Extra-anatomic stenting of the biliary system.

Tumor necrosis interfered with conventional methods of stenting in a patient with hilar cholangiocarcinoma. Therefore, a hepaticoduodenal fistula was percutaneously catheterized and dilated, and a large caliber endoprosthesis inserted to drain the right hepatic ductal system.

Cholangiocarcinoma masquerading as liver abscess.

A 60-year-old man from Eastern Thailand was admitted to hospital because of right upper quadrant abdominal pain and fever. Ultrasonographic examination revealed two cavitary lesions in the right lobe of the liver. Needle aspiration obtained 110 ml of anchovy sauce-like pus which showed no bacteria on gram stain and routine culture. Serological test for E. histolytica antibody was negative. Initially, the patient responded well to metronidazole. Two weeks later, the symptoms recurred and sonography revealed one large cavitary lesion with three adjacent locules in the right lobe of the liver. Repeated needle aspiration again showed anchovy sauce-like pus which grew Enterobacter agglomerans. O. viverrini ova were detected in the stool. Laparotomy revealed histologically proven cholangiocarcinoma. This report indicates that O. viverrini infection associated with CCC can masquerade as liver abscess.

Cholangiographically guided aspiration cytology in the management of malignant biliary obstruction.

Fifteen patients with malignant biliary obstruction were subjected to fine needle aspiration cytology (FNAC) under fluoroscopic guidance. Fourteen (93%) of them were correctly diagnosed to have a malignancy at FNAC. Simultaneous with FNAC or at a later date, all the patients underwent percutaneous biliary drainage with a drop in serum bilirubin from a mean of 23.2 mg/dl to 8.5 mg/dl. Ten patients were subjected to exploratory laparotomy and biopsy at which the diagnosis of FNAC was confirmed in nine of them. The tenth patient with a negative yield at FNAC had a 1.0 cm cholangiocarcinoma. The usefulness of FNAC combined with biliary drainage as an alternative to surgery is highlighted.

Hepatocolangiocarcinoma asociado a carcinoma renal de células claras / Hepatocholangiocarcinoma associated with renal clear cell carcinoma

Se presenta un caso de hepatocolangiocarcinoma asociado a carcinoma renal de células claras en un paciente masculino, de 81 años de edad. Es el primer caso confirmado en el Hospital Santo Tomás

Ultrastructure of cholangiocarcinoma associated with opisthorchiasis.

An electron microscopic study was carried out on eleven surgical liver biopsy specimens obtained from patients with cholangiocarcinoma associated with opisthorchiasis. The tumor cells of histologically well differentiated cholangiocarcinoma had few cytoplasmic organelles. They contained relatively large nuclei, abundant free ribosomes and numerous groups of fine fibrils. Each cell was surrounded by a basement membrane. Numerous long microvilli were seen projecting into the glandular lumen. The moderately differentiated cholangiocarcinomatous cells exhibited increased organelle content, marked variation in the shape of the nuclei with deep cytoplasmic invagination into the nuclear membrane; there were small intranuclear pseudoinclusions, and shorter microvilli. The tumor cells showed intracellular microvillus-lined spaces, abundant free ribosomes, many fine fibrils and their surrounding basement membranes were incomplete. The ultrastructure of the poorly differentiated cholangiocarcinoma was similar to that of the moderately differentiated tumor, except for fewer microvilli, abundant cytoplasmic organelles, and ill-defined or absent basement membrane.