Chylous Leakage: A Rare Complication after Axillary Lymph Node Dissection in Breast Cancer and Surgical Management / 한국유방암학회지

Chylous leakage is an extremely rare complication of surgery for breast cancer. We experienced a case of chylous leakage after axillary lymph node dissection. A 38-year-old woman with invasive ductal carcinoma in the left breast underwent a modified radical mastectomy after four cycles of neoadjuvant chemotherapy. The postoperative serosanguinous drainage fluid became "milky" on the fourth postoperative day. After trying conservative management, we re-explored the axilla and ligated the lymphatic trunk. Although the success of many cases supports conservative management, timely surgical intervention represents an alternative in cases where leakage persists or where the output is high.

Free Floating Thrombus of the Aorta: An Unusual Cause of Peripheral Embolization

PURPOSE: Free-floating thrombus (FFT) of the aorta is very rare but has a high risk of distal embolization. While the necessity of treating such a condition is evident, the diagnostic and therapeutic modalities remain controversial. Thus, we reviewed seven cases of FFT of the aorta. METHODS: A retrospective study was performed usings even patients diagnosed with FFT of the aorta at the Catholic University of Korea between January 1999 and December 2008. We excluded those patients who had thrombi with concomitant atherosclerotic or aneurysmal aorta. RESULTS: The mean patient age was 59.6+/-13.6 years old. The male-to-female ratio was 3:4. Embolization to arteries of the extremities occurred in two patients and to visceral arteries in four patients. Of these seven patients, four were initially treated with anticoagulation, and two were initially treated with thrombectomy; one patient refused any kind of treatment. Of the four patients treated with anticoagulation, three experienced complete dissolution of the thrombi while anticoagulation proved ineffective in the remaining patient who subsequently underwent thrombectomy. In all of the three patients who had received thrombectomy, postoperative anticoagulation was employed. There was no recurrence of FFT of the aorta during the follow-up period. CONCLUSION: Were commend systemic anticoagulation with low molecular weight heparin (LMWH) as the first line of treatment for FFT of the aorta. If the thrombus persists or recurrent embolism occurs during anticoagulation therapy, surgery should be undertaken.

Analysis of the Relationship between Central Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma and the Associated Factors according to the Tumor Size

PURPOSE: The aim of this study was to analyze the relationship between central lymph node metastasis and the associated factors in patients with papillary thyroid carcinoma (PTC) according to the tumor size, and we wanted to determine an appropriate treatment for PTC. METHODS: From June 2005 to May 2007, 218 patients with PTC underwent total thyroidectomy or lobectomy, and they also received central lymph node dissection at our institution. The patients were divided into three groups: group 1 (tumor 10 mm). We retrospectively reviewed these patients to analyze the relationship between tumor size and the clinicopathological characteristics, including age, gender, lymph node metastasis, extrathyroidal extension, capsular invasion and lymphovascular invasion. RESULTS: There were 47 (21.6%) patients in group 1, 101 (46.3%) patients in group 2 and 70 (32.1%) patients in group 3. The tumor size was closely correlated with the presence of extrathyroidal extension, capsular invasion and lymph node metastasis (P<0.001). Lymph node metastasis was not only closely correlated with tumor size, but it was also significantly associated with extrathyroidal extension, capsular invasion and lymphovascular invasion (P<0.05). CONCLUSION: Our study confirmed that some factors, including central lymph node metastasis, capsular invasion and extrathyroidal extension, were frequently observed in patients with papillary thyroid microcarcinoma (PTMC), and central lymph node metastasis was related to tumor size, extrathyroidal extension, capsular invasion and lymphovascular invasion. Therefore, routine central lymph node dissection is recommended during the initial surgery for patients with PTMC.

Laparoscopic Cystogastrostomy for the Patient of Pancreatic Pseudocyst with Intra-abdominal Adhesion

A large symptomatic and unresolved pancreatic pseudocyst is treated surgically by internal drainage to a neighboring adherent viscus. Recently the various minimal invasive approaches have been used to treat this condition. A 30- year-old man who had been in clinical follow-up for a chronic pancreatitis. For the necrotizing pancreatitis, the patient had undergone surgical debridement and external drainage 5 years, and 3 years ago, respectively. Abdominal ultrasonography and computed tomography revealed 8.2x7.7 cm sized pseudocyst in the body of pancreas. Endoscopic internal fistula formation was tried, but it was failed due to bleeding. We underwent adhesiotomy and cystogastrostomy totally with laparoscopic techniques. The patient started a diet on the 5th postoperative day and discharged on the 11th postoperative day. There was no postoperative complicationand no recurrence during 6 months. Laparoscopic cystogastrostomy is safe and feasible method in the pancreatic pseudocyst even in case of severe abdominal adhesion.

Wernicke's Encephalopathy following Gastrectomy in Patients with Gastric Cancer

Wernicke's encephalopathy is a neurological disorder that is caused by a thiamine deficiency, and characterized by acute confusion, ataxia, a change in the patient's state of mind and abnormal eye movement (op-thalmophlegia and nystag-mus). This encephalopathy can be found in patients with chronic alcoholism, anorexia nervosa, hemodialysis, AIDS and gastroplasty for morbid obesity. The diagnosis of this disease is difficult because not all cases display the typical symptoms. However, this disease can be confirmed not only by the clinical symptoms but also by the brain MRI findings, low thiamine level and clinical response to thiamine replacement therapy. We experienced two cases of Wer-nicke's encephalopathy in patients who underwent a gas-trec-tomy for gastric cancer. However, this condition was not diagnosed until the patients showed neurological symptoms and the typical MRI findings. These patients improved after vitamin B(1) (thiamine) replacement.

A Comparison between Endoscopic Thyroidectomy Performed by the Axillary Approach and by a Conventional Thyroidectomy / 대한내분비외과학회지

PURPOSE: Endoscopic thyroidectomy has not become a widespread procedure because of limited advantages to its use. We have performed endoscopic thyroidectomies by use of the axillary approach. The purpose of this study was to determine the efficacy of this surgical procedure. METHODS: Between June of 2002 and December of 2002, 17 patients underwent an endoscopic thyroidectomy by use of the axillary approach while 11 patients underwent a conventional thyroidectomy. Each procedure was performed by one surgeon under general anesthesia. Patients with thyroid carcinoma at the preoperative diagnosis or who received a bilateral thyroidectomy were excluded. We compared the age, size of the tumor, postoperative pain (48 hours after surgery), surgical time, cosmetic result, length of hospital stay, and paresthesia. Statistical analysis was determined by use of the Mann-Whitney test and the chi-square test using SPSS software. RESULTS: The mean age of the patients was 46.6 years who received a conventional thyroiodectomy and 32.9 years who underwent the axillary approach. The size of the tumor was 3.1 cm for patients who received conventional thyroiodectomy and 3.3 cm for patients who underwent the axillary approach. The operation time was 80.91±16.1 (65~100) minutes for the conventional thyroiodectomy and 135.3± 34.6 (80~210) minutes for the axillary approach. The difference between the two approaches in regards to parameters such as postoperative pain, parethesia, and total hospital days was negligible. The degree of satisfaction was 2.7±0.8 for the conventional thyroiodectomy and 1.1±0.3 for the axillary approach. CONCLUSION: While conventional thyroidectomy still offers an advantage in terms of surgical time, performance of endoscopic thyroidectomy by the axillary approach has an advantage in producing better cosmetic results. Although a multitude of patients will be necessary to follow in further studies, the use of endoscopic thyroidectomy by the axillary approach could become the procedure of choice by offering better cosmetic results to young patients who present with thyroid nodules.

Current Status of Endoscopic Thyroidectomy in Korea / 대한내분비외과학회지

PURPOSE: The endoscopic surgery has been widely used and developed in operations of the thyroid and parathyroid gland because of the cosmetic advantage and the development of laparoscopic instrument. Since the first endoscopic thyroid surgery in late 1990's, many endoscopic operations for thyroid tumors have been performed in Korea. The authors analyzed the current status of endoscopic thyroid surgery performed in Korea. METHODS: We have collected and analyzed the data of endoscopic thyroid operations using survey. RESULTS: The surgeons working in 16 hospitals answered the questions in survey. The total endoscopic thyroid operations were performed over 1,200 cases until the end of 2004. In the pathologic diagnosis, nodular hyperplasia was most frequent in 64.5%. The axillary approach was most frequently applied in 9 hospitals (56.2%). Most of endoscopic thyroid operations were performed in 2~3 hours. The operation time was decreased according to the experience. The endoscopic surgery for malignant tumors were also performed in 11 hospitals, The hospital stay was usually 3~4 days. The most common complications in endoscopic thyroid surgery were temporary recurrent laryngeal nerve paralysis and anteior chest wall discomfort or paresthesia. The most common reason for conversion to conventional surgery was the intraoperative diagnosis as for a malignancy. CONCLUSION: Endoscopic thyroid surgery has been perfomed in many hospitals not only special thyroid clinic in Korea. The operation cases are increasing rapidly in these days. According to the development of technique and instrument, the endoscopic surgery are applied to various neck disease involving malignancy. The safety and efficacy of endoscopic surgery for malignancy should be further evaluated with accumulation of experience of endoscopic operation and long term follow-up of thyroid cancer patients.

Parathyroid Cyst: Description of Two Cases and Review of the Literature / 대한내분비외과학회지

Parathyroid cysts are uncommon causes of neck or mediastinal masses. They have been mistaken for cystic thyroid nodules, brachial cleft cysts, or thyroglossal duct cysts. Two types of parathyroid cysts have been recognized; the non- functioning forms, which are more frequent and the functioning paratyroid cysts, which are rarer and cause hyperparathyroidism. Parathyroid cysts are usually located in the inferior parathyroid gland, which are most commonly involved with a left-sides predominance. Although their location in mediastinum has also been described. Parathyroid cysts may present as a diagnostic problem. It is sometimes difficult that parathyroid lesions are distinguished from thyroid ones with current imaging techniques. Diagnosis is based on the histopathological appearance of the cyst and PTH level in the cystic fluid. Percutaneous needle aspiration of parathyroid cysts reveals crystal clear fluid. Elevated PTH levels in the cystic fluid confirms the diagnosis. The presence of parathyroid tissue within the cyst wall is diagnostic. Nonfunctioning cyst may be treated with aspiration alone, surgical excision is indicated for functioning cyst. We present the case of two patients with a parathyroid cyst.

Expression of estrogen receptor beta, estrogen receptor alpha and cyclooxygenase II in advanced breast cancer / 한국유방암학회지

PURPOSE: Although the role of the estrogen receptor alpha (ER alpha, previously called the estrogen receptor) in breast cancer is well established, that of the second human estrogen receptor (ER), estrogen receptor beta (ER beta), remains uncertain. The expression of cyclooxygenase II (COX II) could also be regulated by sex steroids such as estrogen and progesterone. To investigate whether the expressions of the ER beta, ER alpha, and COX II are elevated in more aggressive breast cancers, the expression of the ER beta was studied by immunohistochemical staining in 20 primary breast cancer and original breast cancer tissues from 20 recurrent cancer patients, and its associations with ER alpha and cyclooxygenase (COX) II were evaluated. METHODS: Paraffin tissue sections from 40 breast cancers, surgically excised at the Department of Surgery, the Catholic University of Korea. were obtained. The immunohistochemical analysis was conducted on 20 non-recurrent, and 20 recurrent primary breast cancer tissues, using polyclonal antibodies to ER beta, ER alpha, and the corresponding monoclonal antibodies to COX II. RESULTS: Of the 40 patients, 15 (37.5%) were ER beta-positive, 30 (75%) were ER alpha-positive, and 24 (60%) were COX II-positive. The ER bata status was not related to the tumor size or menopausal status, but was related to the nodal status. The stati of ER alpha and COX II were not related to other clinico-pathological factors. The ER beta positivity was significantly more frequent in the study than the control group. (ER beta, p = 0.0222; ER alpha p = 0.1441; COX II, p = 1.00) The presence of ER beta was significantly related to the expression of ER alpha and COX II (p = 0.0455, p = 0.0381, respectively). CONCLUSION: These results suggest that the expression of ER beta is associated with early recurrence in breast cancer and the expression of COX II in the presence of ER beta implies the possibility of prognostic significance.

Expression of estrogen receptor beta, estrogen receptor alpha and cyclooxygenase II in advanced breast cancer / 한국유방암학회지

PURPOSE: Although the role of the estrogen receptor alpha (ER alpha, previously called the estrogen receptor) in breast cancer is well established, that of the second human estrogen receptor (ER), estrogen receptor beta (ER beta), remains uncertain. The expression of cyclooxygenase II (COX II) could also be regulated by sex steroids such as estrogen and progesterone. To investigate whether the expressions of the ER beta, ER alpha, and COX II are elevated in more aggressive breast cancers, the expression of the ER beta was studied by immunohistochemical staining in 20 primary breast cancer and original breast cancer tissues from 20 recurrent cancer patients, and its associations with ER alpha and cyclooxygenase (COX) II were evaluated. METHODS: Paraffin tissue sections from 40 breast cancers, surgically excised at the Department of Surgery, the Catholic University of Korea. were obtained. The immunohistochemical analysis was conducted on 20 non-recurrent, and 20 recurrent primary breast cancer tissues, using polyclonal antibodies to ER beta, ER alpha, and the corresponding monoclonal antibodies to COX II. RESULTS: Of the 40 patients, 15 (37.5%) were ER beta-positive, 30 (75%) were ER alpha-positive, and 24 (60%) were COX II-positive. The ER bata status was not related to the tumor size or menopausal status, but was related to the nodal status. The stati of ER alpha and COX II were not related to other clinico-pathological factors. The ER beta positivity was significantly more frequent in the study than the control group. (ER beta, p = 0.0222; ER alpha p = 0.1441; COX II, p = 1.00) The presence of ER beta was significantly related to the expression of ER alpha and COX II (p = 0.0455, p = 0.0381, respectively). CONCLUSION: These results suggest that the expression of ER beta is associated with early recurrence in breast cancer and the expression of COX II in the presence of ER beta implies the possibility of prognostic significance.

Male Breast Cancer / 한국유방암학회지

PURPOSE: Carcinomas of the male breast constitutes only 1% of all breast cancer and less than 1.5% of all malignant tumors in men. The low incidence of this disease prevents therapeutic questions from being addressed in prospective randomized trials. Our aim was to cover the characteristics of the etiology, presentation and treatment of male breast cancer; and therefore provide an overview of knowledge in this area. METHODS: We retrospectively analyzed 16 male breast cancer patients, who had been treated between 1983 and 1992 at the Department of Surgery, College of Medicine, The Catholic university of Korea. RESULTS: The peak age of incidence was in the 7th and 8th decades. The most common symptom was a palpable mass in the breast (75.1%), and the duration of symptom varied between 3 days and 10 years. According to the TNM staging system, there were 18.8%, 31.3%, 18.8%, 12.5%, 6.3%, at stages 0, I, II, III and IV, respectively, and 12.5% with an unknown stage. A modified radical mastectomy was performed in 11 patients (68.8%) and postoperative adjuvant therapy in 12 patients (75.1%). The mean duration of following up was 41.2 months, during which time 2 patients were lost. CONCLUSION: Sixteen male breast cancer patients were encountered and men with breast cancer were observed to be older, have a longer duration of symptom, and more likely to have a familial tendency. However, our review revealed that male breast cancer was not as far advanced and had more chance of cure than initially thought. Therefore, the early detection and aggressive treatment of breast cancer are important for improving the survival.

A Carcinosarcoma of the Esophagus

A carcinosarcoma of the esophagus is an uncommon malignancy accounting for approximately 1~2% of all esophageal neoplasms. Histologically, both carcinomatous and sarcomatous components are observed. The terms used to describe this lesion include carcinosarcoma, pseudosarcoma, polypoid carcinoma, pseudosarcomatous carcinoma pseudosarcomatous squamous cell carcinoma and a spindle cell variant of a squamous cell carcinoma. It presents as a bulky intraluminal polypoid lesion mainly in the mid to lower esophagus. It often presents relatively early because of its rapid intraluminal growth. Ultimately, the treatment is similar to that of an esophageal carcinoma requiring an esophagectomy for resectable lesions. We report a case of a 64-year-old man with a carcinosarcoma of the esophagus. Endoscopy revealed a 1.5 cm sized polypoid mass located 25 cm from the incisor with friable nature. Radiological studies revealed a bulky polypoid intraluminal mass with a lobulated border, measuring approximately 7 cm in length, in the mid esophagus that expands the lumen in conjunction with the enlargement of the regional lymph nodes. An esophagectomy was performed.

Methylation of P16 and hMLH1 in Gastric Carcinoma

PURPOSE: We investigated the impacts of the methylation states of the P16 and the hMLH1 genes on pathogenesis and genetic expression of stomach cancer and their relationships with Helicobater pylori infection, and with other clinico-pathologic factors. MATERIAL AND METHODS: In our study, to detect protein expression and methylation status of the P16 and the hMLH1 genes in 100 advanced gastric adenocarcinomas, used immunohistochemical staining and methylation-specific PCR (MSP) and direct automatic genetic sequencing analysis. RESULTS: Methylation of the P16 gene was observed in 19 out of 100 cases (19%) and in the 18 of those cases (94.7%) loss of protein expression was seen. We were sble to show that loss of P16 gene expression was related to methylation of the P16 gene (kappa coefficient=0.317, P=0.0011). Methylation of the hMLH1 gene was observed in 27 cases (27%), and in 24 cases of those 27 cases (88.8%), loss of protein expression was seen, which suggested that loss of protein expression in the hMLH1 gene is related to methylation of hMLH1 gene (kappa coefficient=0.675, P<0.0001). Also methylation of the hMLH1 gene was related to age, size of the mass, and Lauren's classification. CONCLUSION: We found that methylation of DNA plays an important role in inactivation of the P16 and the hMLH1 genes. The methylation of the hMLH1 genes is significantly related to age, size of the mass, and Lauren's classification.

Central Vein Catheterization with an Electrocardiogram

PURPOSE: This study analyzed the value of an electrocardiogram (ECG) using an arterial pulsator in central vein catheterization (CVC). METHODS: In 442 patients who underwent CVC with an ECG and an arterial pulsator, this study evaluated the rates of change in the P wave and the QRS wave at the limb lead II before and after insertion. After insertion, a plain chest X-ray was checked in order to locate the catheter tip. RESULTS: After catheterization, the P wave and the QRS wave increased together at 97% but the P wave (change rate: 0.5~21.0) was more sensitive than the QRS wave (change rate: 0.5~5.8). For an abnormal location (3%), the rate of change in the P wave was 2.0 were 95% and 100%, and those of the QRS wave >1.4 were 90% and 100%. CONCLUSION: In central vein catheterization, an electrocardiogram with an arterial pulsator can be a useful method, and the normal position of the catheter tip can be estimated by using a rate of change in the P wave >2.0 or a rate of change in QRS wave >1.4.

Macromastia with Multiple Fibroadenomas in a Wilson's Disease Patient / 대한내분비외과학회지

Wilson's disease is an autosomal recessive disorder of copper metabolism in individuals with mutant ATP7B genes. Impairment of normal excretion of hepatic copper results in toxic accumulation of the metal in liver, brain and other organs. Clinical manifestations include hepatic, neurologic or psychiatric disturbances. Penicillamine, as a chelator of copper, is the drug of choice in the treatment of Wilson's disease but after treatment of penicillamine, granulocytopenia, thrombocytopenia, the nephrotic syndrome, Goodpasture's syndrome, pemphigus vulgaris or pleural effusion may supervene. We report a case of macromastia with multiple fibroadenomas in a patient who was treated with penicillamine for Wilson's disease.

A Clinical Analysis of Endoscopic Thyroidectomy by the Axillary and Anterior Chest Approach / 대한내분비외과학회지

PURPOSE: The thyroid suregry has recently become one of the newest fields for the application of endoscopic surgery. We have performed endoscopic thyroidectomy by an anterior chest approach and an axillary approach. In this study, we evaluated these two types of endoscopic procedures with regard to efficacy and patients' complaints after surgery. METHODS: Between December 2000 and March 2002, 41 patients were treated by endoscopic thyroidectomy via axillary or anterior chest approach. Each procedure was performed by one surgeon under a general anesthesia. We analysed the operating time, postoperative complications, postoperative scar, the degree of pain to assess the surgical invasiveness of each procedure. RESULTS: Three cases treated using anterior chest approach, and 2 cases treated using axillary approach were converted to conventional thyroidectomy. The mean age of patients was 36 years in anterior chest approach group and 30 years in axillary approach group. The operation time was 238±60 (160~370) minutes in anterior chest approach and 178±71 (100~295) minutes in axillary approach. Postoperative complications are; 1 case of a minimal hematoma, 3 cases of minor wound infection, 3 cases of chest pain in anterior chest approach group, and 1 case of a minimal hematoma, 1 case of transient recurrent laryngeal nerve injury, 1 cases of transient swallowing difficulties in axillary approach group. CONCLUSION: Endoscopic (gasless and axillary approach) thyroidectomy is a safe and effective procedure. Gasless endoscopic thyroidectomy is a useful procedure for unexperienced surgeon due to safety. Endoscopic thyroidectomy by the axillary approach is a better effective procedure with good cosmetic result for a unilateral tumor especially in young women.

Value of Elevated Ki67 Index (>10%) and p53 Protein Expression as Prognostic Factors in GISTs

PURPOSE: Although gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors and express CD117, the prediction of their malignant potential remains difficult. The aim of this study is to evaluate the prognostic accuracy of elevated Ki67 index and p53 overexpression in combination with classical prognostic factors (tumor size and mitotic index). METHODS: A retrospective study was conducted in 84 patients who had been re-evaluated for confirmation of diagnosis based on immunohistochemical analysis with CD117 expression, between Jan 1991 and Dec 2001. Cases were classified as very low, low, intermediate and high-risk groups according to 2001 NIH consensus symposium. Elevated Ki67 index was assigned to the lesion that displayed 10% or more of immunoreactive cells. And p53 expression was assigned to the area with 5% or more of eosinophilic nucleus. RESULTS: Elevated Ki67 was noted in 37 (44.0%) out of 84 cases. High-risk patients showed elevated Ki67 index more frequently (P<0.0001) and there was significant relation between elevated Ki67 and survival rate (P=0.0417). The p53 expression was noted in 32 (38.1%) out of 84 cases. The p53 expression was significantly higher in high-risk patients (P=0.0081) than low-risk patients. But, there was no significant relation between p53 expression and survival rate. As a result of multivariate analysis, tumor size (P=0.0059), mitotic index (P=0.0016) and elevated Ki67 index (P=0.0384) were proved as significant independent prognostic factors. CONCLUSION: According to the results of our retrospective study, p53 expression is related to disease progression but its value as a prognostic factor in GISTs is uncertain. It is suggested that tumor size, mitotic rate and elevated Ki67 index are the helpful prognostic factors in GISTs.

Deep Vein Thrombosis Casused by Congenital Absence of Inferior Vena Cava Combined with Hyperhomocysteinemia Due to C677T Methylenetetrahydrofolate Reductase Homozygos Mutation

We present a case of suprarenal & infrarenal absence of inferior vena cava combined with hyperhomocysteinemia in a 39-year-old woman who presented with symptoms of deep venous thrombosis. The patient has also C677T methylenetetrahydrofolate reductase homozygous mutation. Deep vein thrombosis has multifactorial etiology involving both genetic and acquired factors. Absence of inferior vena cava is a rare congenital anomaly, but recently it was confirmed as important risk factor for the development of deep vein thrombosis especially young person. Hypercoagulability by the hyperhomocysteinemia with suggested tendency to venous stasis mediated by agenesis of inferior vena cava must have caused the deep vein thrombosis in our patient. To our knowledge, such an association has not been reported. Clinical features and prognosis of this entity are discussed.

Biliary Manometry in Patients with Common Bile Duct Stones / 한국간담췌외과학회지

BACKGROUND/AIMS: The conventional treatment of patients with common bile duct (CBD) stones was to insert a T-tube via the duct after stone removal. But since the placement of T-tubes resulted in a lot of complications, a few alternative methods have been suggested lately, such as primary closure or intraductal drainage etc. Deciding whether to perform primary closure or to insert a stent or a T-tube is usually based on objective findings such as inspection, palpation or intraoperative cholangiogram. We made a study using the intraoperative biliary manometry as an objective indicator in decision making among the procedures. METHODS: The study was based on 23 patients (10 male, 13 female) who underwent common bile duct exploration for stone removal from March 2002 to May 2003. The basal pressure and frequency of phasic contraction of the Sphincter of Oddi were measured intraoperatively by manometry RESULTS: Primary closure after CBD exploration was performed in 15 cases, intraductal drainage in the remaining 8 cases. No complication such as bile leakage or postoperative obstructive jaundice was observed. CONCLUSION: The intraoperative biliary manometry is a simple and useful tool that can be used as an indicator in deciding whether to perform a drainage procedure after common bile duct stone removal.

Three Cases of Biliary Cystadenoma and Biliary Cystadenocarcinoma

A biliary cystadenoma and a cystadenocarcinoma are rare intrahepatic cystic neoplasm. The clinical feature is not marked but abdominal fullness and mass are the most common symptoms. The tumor is commonly a large multilocular cystic mass which requires hepatectomy for cure. We experienced one case of biliary cystadenoma and two cases of biliary cystadenocarcinoma. The biliary cystadenoma case was a 58-year-old female with right upper quadrant discomfort for 5 months and a 17 cm sized multilocular cystic mass. The serum CA 125 level was elevated but returned to normal level after resection. A right hepatectomy was performed and the patient has had no recurrence for 14 months after the resection. One of the biliary cystadenocarcinoma cases was a 42-year-old man with a 12 cm sized multilocular cystic mass in the right upper quadrant of his abdomen. A right hepatectomy was performed and the patient has had no recurrence for 12 months after the resection. The other biliary cystadenocarcinoma case was a 70-year-old man with right upper quadrant pain and a 5 cm sized cystic mass. A left hepatecomy was performed and the patient has had no recurrence for 8 month after the resection. The treatment of choice for a biliary cystadenoma or cystadenocarcinoma is complete resection. We report three cases of biliary cystadenoma and cystadenocarcinoma with a review of the literature.