The new classifications of biliary tract diseases based on actual anatomy / 中华外科杂志

In order to facilitate the treatment strategies for biliary tract injury, hilar cholangiocarcinoma, bile duct tumor thrombus, cholangiocellular carcinoma and bile duct cystic dilatation, many classifications have been made, even more than 10 types for one disease. Each type is represented by numbers or English alphabet, which are not only confusing but also difficult to remember. The Academician Mengchao Wu divided the liver into five sections and four segments base on its anatomy, this classification is very direct and visual, thus had been using till now. In order to overcome those complicated problems, it is considered to develop a new classification based on actual anatomic location similar to that for liver cancer, which is easy to remember and to directly determine the treatment strategy. All kinds of classifications have their own characteristics and advantages and disadvantages. This practical classifications avoid the complexity and may be useful for clinicians.

Research progress in the diagnosis and treatment of intrahepatic cholangiocellular carcinoma / 介入放射学杂志

Intrahepatic cholangiocellular carcinoma (ICC) is a primary tumor originating from the epithelial cells of bile duct. In recent years, incidence of ICC in the world is on the rise, and it has become the second common malignant tumors of the liver, with its incidence being next only to hepatocellular carcinoma (HCC). The onset of ICC is insidious, its clinical manifestations are lack of specificity, most of the patients are already in the advanced stage when the diagnosis is confirmed, thus, affecting the treatment and prognosis. Therefore, early diagnosis and treatment is essential. The radical treatment plan is mainly surgical excision, and other treatment options include systemic chemotherapy, local ablation, transcatheter arterial chemoembolization (TACE), selective intraarterial radiotherapy with yttrium-90 microspheres (SIRT-90Y), 125I seed implantation, etc. This article aims to make a comprehensive introduction about the recent advances in the diagnosis and treatment of ICC. (J Intervent Radiol, 2018, 27:285-289)

Analysis on MRI manifestation of recurrent pyogenic cholangitis accompanied with intrahepatic cholangiocarcinoma / 中国医学装备

Objective:To investigate the MRI manifestation of recurrent pyogenic cholangitis accompanied with intrahepatic cholangiocarcinoma.Methods: A total of 230 patients with recurrent pyogenic cholangitis were selected from our hospital. 64 patients were made a diagnosis with intrahepatic cholangiocarcinoma by pathology and MRI and were brought into our research. Their clinical data was analyzed to investigate their MRI manifestation. Results: Compared with non-atrophy liver lobes, the morbidity of cholangiocarcinoma was higher in atrophy liver lobes (78.18%vs.28.77%,P<0.001).Compared with liver lobes without hepatic portal vein blocking, the morbidity of cholangiocarcinoma was higher in liver lobes with hepatic portal vein blocking (78.18%vs.28.77%,P<0.001). Compared with liver lobes without hepatolith, the morbidity of cholangiocarcinoma was higher in liver lobes with hepatolith (65.00%vs.36.76%,P=0.001).Conclusion: Recurrent pyogenic cholangitis accompanied with intrahepatic cholangiocarcinoma mainly occurs in atrophy liver lobes, liver lobes with hepatic portal vein blocking and liver lobes with hepatolith. The main MRI manifestation of cholangiocarcinoma is less blood supply, but few neoplasms have much blood supply.

The Surgical Treatments for the Hepatolithiasis

Hepatolithiasis is characterized by its intractable nature and frequent recurrences that require multiple operative interventions. Intrahepatic stones consist of calcium bilirubinate in most cases, but these stones contain more cholesterol than the stones in the common bile duct. The pathogenesis of primary bile duct stones is based upon bile stasis and infection. Bile duct stricture and dilatation of the duct are usually present in cases with brown pigmented stones. In addition to cholangitis, liver abscess and longstanding sepsis, intrahepatic stones and strictures can cause secondary biliary cirrhosis and intrahepatic cholangiocarcinomas. Pyogenic cholangitis that's due to strictures and hepatolithiasis tends to recur; therefore, operations such as stricturoplasty, hepaticojejunostomy and liver resection are inevitable. The primary goals of surgery are to eliminate stones and the atrophic liver tissue, and to correct the bile stasis. Recent advances have been made in noninvasive treatments, such as percutaneous transhepatic cholangioscopic lithotripsy (PTCSL). Because postoperative residual stones and recurrent stones occur frequently, PTCSL and dilatation therapy will improve the outcomes of patients suffering with hepatolithiasis combined with bile duct stricture.

Putative Tumor Suppressor Gene Loci onChromosome 20q in Intrahepatic Cholangiocellular Carcinoma that were Found by Microsatellite Marker Analysis

PURPOSE: Intrahepatic cholangiocellular carcinoma (ICC) is the second most common malignant tumor in the liver, and it arises from epithelial cells in the intrahepatic bile duct. While the reported risk factors include liver fluke infection, hepatolithiasis and sclerosing cholangitis, the genetic mechanisms involved in the development of ICC are not well understood, and only a few cytogenetic studies of ICC have been published. We recently found genetic imbalance on chromosome 20q in ICC with using Comparative Genomic Hybridization. So, we tried to find gene loci on chromosome 20q. (ED note: what kind of loci were you looking for) METHODS: We used 16 fresh frozen ICC tumor tissues and the paired normal liver tissues for DNA extraction. A set of primers for 10 microsatellite loci on chromosome 20q13-qter, based on an updated GeneMap99 and Ensemble, was purchased from Research Genetics. The markers selected for testing exhibited high levels of heterozygosity and relatively uniform distributions. Loss of heterozygosity (LOH) was analyzed by an automatic DNA analyzer. Using the Ensemble Web site, mining of putative tumor suppressor genes were developed between microsatellite markers that showed LOH. RESULTS: In one case, microsatellite instability (MSI) was found in all the markers except D20S196, and MSI was found in only one marker, d20S196, in another case. (Ed note: check this and it wasn't clear.) The most frequent region which have LOH on chromosome 20q13-qter was on D20S109 and D20S196, and their invidence was 12.5%. (ED note: the last part of the sentence makes no sense at all. You have to rewrite it.) D20S174, D20S107, D20S170, D20S96 and D20S119 were 6.3% and D20S836, D20S886 and D20S were 0%. (ED note: this sentence also makes no sense. They were 6% and 0% of what?) We found eight genes between D20S109 and D20S196: PTPN1, QSNf41 HUMAN, CT175 HUMAN, PARD6B, BCAS4, TMSL6, ADNP and DPM1. Among these, PTPN1, PARD6B and BCAS4 are well known oncogenes, so the other five genes are thought to be putative tumor suppressor genes. CONCLUSION: Using this approach, we identified two distinctive allelic losses defined by microsatellite markers as follows; D20S109 and D20S196. We identified five genes which can make contribution to the development or progression of intrahepatic cholangiocellular carcinoma. Further study will be carried out to confirm these genes have a critical role in the development or progression of intrahepatic cholangiocellular carcinoma using immunohistochemical study or other molecular biology work.

Polycystic Kidney Complicated by Cholangiocellular Carcinoma Presenting as Fever of Unknown Origin / General Medicine

We report the case of a 59-year-old man who presented with classical-type fever of unknown origin (FUO) during observation of hypertension and polycystic kidney. The presence of malignancy was suspected based on elevation of tumor marker levels. We examined the patient carefully and attempted diagnostic imaging, but definitive diagnosis was difficult due to the presence of multiple hepatic cysts. Hepatic biopsy detected adenocarcinoma, but identifying whether lesions were primary cholangiocellular carcinoma or metastases was difficult, and we were ultimately unable to diagnose the tumors as cholangiocellular carcinoma until autopsy. Polycystic kidney with hepatic cysts and complicated by cholangiocellular carcinoma is rare, but should be considered among the differential diagnosis for FUO, which itself is frequently encountered.

Mucin-Producing Intrahepatic Cholangiocelluar Carcinoma Presenting as a Focal Dilatation of the Intrahepatic Bile Duct

A case of a mucin-producing intrahepatic cholangiocellular carcinoma (MPCC) is reported. A 58-year old female presented with epigastric discomfort of several years duration. The physical examination and laboratory findings were normal. Abdominal ultrasonography (US) and computed tomography (CT) showed a focal dilatation of the right posterior intrahepatic bile duct. There was no abnormal mass in the liver parenchyma. Endoscopic retrograde cholangiopancreaticography (ERCP) showed a filling defect in the right posterior hepatic duct. There was no anatomical abnormality and abnormal staining on the heaptic angiography. At the operation, the right posterior hepatic duct was filled with mucin. The patient had a right posterior segmentectomy. Histologically, a 2.5 X 0.6 X 0.6 cm sized mucin-producing intrahepatic cholangiocellular carcinoma was found in segment 6 of the liver. The postoperative recovery was good, and the patient has had a good social life for the last 3 years, with no evidence of tumor recurrence. In patients with a focal dilatation of the intrahepatic bile duct on CT or US with no underlying cause, an intrahepatic malignancy has to be suspected.