Aneurisma de la aorta abdominal asociado a íctero / Aneurysm of the abdominal aorta associated with icterus

El aneurisma de la aorta abdominal como causa de íctero obstructivo es una situación de excepción en la clínica. El objetivo de esta presentación fue exponer la coexistencia del aneurisma de la aorta abdominal y el íctero. Una asociación muy poco frecuente y de difícil diagnóstico, que coloca al cirujano vascular en la toma de una especial conducta terapéutica. La cuidadosa revisión de los antecedentes patológicos y el análisis del comportamiento clínico del paciente permitieron la solución terapéutica adecuada. Se logró demostrar que el íctero obedecía a una lesión maligna de vías biliares conocida como colangiocarcinoma, que concomitó con la existencia de un aneurisma del V segmento aórtico y no fue el resultado de una compresión extrínseca de la dilatación de la aorta, sobre las vías biliares. La conducta quirúrgica, encaminada a erradicar el íctero y evitar la ruptura aneurismática con resección del aneurisma y colocación de prótesis, no resultó posible por lo avanzado de la lesión tumoral y el grado de metástasis ya establecidos. Solo se realizó resección de la vesícula biliar y seguimiento posterior por oncología(AU)

Abdominal aortic aneurysm as a cause of obstructive icterus is an exceptional situation in the clinic. The aim of this presentation was to expose the coexistence of abdominal aortic aneurysm and icterus. A very rare and difficult to diagnose association, which places the vascular surgeon in a special therapeutic approach. The careful review of the pathological history and the analysis of the patient's clinical behavior allowed the appropriate therapeutic solution. It was possible to demonstrate that the icterus was due to a malignant lesion of the biliary tract known as cholangiocarcinoma, which concomitated with the existence of an aneurysm of the V aortic segment and was not the result of extrinsic compression of the dilatation of the aorta on the biliary tract. The surgical procedure, aimed at eradicating the icterus and avoiding aneurysmal rupture with aneurysm resection and prosthesis placement, was not possible due to the advanced tumor lesion and the degree of metastasis already established. Only gallbladder resection was performed and subsequent follow-up by oncology(AU)

Elementos etiopatogénicos y diagnósticos del tumor de Klatskin o colangiocarcinoma hiliar / Etiopathogenetic and Diagnostic Elements of Klatskin's Tumor or Hilar Cholangiocarcinoma

RESUMEN Introducción: El colangiocarcinoma hiliar es un tumor poco frecuente, de mal pronóstico y elevada mortalidad; con un curso silente hasta la fase avanzada de la enfermedad. Objetivo: Describir la etiopatogenia y el diagnóstico por imágenes del colangiocarcinoma hiliar. Métodos: De las bases datos PubMed, SciELO y Latindex, se seleccionaron artículos publicados desde 2005 hasta mayo de 2020, relacionados con el colangiocarcinoma hiliar/ perihiliar: etiopatogenia, diagnóstico clínico, estudios de laboratorio y estudios imaginológicos. Desarrollo: Ictericia obstructiva (90 por ciento), pérdida de peso (60 - 75 por ciento) y dolor abdominal (40 por ciento) constituyen los síntomas de presentación más frecuentes. Los factores predisponentes, genéticos y ambientales, desencadenan respuesta inflamatoria crónica que lesionan el DNA de las células ductales provocando diferenciación celular anómala con el desarrollo de colangiocarcinoma. Las infecciones parasitarias y enfermedad litiásica de las vías biliares, en países orientales y la colangitis esclerosante primaria, en occidente, constituyen los principales factores predisponentes. El trípode para el diagnóstico lo conforman: la ecografía, tomografía axial computarizada y la resonancia magnética nuclear. Conclusiones: El colangiocarcinoma hiliar es una causa de colestasis poco frecuente en la población general, con un predominio sexta década de la vida y en el sexo masculino, siendo la ictericia el motivo de consulta de estos pacientes, donde la ecografía y la tomografía axial computarizada juegan el papel más importante en su diagnóstico y donde la clasificación de Bismuth-Corlette y TNM son esenciales para la correcta planificación del tratamiento(AU)

ABSTRACT Introduction: Hilar cholangiocarcinoma is a rare tumor, with poor prognosis and high mortality, with a silent course until the advanced stage of the disease. Objective: To describe the etiopathogenesis and imaging diagnosis of hilar cholangiocarcinoma. Methods: From the PubMed, SciELO and Latindex databases, articles published from 2005 to May 2020 were selected, insofar they were related to hilar/perihilar cholangiocarcinoma: etiopathogenesis, clinical diagnosis, laboratory studies and imaging studies. Development: Obstructive jaundice (90 percent), weight loss (60-75 percent) and abdominal pain (40 percent) are the most frequent presenting symptoms. Predisposing factors, either genetic and environmental, trigger chronic inflammatory responses that damage the DNA of ductal cells, causing abnormal cell differentiation with the development of cholangiocarcinoma. Parasitic infections and bile duct stone disease in Eastern countries and primary sclerosing cholangitis in the West are the main predisposing factors. The tripod for diagnosis is made up of ultrasound, computerized axial tomography and nuclear magnetic resonance. Conclusions: Hilar cholangiocarcinoma is a rare cause of cholestasis among the general population, with a predominance during the sixth decade of life and among males, jaundice being the reason for consultation of these patients, in which ultrasound and computerized axial tomography play the most important elements for its diagnosis, while the TNM and Bismuth-Corlette classification are essential for the correct planning of treatment(AU)

Cholangiocarcinoma arising in von Meyenburg complexes / 대한간학회지

No abstract available.

Icterícia colestática por lesões de natureza maligna: ensaio iconográfico / Cholestatic jaundice by malignant lesions: pictorial essay

A icterícia colestática de natureza tumoral maligna tem como causas mais frequentes o tumor da cabeça do pâncreas, o tumor da papila, o colangiocarcinoma e os quadros obstrutivos biliares determinadospor lesão secundária hepática parenquimatosa ou linfonodal. Os pacientes geralmente se apresentam com perda ponderal, dor abdominal, icterícia progressiva e aumento de bilirrubina direta, sendo fundamental a avaliação pelos métodos de imagem para o adequado diagnóstico, estadiamento e planejamento terapêutico. O presente ensaio ilustra, com correlação anatomocirúrgica, os aspectos de imagem da ultrassonografia, tomografia computadorizada e, em situaçõesespecíficas, colangiorressonância, das principais neoplasias malignas que cursam com icterícia colestática.

Malignant obstructive jaundice is most commonly caused by cancerof pancreatic head, papilla tumor, cholangiocarcinoma and biliary obstruction induced by secondary lesions of the liver or lymph nodes. Patients usually present with weight loss, abdominal pain, jaundice and progressive increase of direct bilirubin, being essential the evaluation by imaging methods for the proper diagnosis, staging and therapeutic planning. This essay illustrates the imaging aspects of ultrasound and computed tomography – and in specific situations magnetic resonance cholangiography – of the major malignancies that lead to cholestatic jaundice.

Association of parasitic infections and cancers.

Recent advances in the fields of molecular biology, epidemiology and infectious diseases have led to significant revelations to clarify the relationship between cancer and infective agents. This article reviews the relationship between parasitic infections and carcinogenesis and the possible mechanisms involved. Few parasites, e.g., Schistosoma haematobium and Opisthorchis viverrini have been found to be strongly associated with bladder cancer and cholangiocarcinoma respectively. The evidence for the association of several other parasites and cancers has also been postulated.

A case with intrahepatic double cancer: hepatocellular carcinoma and cholangiocarcinoma associated with multiple von Meyenburg complexes

Combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) is sometimes found in resected livers, however, cases with double cancer of HCC and CC are very rare. As well, the rarity of CC arising in von Meyenburg complexes (VMCs) is appreciated. We report the case of a 74-year-old man found to have intrahepatic double cancer composed of well-differentiated HCC and CC which exhibited a histologic progression from VMCs to adenomatous lesions and CC. To our knowledge, this is the first case report published in the literature of a double HCC and CC associated with multiple VMCs. The pathogenesis and previous associated reports of these lesions are discussed.

Colangiocarcinoma / Cholangiocarcinoma

El colangiocarcinoma es uno de los cánceres más raros, siendo el menos frecuente de los del hígado y el tracto biliar. Puede originarse en cualquier nivel del árbol biliar. Los pacientes se presentan clásicamente con una ictericia indolora y prurito, la colangitis no es común. Para su estudio y tratamiento, se clasifican en tres grandes grupos: los carcinomas intrahepáticos, los parahiliares y los distales. Existen también tumores difusos, pero son sumamente raros. Los carcinomas perihiliares son los más comunes. Esta clasificación es útil en el monitoreo de resultados, ya que los tumores intrahepáticos usualmente son manejados como carcinomas hepatocelulares con resección de hígado, mientras que los tumores distales son tratados como cánceres de la cabeza del páncreas, con una pancreatoduodenectomía. Las lesiones perihiliares pueden ser tratadas con una variedad de procedimientos quirúrgicos o no quirúrgicos. La cirugía es el único procedimiento potencialmente curativo. La resecabilidad y el pronóstico depende de la localización del tumor, a través del árbol biliar, la extensión o no al parénquima hepático y la invasión del tumor a los vasos sanguíneos mayores

alpha 1-antitrypsin phenotype PiMZ, a risk factor for liver cirrhosis but not for liver cancers in Thailand.

The risk of developing liver cirrhosis, hepatoma (HCC) and bile duct carcinoma (BDC) have been associated with homozygous alpha 1-antitrypsin (AT) deficiency especially linked to the Z allele. While the association between liver cancers and AT deficiency remains debatable, the risk of adult AT deficiency carriers to develop liver cirrhosis has not been assessed quantitatively. Liver cancers and liver diseases with subsequent liver cirrhosis are highly prevalent in tropical countries such as Thailand and heterozygous AT phenotypes are rather common in this country as well. The aim of this study was to assess the risk of developing liver cirrhosis, HCC and BDC by means of case-control studies with Thai patients and controls in connection with AT deficiency. For hepatitis, HCC and BDC to association with AT deficiency was detected. Carriers of PiMZ phenotype in Thailand have a high risk to develop liver cirrhosis (odds. ratio of 10.8, 95% confidence interval = 1.3-88.1). Patients with predisposing diseases should be screened for Pi phenotypes so that rigorous measures to combat the occurrence of liver cirrhosis can be implemented.