A Case of a Choledochal Cyst Combined with a Hepatocellular Carcinoma / 대한소화기내시경학회지

A choledochal cyst is relatively rare lesion in the biliary system, and a carcinoma arising from such a cyst is rarely reported. Until now, a case of a hepatocellular carcinoma combined with a choledochal cyst had not been reported. A 45-year-old woman was recently admitted due to abdominal pain. An abdominal computed tomography revealed a 5 cm-sized low attenuative mass involving the right anterior and left medial segment of the liver and gallbladder fossa. An endoscopic retrograde cholangiopancreatogram showed fusiform dilatation of the common bile duct, but anomalous union of pancreaticobiliary duct was not observed. Fine-needle aspiration of the liver was conducted and yielded a hepatocellular carcinoma. On celiac arteriography, a hypervascular hepatic mass was also found. Transarterial chemoembolization was performed. It is believed this may be the first case of a choledochal cyst combined with a hepatocellular carcinoma in the literature. Hence, this case is herein reported with a review of related literatures.

A Case of Mucinous Ductal Ectasia of the Pancreas Associated with Malignant Ascites and Liver Metastasis / 대한소화기내시경학회지

A 71-year-old man was admitted due to abdominal distension and periumbilical pain. He was diagnosed as having mucinous ductal ectasia (MDE) of the pancreas three months prior, but refused an operation. Three months later, an abdominal computed tomography revealed more dilated pancreatic duct, newly developed liver metastasis and ascites in comparison with previous findings. Fine-needle aspiration cytology of the cystic lesion in the pancreatic head was conducted and yielded adenocarcinoma. Also, an ascitic fluid cytology determined adenocarcinoma. This patient was diagnosed to be inoperable and received palliative chemotherapy and pain control. The patient expired 5 months after the initial diagnosis.

A Case of Pancreatic Pseudocyst Resolved by Transpapillary Drainage via the Main Pancreatic Duct / 대한소화기내시경학회지

A 68-year-old man was admitted due to abdominal pain. He was diagnosed as having recurrent pancreatitis with a pseudocyst, which is communicated through the main pan- creatic duct. An endoscopic pancreatic sphincterotomy and insertion of a nasopancreatic tube into the main pancreatic duct via transpapillary drainage were performed. As a result, the pseudocyst disappeared and the pain was relieved. Thus it was concluded that transpapillary drainage via the main pancreatic duct is a safe and effective treatment for pancreatic pseudocysts, which is communicated through the main pancreatic duct.

Biliary Tract & Pancreas; A Case of Hilar Cholangiocarcinoma Combined with Carcinoma of the Ampulla of Vater / 대한소화기내시경학회지

Hepatie hilar ductal carcinoma is relatively rare, but the prognosis is known to be poor because an early diagnosis is difficult. Because the majority of patients are already infiltrated into adjacent organ by itself at the diagnosis, the rate of resectability is low. The best method of treatment is curative resection, and the range of tumor invasion is very important. The preoperative diagnosis is difficult because the cholangiography may be normal in cases of superficial invasion. Multifocal lesions within the biliary tract may be identified in as many as 10 percent of patients, Especially, the papillary type has the best prognosis and is associated with multiple tumors within the bile duct. We report a case that percutaneous transhepatic cholangiogram showed normal distal common bile duct, but the hepatic hilar confluence and ampulla of Vater lesion was confirmed as adenocarcinoma.