes providing bile flow. The information on the proximal extrahepatic bile duct embryonal development, variant anatomy, innervation, arterial, venous and lymphatic supply is too general and not detailed. The present review brought together and systemized exiting to the date data on anatomy and function of this biliary tract portion. Unique, different from the majority of hollow organs organization of the proximal extrahepatic bile duct adapts them to the flow of the bile, i.e. viscous aggressive due to pH about 8.0 and detergents fluid, under higher wall pressure than in other parts of biliary tree.

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Leakage Via Aberrant Bile Duct Due to Cholangiocarcinoma

HPB Surgery ◽

10.1155/1998/61506 ◽

1998 ◽

Vol 11 (2) ◽

pp. 125-128 ◽

Cited By ~ 3

Author(s):

R. Stanton ◽

P. I. Craig ◽

J. O. Jorgensen ◽

D. L. Morris

Keyword(s):

Bile Duct ◽

Hepatic Duct ◽

Open Cholecystectomy ◽

Bile Leak ◽

Biliary Tree ◽

Unusual Presentation ◽

Subsequent Investigation ◽

The Right ◽

Aberrant Bile Duct

The case of a male who had an open cholecystectomy complicated by presistent bile leak from an aberrant bile duct is presented. The persistence and volume of bile leak resulted in subsequent investigation of the biliary tree which demonstrated a cholangiocarcinoma of the right hepatic duct. This case is presented as an unusual presentation of cholangiocarcinoma and to highlight the value of modern techniques in imaging the biliary tree.

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Metastatic Neoplasms of the Large Bile Ducts- A Clinicopathological Study

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.119 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S58-S58

Author(s):

A Verma ◽

I Nalbantoglu ◽

A Barbieri

Keyword(s):

Gastrointestinal Tract ◽

Bile Duct ◽

Hepatic Duct ◽

Biliary Tree ◽

Primary Site ◽

Primary Adenocarcinoma ◽

Common Hepatic Duct ◽

Biliary Strictures ◽

Left Hepatic Duct ◽

Treatment Considerations

Abstract Introduction/Objective Biliary strictures are often considered malignant until proven otherwise. While the majority of malignant biliary strictures represent a primary neoplasm, secondary involvement by metastasis also rarely occurs. Primary cholangiocarcinoma and metastatic disease have different treatment considerations and likely different prognoses. The aim of this study is to look at the clinico-pathological characteristics of metastatic neoplasms of the bile duct. Methods/Case Report We retrospectively searched the pathology archives for biliary biopsies between 1991-2020. Patients with primary biliary, gallbladder, pancreatic, ampullary and hepatic malignancies and all cases of lymphoma were excluded from the study. A total of 20 cases were included. Results (if a Case Study enter NA) The median age of the patients was 63 years with a M:F ratio of 1.9:1. The biopsies were taken from the common bile duct (n=17), common hepatic duct (n=2) and left hepatic duct (n=1). 8 patients had synchronous and 12 had metachronous presentation. The overall median interval between the bile duct metastasis and primary was 18 months (Range: 0-100 months) for all patients and 33 months for metachronous cases. For 13 tumors, the primary site of origin was in the gastrointestinal tract (colon: 7; stomach: 4; anal canal: 1; gastro-esophageal junction: 1). Other primary sites included breast (3 cases), lung, endometrium and adrenal (1 each). One case presented with metastatic melanoma with an occult primary. Adenocarcinoma was the most common histological subtype seen in 17 cases. Other histological subtypes were squamous cell carcinoma, adrenocortical carcinoma and melanoma. Conclusion Secondary involvement of the bile duct by metastasis is rare. Most cases are metastasis from the lumenal gastrointestinal tract, with colon being the most common primary site. They are more likely to have a metachronous presentation with rare instances of bile duct metastasis as the first presentation. Awareness of secondary involvement of the biliary tree by metastasis is important as they can have prognostic and therapeutic significance.

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Granular cell tumor of the common hepatic duct presenting as cholangiocarcinoma and acute acalculous cholecystitis

Acta chirurgica iugoslavica ◽

10.2298/aci0804099b ◽

2008 ◽

Vol 55 (4) ◽

pp. 99-101 ◽

Cited By ~ 8

Author(s):

D. Bilanovic ◽

I. Boricic ◽

D. Zdravkovic ◽

T. Randjelovic ◽

N. Stanisavljevic ◽

...

Keyword(s):

Granular Cell Tumor ◽

Hepatic Duct ◽

Acalculous Cholecystitis ◽

Granular Cell ◽

Biliary Tree ◽

Cell Tumor ◽

Common Hepatic Duct ◽

Benign Tumors ◽

Acute Acalculous Cholecystitis ◽

Extrahepatic Biliary Tree

Granular cell tumors (GCT) are rare benign tumors. Less than 1% of GCTs involve the extrahepatic biliary tree. Most researches favor a Schwann cell origin. Patient, caucasion, female, 31 year old presented with 4 month history of painless jaundice and pruritus. US and CT revealed dilatation of intrahepatic biliary tree and surgery was performed. Firm tumor mass was found above the conjunction of cystic duct and common hepatic duct (CHD) that caused obstruction and gallblader empyema. The patient underwent radical surgical procedure because Klatskin tumor was clinically suspected. Patohystology and immunohistochemistry confirmed granular cell tumor. Eight years after surgery the patient is wellbeing without symptoms. To our knowledge 69 cases of GCT of the extrahepatic biliary tree have been reported and none of the acute acalculous cholecystitis case accompanied by GCT of CHD. Granular cell tumors are rarely diagnosed preoperatively. Wide resection offers the best chance for cure.

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Anomalous anatomical variation in extrahepatic biliary tree and pancreas and its related vessels: a cadaveric study

International Surgery Journal ◽

10.18203/2349-2902.isj20193658 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3111

Author(s):

Mahim Koshariya ◽

Sheikh Behram ◽

Jay Prakash Singour ◽

Shashikant Tiwari ◽

Vidhu Khare

Keyword(s):

Cystic Duct ◽

Hepatic Duct ◽

Anatomical Variation ◽

Clinical Importance ◽

Biliary Tree ◽

Cystic Artery ◽

Common Hepatic Duct ◽

Left Hepatic Duct ◽

Extrahepatic Biliary Tree ◽

Insight Into

Background: Congenital anamolies of extrahepatic biliary apparatus and pancreas have long been recognized and are of clinical importance because when present may surprise the surgeon during surgery and lead to iatrogenic injuries. Surgeries on extra-hepatic biliary apparatus and pancreas are regularly performed throughout the world. Thus insight into the normal anatomy and congenital variations will reduce complication and definitely improve outcome.Methods: Study was conducted in department of surgery GMC Bhopal and dissection was carried out in Department of Forensic Medicine on 100 cadavers with approval from ethical committee.Results: In 100 cases 70 were male and 30 female. The most common variation in extra hepatic biliary apparatus was short cystic duct was found in 6% cases then formation of common hepatic duct by union of right hepatic duct and left hepatic duct was intrahepatic in 3% cases. There was low insertion of cystic duct with common hepatic duct in 1% case. Cystic artery originating from left hepatic artery in 1% case, in 1% case cystic artery was anterior to common hepatic duct. In Pancreas anterior arterial arcade was absent in 2% cases and its origin varied in 2% case. Posterior pancreatic arcade absent in 1% cases and variation in origin was present in 1% case. The variation in pancreatic duct course was present in 22% cases.Conclusions: Thus significant variation was seen and it could definitely be helpful to hepatobiliary, laproscopic surgeons, radiologist and will further contribute to literature on variation of extrahepatic biliary apparatus and pancreas and its related vessels.

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Congenital biliary web- a rare cause of obstructive jaundice in an infant: A case report

Journal of Pediatric and Adolescent Surgery ◽

10.46831/jpas.v1i1.7 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Allah Ditta ◽

Muhammad Bilal Mirza ◽

Muhammad Waqas-ur-Rehman ◽

Maria Fahim ◽

Farrakh Mehmood Satar ◽

...

Keyword(s):

Obstructive Jaundice ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Biliary Tree ◽

Postoperative Recovery ◽

Common Hepatic Duct ◽

Rare Entity ◽

Case Presentation ◽

Complete Obstruction ◽

The Common

Background: Congenital biliary web of the extra-hepatic biliary tree is becoming exceedingly rare cause of obstructive jaundice in children. Case Presentation: We report a case of 5-month-old male baby who presented with acholic stools and persistent jaundice since birth. Magnetic resonance cholangiopancreatography (MRCP) showed contracted gall bladder and focal narrowing at mid portion of the common bile duct (CBD) with proximal dilatation of biliary channels. On exploration, a complete web was found just proximal to the confluence of cystic duct and common hepatic duct causing complete obstruction of biliary tree. A Roux-en-Y hepatico-jejunostomy was done. Postoperative recovery was uneventful. Conclusion: We conclude that congenital biliary web is a rare entity and should be considered in the differential diagnosis of biliary atresia.

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Intraductal papillary neoplasm of the bile duct: two case reports and review of the literature

Case Reports in Internal Medicine ◽

10.5430/crim.v6n2p25 ◽

2019 ◽

Vol 6 (2) ◽

pp. 25

Author(s):

Vishal Kaila ◽

Siddharth B Javia ◽

Nirav Thosani ◽

Isaac Raijman

Keyword(s):

Bile Duct ◽

Case Reports ◽

Biliary Tree ◽

Imaging Studies ◽

Intraductal Papillary Neoplasm ◽

Single Operator ◽

Papillary Lesions ◽

Extrahepatic Biliary Tree ◽

Papillary Neoplasm ◽

Made In

Background: Intraductal Papillary Neoplasm of the Bile Duct (IPNB) is a rare disease that is characterized by papillary lesions in the intra and extrahepatic biliary tree. Traditional imaging studies may show biliary dilation and/or filling defects. Endoscopic retrograde cholangiopancreatography can demonstrate diffuse bile duct dilatation as well as amorphous filling defects, however visualization of the biliary system can be limited by obstruction by the papillary lesions or mucin. Digital single operator cholangioscopy can be used to aid in diagnosis.Case Presentation: We report two elderly Caucasian males that presented with fatigue and obstructive jaundice. In both cases, the diagnosis of IPNB of was made. In one case, digital single operator cholangioscopy was used successfully to make the diagnosis.Conclusions: We present two cases of IPNB as well as a review of the clinical characteristics of IPNB and the utility of digital single operator cholangioscopy to aid in diagnosis. In IPNB, timely diagnosis is paramount. Traditional imaging studies can be inadequate, digital single operator cholangioscopy allows for quick diagnosis and, if indicated, further intervention.

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