Comparison of the Clinicopathologic Characteristics of Intraductal Papillary Neoplasm of the Bile Duct according to Morphological and Anatomical Classifications

BACKGROUND: Intraductal papillary neoplasm of the bile duct (IPNB) is a recently defined entity and its clinical characteristics and classifications have yet to be established. We aimed to clarify the clinical features of IPNB and determine the optimal morphological classification criteria. METHODS: From 2003 to 2016, 112 patients with IPNB who underwent surgery were included in the analysis. After pathologic reexamination by a specialized biliary-pancreas pathologist, previously suggested morphological and anatomical classifications were compared using the clinicopathologic characteristics of IPNB. RESULTS: In terms of histologic subtypes, most patients had the intestinal type (n = 53; 48.6%) or pancreatobiliary type (n = 33; 30.3%). The simple “modified anatomical classification” showed that extrahepatic IPNB comprised more of the intestinal type and tended to be removed by bile duct resection or pancreatoduodenectomy. Intrahepatic IPNB had an equally high proportion of intestinal and pancreatobiliary types and tended to be removed by hepatobiliary resection. Morphologic classifications and histologic subtypes had no effect on survival, whereas a positive resection margin (75.9% vs. 25.7%; P = 0.004) and lymph node metastasis (75.3% vs. 30.0%; P = 0.091) were associated with a poor five-year overall survival rate. In the multivariate analysis, a positive resection margin and perineural invasion were important risk factors for survival. CONCLUSION: IPNB showed better long-term outcomes after optimal surgical resection. The “modified anatomical classification” is simple and intuitive and can help to select a treatment strategy and establish the proper scope of the operation.

A Case of Adenomyomatous Hyperplasia of the Distal Common Bile Duct Mimicking Malignant Stricture / 대한소화기학회지

Adenomyomatous hyperplasia is a reactive malformation or non-neoplastic tumor-like lesion frequently observed in the gallbladder, stomach, duodenum and jejunum, but rare in the extrahepatic bile duct. A 42-year-old man with epigastric discomfort had a stricture in the common bile duct on initial CT scans. Initially, it was regarded as a malignant lesion with some evidence, but histopathologic examinations of multiple biopsies obtained by multiple sessions of endoscopic retrograde cholangiopancreatography showed no evidence of malignancy. The patient had undergone the pylorus preserving pancreaticoduodenectomy because of the possibility of malignancy; however, the final diagnosis was adenomyomatous hyperplasia. It is important to distinguish a malignancy from benign biliary stricture with endoscopic biopsies. Surgery for suspected biliary malignancy often reveals benign lesions. Therefore, a correct diagnosis is important before deciding upon treatment of bile duct stricture. In conclusion, in younger patients with bile duct stricture where there is no evidence of histologic malignancy despite multiple biopsies, the possibility of benign disease such as adenomyomatous hyperplasia should be considered, to avoid unnecessary radical surgery.

Comparison of tolerance to ischemia-reperfusion injuries between different parts of extrahepatic bile duct during orthotopic autologous liver transplantation in rats / 第二军医大学学报

Objective: To observe the tolerance to ischemia-reperfusion injuries in different parts of extrahepatic bile duct during orthotopic autologous liver transplantation in rats, so as to lay a foundation for selection of anastomosis site during liver transplantation. Methods: Thirty SD rats were randomly divided into 3 groups: group I, sham operated(n=6); group II, 1 h ischemia in biliary tract followed by 1 h reperfusion (n=12); and group III, 1 h ischemia in biliary tract followed by 2 h reperfusion(n=12). TUNEL assay, pathomorphology score and ultrastructural quantitative analysis were used to analyze the epithelia of hilar bile duct, proximal, and distal common bile duct. Results: The results of TUNEL assay and pathomorphology score were not significantly different between the proximal and distal common bile ducts in group II (P>0.05), but the injury was more serious in hilar bile duct compared with those of the proximal and distal common bile ducts (P<005); the hilar bile duct had the most serious injuries as indicated by the changes of mitochondrial mean volume (V) and area density of microvilli (AMV), and the proximal common bile duct had the slightest injury (P<0.05). In group 1, the most severe injury was found in the hilar bile duct, followed by distal common bile duct and proximal common bile duct in order (P<0.05). Conclusion: The tolerance to ischemia-reperfusion is different in different parts of bile duct during liver transplantation, with the distal common duct having the best tolerance, which may be used for bile anastomosis during transplantation.

Comparison of tolerance to ischemia-reperfusion injuries between different parts of extrahepatic bile duct during orthotopic autologous liver transplantation in rats / 第二军医大学学报

0.05),but the injury was more serious in hilar bile duct compared with those of the proximal and distal common bile ducts(P

A case of Rare Extrahepatic Bile Duct Anomaly / 한국간담췌외과학회지

The frequency of anatomical variation of the bile duct system is relatively common. The constitution of a normal biliary confluence by union of the right and left hepatic ducts is reported in only 57% (Couinaud 1957) to 72% (Healy & Schroy 1953) of cases. While many of these variations have little or no clinical importance, some cases cause symptoms and signs, or may lead to incorrect diagnosis and inappropriate management of biliary disorder. We report a case of rare extrahepatic bile duct anomaly in a 60-year-old man. His chief complaint was intermittent right upper quadrant pain for six months.There was a low union of both extrahepatic ducts and the cystic duct. The left extrahepatic duct fused with the right extrahepatic duct anteriorly and the long cystic duct ran alongside and parallel with the right and left extrahepatic duct before joining them. Distal CBD cancer was also combined.

A Rare Case of Extrahepatic Bile Duct Anomaly Associated with Multiple Stones / 대한소화기내시경학회지

Congenital anomaly of the extrahepatic biliary system is relatively common, especially vascular variations are much more frequent than anatomic variations. The normal anatomical structure is encountered in only 35 percent of individuals, many of these variations have little or no clinical improtance, but some cases induce symptoms and signs or may lead to incorrect diagnosis and inappropriate management. These are very important to correct diagnosis of biliary variations observed during ultrasonography, cholangiography and endoscopic retrograde cholangiopancreatography(ERCP) and to accurate management by surgeon or endoscopist since accidental section or ligation of aberrant structures can lead to serious complications. We experienced a very rare case of extrahepatic bile duct anomaly confirmed by ERCP. The right and left extrahepatic ducts were connected at the level of the pancreatic segment of the common bile duct and the cystic duct drains to the right extrahepatic duct. There were several stones in the distal portion of the left extrahepatic duct and gallbladder.

A Rare Case of Extrahepatic Bile Duct Anomaly Associated with Multiple Stones / 대한소화기내시경학회지

Congenital anomaly of the extrahepatic biliary system is relatively common, especially vascular variations are much more frequent than anatomic variations. The normal anatomical structure is encountered in only 35 percent of individuals, many of these variations have little or no clinical improtance, but some cases induce symptoms and signs or may lead to incorrect diagnosis and inappropriate management. These are very important to correct diagnosis of biliary variations observed during ultrasonography, cholangiography and endoscopic retrograde cholangiopancreatography(ERCP) and to accurate management by surgeon or endoscopist since accidental section or ligation of aberrant structures can lead to serious complications. We experienced a very rare case of extrahepatic bile duct anomaly confirmed by ERCP. The right and left extrahepatic ducts were connected at the level of the pancreatic segment of the common bile duct and the cystic duct drains to the right extrahepatic duct. There were several stones in the distal portion of the left extrahepatic duct and gallbladder.

An Immunohistochemical and Histochemical Study on AutonomicInnervation of the Gall Bladder and Bile Ducts in Cats / 第三军医大学学报

This paper is to report the autonomic innervation of the gall bladder and extrahepatic bile ducts studied on whole mount stretch preparations and cryostat sections with acetylcholinesterase staining, glyoxylic acid induced fluorescence histochemical method, and PAP immunohistochemical method.The autonomic nerves of the gall bladder and extrahepatic bile dudts in cats consist of two plexuses, composed of cholinergic, adrenergic and peptidergic nerves, and situated in the subserosa and submucosa respectively. They are known as subserosal and submucosal ganglionated plexuses. They distribute in the region from the fundus of the bladder, to the neck and the cystic duct, through the common bile duct downward, finally to the duodenal papilla.The adrenergic nerves mainly run along the, blood vessels, distributing in the serosa and lamina propria of the mucosa of the bladder, and participating in the formation of the subepithelial and perivasctilar plexuses. The adrenergic nerves are most densely distributed in the cystic duct and mosl sparsely in the fundus. This finding is in good agreement with the tissue concentration of noradrenaline(NA) determined with biochemical asssay, which is also the highest in the tissue of the cystic duct. The difference of NA concentration between the cystic duct tissue and other biliary tissues was statistically Gignificant(P0.05).Immunohistochemical study revealed that there are 4 kinds of immunoactivc peptidergic nerves, i. e. nerves with vasoactive intestinal polypeptide (VIP), substance P(SP), L-enkephalin (L-ENK), and somatostatin (SOM) respectively. The 4 kinds of nerves distribute extensively in all the tissue layers of the ex-trahepatic biliary tract and participate in the formation of all the nerve plexuses. Among them, VIP nerves are the richest, then the SP and L-ENK nerves, and the SOM nerves the sparsest. In general, peptidergic nerves are densely distributed in the sphincter of Oddi.Finally the physiological significance of the peptidergic nerves was discussed.