Accuracy of conventional CT in predicting resectability of cholangiocarcinoma: A retrospective review.

Objective : Cholangiocarcioma is the common malignant bile duct tumor Thailand, particularly in the Northeastern part of the country. Since tumor resection is the curative treatment for Cholangiocarcioma, preoperative imaging plays and important role in evaluating the extension and resectability status of this tumor. This present work was designed to assess the capability of cinventional CT scan in predicting the resectability of Cholangiocarcioma. Materials and methods : Conventional CT of twenty three patients who had pathologically proven Cholangiocarcioma, were retrospectively reviewed between January 2002 and Decem ber 2002. The CT images were interpreted by 2 gastrointestinal radiologists with consensus. Results : The accuracy was 87%, positive predictive value 57% and negative predictive value 100%. Conclusion : CT scan remains and important tool that can provide valuable information regarding the criteria for resectability.

Malignant mesothelioma.

A 27 year old Thai male presented with progressive abdominal distension without leg edema, low grade fever and 10 Kgs weight loss over 2 months. Physical examination revealed cachexia,a markedly distended abdomen, with a fluid thrill, but no hepatosplenomegaly. An abdominal tap produced serosanguinous fluid. Analysis of the ascitic fluid demonstrated white blood cell 300 /mm3, red blood cell 270,000 /mm3, SAAG 0.9 gm/dl, ascites protein 3 gm/dl, AFB stain no organisms seen. Cytology showed a few mesothelial cells but no malignant cells. A chest X-ray was normal. The patient underwent laparoscopy. The peritoneum was studded with whitish miliary nodules and fibrin plaques. Peritoneal biopsy revealed chronic inflammation with fibrosis, no granuloma or specific organism. Abdominal CT images demonstrated a large multiseptated cystic mass with a thick wall, occupying almost the entire abdominal cavity. Abdominal exploration demonstrated a huge intraabdominal cystic mass, with multiple discrete white nodules on the surface of the cystic wall and the liver. Histology demonstrated most of tumor cells were deeply embedded in collagenous tissue with a biphasic pattern and high mitotic figure.Immunoperoxidase staining demonstrated tumor markers as follow vimentin, cytokeratin (AE1/AE3), epithelial membrane antigen (EMA) and neurospecific enolase (NSE). The final diagnosis was biphasic malignant mesothelioma. Up to now, no standard treatment is available. Surgery for localized tumors has been reported. Other treaments, such as external radiation, intraperitoneal instillation of radioactive gold and chemotherapy have generally failed to improve overall survival. The median survival is 2 to 12 months after diagnosis with a total duration of about 1 year from the onset of symptoms.