Gallbladder polyps: correlation and agreement between ultrasonographic and histopathological findings in a population with high incidence of gallbladder cancer / Pólipos da vesícula biliar: correlação e concordância entre achados ultrassonográficos e histopatológicos em uma população com alta incidência de câncer de vesícula biliar

ABSTRACT BACKGROUND: Gallbladder polyps are becoming a common finding in ultrasound. The management has to consider the potential risk of malignant lesions. AIMS: The aim of this study was to analyze the ultrasound findings in patients undergoing cholecystectomy due to gallbladder polyps and compare them for histopathological findings (HPs). METHODS: Patients with an ultrasonographic diagnosis of gallbladder polyp and who underwent cholecystectomy from 2007 to 2020 were included in the study. RESULTS: A total of 447 patients were included, of whom 58% were women. The mean age was 45±12 years. The mean size of polyps in US was 7.9±3.6 mm. Notably, 9% of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p=0.003). Histopathological findings confirmed the presence of polyps in 88.4%, with a mean size of 4.8±3.4 mm. In all, 16 cases were neoplastic polyps (4.1%), 4 of them being malignancies, and all were single and larger than 10 mm. We found a significant correlation between ultrasound and histopathological findings polyp size determination (r=0.44; p<0.001). The Bland-Altman analysis obtained an overestimation of the US size of 3.26 mm. The receiver operating characteristic (ROC) curve analysis between both measures obtained an area under the receiver operating characteristic curve (AUC) of 0.77 (95%CI 0.74-0.81). Ultrasound polyps size larger than 10 mm had an odds ratio (OR) of 8.147 (95%CI 2.56-23.40) for the presence of adenoma and malignancy, with a likelihood ratio of 2.78. CONCLUSIONS: There is a positive correlation and appropriate diagnostic accuracy between ultrasound size of gallbladder polyps compared to histopathological records, with a trend to overestimate the size by about 3 mm. Neoplastic polyps are uncommon, and it correlates with size. Polyps larger than 10 mm were associated with adenoma and malignancy.

RESUMO RACIONAL: Os pólipos da vesícula biliar estão se tornando um achado comum na ultrassonografia (US). O manejo deve levar em consideração o risco de lesões malignas. OBJETIVOS: Analisar os achados da ultrassonografia em pacientes submetidos à colecistectomia por pólipos vesicais e compará-los com os achados histopatológicos. MÉTODOS: Foram revisados os prontuários médicos dos pacientes com diagnóstico ultrassonográfico de pólipo vesicular e submetidos à colecistectomia no período de 2007 a 2020. RESULTADOS: Foram incluídos no estudo 447 pacientes. A média de idade foi 45±12anos, sendo 58% mulheres. O tamanho médio dos pólipos na US foide 7,9±3,6mm. Nove por cento foram maiores que 10 mm, e os pólipos únicos encontrados foram maiores do que os múltiplos (p=0,003). A HP confirmou a presença de pólipos em 88,4%, tamanho médio 4,8±3,4mm. Dezesseis eram pólipos neoplásicos (4,1%) e quatro deles malignos, únicos e maiores que 10 mm. Foi encontrado correlação significativa entre a determinação do tamanho do pólipo ao ultrassonografia e histopatológicos (r=0,44; p<0,001). A análise de Bland-Altman obteve uma superestimação do tamanho do pólipo ao US em 3,26 mm. A análise da curva da característica de operação do receptor entre as duas medidas obteve uma área sob a curva curva da característica de operação do receptor (AUC) de 0,77 (IC95% 0,74-0,81). Pólipos ao ultrassonografia maiores que 10 mm apresentaram razão de chance (OR) de 8,147 (IC95% 2,56-23,40) para presença de adenoma e malignidade, com razão de verossimilhança de 2,78. CONCLUSÕES: Há uma correlação positiva e acurácia diagnóstica apropriada entre o tamanho dos pólipos da vesícula biliar por ultrassonografia em comparação com os achados histopatológicos, com uma tendência de superestimar o tamanho em cerca de 3 mm. Pólipos maiores que 10 mm foram associados a adenoma e malignidade.

Cholangiohydatidosis: an Infrequent Cause of Obstructive Jaundice and Acute Cholangitis

ABSTRACT Background. One of the evolutionary complications of hepatic echinococcosis (HE) is cholangiohydatidosis, a rare cause of obstructive jaundice and cholangitis. The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohydatidosis and secondary cholangitis in terms of post-operative morbidity (POM). Material and method. Case series of patients operated on for cholangiohydatidosis and cholangitis in the Department at Surgery of the Universidad de La Frontera and the Clínica Mayor in Temuco, Chile between 2004 and 2014. The minimum follow-up time was six months. The principal outcome variable was the development of POM. Other variables of interest were age, sex, cyst diameter, hematocrit, leukocytes, total bilirubin, alkaline phosphatase and transaminases, type of surgery, existence of concomitant evolutionary complications in the cyst, length of hospital stay, need for surgical re-intervention and mortality. Descriptive statistics were calculated. Results. A total of 20 patients were studied characterized by a median age of 53 years, 50.0% female and 20.0% having two or more cysts with a mean diameter of 13.3 ± 6.3 cm. A median hospital stay of six days and follow-up of 34 months was recorded. POM was 30.0%, re-intervention rate was 10.0% and mortality rate was 5.0%. Conclusion. Cholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with significant rates of POM and mortality.(AU)

False Positive Diagnosis of Hepatocellular Carcinoma in Liver Resection Patients

The diagnosis of hepatocellular carcinoma (HCC) is based on imaging studies particularly in high-risk patients without histologic confirmation. This study evaluated the prevalence and characteristics of false-positively diagnosed HCC in a liver resection cohort for HCC. A retrospective review was performed of 837 liver resection cases for clinically diagnosed HCC between 2005 and 2010 at our institute. High-risk patients with tumors > 1 cm with one or two image findings consistent with HCC and tumors 0.05) compared to non-HCC patients except for higher rate of history of alcoholism (P < 0.05) observed in non-HCC patients. Four of 18 non-HCC patients (22.2%) showed diagnostic discordance on the dynamic imaging study. Despite the recent progression in diagnostic imaging techniques, 2.2% of cases were false-positively diagnosed as HCC in a liver resection patient cohort; and the final diagnosis was benign disease in 0.8% of liver resection patients clinically diagnosed with HCC.

Benign nodules mimicking hepatocellular carcinoma on gadoxetic acid-enhanced liver MRI

No abstract available.

Intrahepatic Cholangiocarcinoma with Ductal Plate Malformation-like Feature Associated with Bile Duct Adenoma

No abstract available.

RE: Diffusion-Weighted MRI in Intrahepatic Bile Duct Adenoma Arising from the Cirrhotic Liver

No abstract available.

Diffusion-Weighted MRI in Intrahepatic Bile Duct Adenoma Arising from the Cirrhotic Liver

A 64-year-old male patient with liver cirrhosis underwent a CT study for hepatocellular carcinoma surveillance, which demonstrated a 1.4-cm hypervascular subcapsular tumor in the liver. On gadoxetic acid-enhanced MRI, the tumor showed brisk arterial enhancement and persistent hyperenhancement in the portal phase, but hypointensity in the hepatobiliary phase. On diffusion-weighted MRI, the tumor showed an apparent diffusion coefficient twofold greater than that of the background liver parenchyma, which suggested that the lesion was benign. The histologic diagnosis was intrahepatic bile duct adenoma with alcoholic liver cirrhosis.

Hamartoma de glándula peribiliar: reporte de dos casos / Peribiliar gland hamartoma: report of two cases

El hamartoma peribiliar (HPB) o adenoma de conductos biliares corresponde a un tumor hepático benigno, que representa tan solo el 1,3 por ciento de todos los tumores primarios del hígado. Macroscópicamente corresponde a una lesión redondeada bien delimitada, subcapsular, siendo habitualmente diagnosticado como un hallazgo intra-operatorio o de autopsia. Se presentan dos pacientes con diagnóstico incidental de HPB realizado en la Unidad de Anatomía Patológica del Hospital Hernán Henríquez de Temuco.

Peribiliary gland hamartoma (PGH) or bile duct adenoma corresponds to a benign liver tumor, which represents only 1.3 percent of all primary liver tumors. Corresponds to a macroscopically well-defined round lesion, subcapsular, and is usually diagnosed as an intra-operative findings or autopsy. We report two patients with incidental diagnosis of PGH conducted in the Pathology Unit of the Hospital Hernán Henríquez in Temuco.

Imaging Findings of Intrahepatic Bile Duct Adenoma (Peribiliary Gland Hamartoma): a Case Report and Literature Review

Intrahepatic bile duct adenoma is a rare benign epithelial hepatic tumor derived from bile duct cells. We report the imaging findings of a patient with bile duct adenoma, which appeared as a small heterogeneously enhancing mass with focal small cystic change on CT and MRI. Follow-up images at seven months showed a slight increase in tumor size, which could be partly explained by intratumoral hemorrhage on pathologic examination. Although rare, bile duct adenoma should be considered as a differential diagnosis of a small hypervascular tumor located in the periphery of liver. Focal cystic change and intratumoral hemorrhage may occur.

Bilioma subhepático: reporte de un caso y revision de la literatura / Sub-hepatic bilioma: report of a case and review of literature

Los biliomas son colecciones encapsuladas de bilis fuera del árbol biliar que son ocasionadas principalmente por traumatismos a este nivel, patologías comunes de la víabiliar, iatrogénicas y en algunas ocasiones sin causa aparente. Se describe un caso clínico de una paciente de 86 años con dolor abdominal en cuadrante superior derecho, fiebre e ictericia, colecistectomizada y con una coledocolitiasis, que fue sometida finalmente a una cirugía de emergencia por una peritonitis química.

Biliomas are encapsulated collections of bile outside the biliary tree, caused mainly by trauma to the liver or bile ducts, or by acute obstruction of them, and not infrecuently without an apparent cause. We present an 86 y.o. female patient who comes to the ER withright upper quadrant abdominal pain, fever and jaundice. Gallbladder had been removed previously but she had a dilated bile duct consistent with choledocolithiasis. Surgery wasperformed when she developed peritonitis and a sub-hepatic bilioma was found.

Cytological diagnosis of cholangiocarcinoma with rib metastasis in a young female--a case report.

Intrahepatic cholangiocarcinomas are second most common primary tumors of the liver. They are usually seen in 6th to 7th decades of life and at an advanced stage leading to poor prognosis. Their occurrence in the young age group is rare. Histopathological features of this tumor are well documented but literature regarding cytomorphological features on FNA is limited. We describe the cytological features of this tumor in a young woman presenting primarily with a rib metastasis. FNA smears from hard lump in the right chest wall and liver mass showed small round tumor cells arranged in the form of sheets, clusters and occasional tubules. The cells showed mild pleomorphism and bland nuclear morphology. Intimately admixed with tumor cells were spindle shaped fibroblastic cells. Serum alpha-fetoprotein level was within normal limit. Special stain for bile and immunocytochemical staining for NSE, chromogranin and CALLA were all negative. Cholangiocarcinoma was diagnosed based on cytological findings and special stains and this diagnosis was histologically confirmed on biopsy.

Hiperplasia quística papilar adenomatosa de conductos biliares en pollos de engorde: primeros casos reportados en Venezuela / Cystic papillary adenomatous bile duct hyperplasia in broiler chickens first report in Venezuela

Se describen los hallazgos histopatológicos de ochenta casos de hiperplasia adenomatosa de conductos biliares (34,7 por ciento), de un total de doscientos treinta hígados de pollos de engorde de 36 a 52 días de edad, decomisados en dos plantas procesadoras. Los hígados se observaron aumentados de tamaño, pálidos, de superficie irregular, de aspecto granular, áreas de necrosis manera de puntillao blanquecino, exudado fibrinoso en cápsula y hemorragias petequiales subcapsulares. Al corte, el parénquima mostró consistencia dura y en algunas ocasiones con formaciones quísticas. Por histopatología se observó infiltración focal de mononucleares alrededor de conductos y en el perénquima, constituidos por linfocitos, plasmocitos y granulositos inmaduros en espacios portales, de generación vacuolar y necrosis de hepatocitos, fibrosis interlobulillar, perilobulillar y espacios portales engrosados con marcada fibroplasia. El cambio histopatológico más relevante fue la hiperplasia de leve a severa de conductos biliares, con dilatación, proliferación, colestasis y colangiohiperplasia quística papilar adenomatosa con fibrosis hepática severa en los casos estudiados

A Case of Familial Adenomatous Polyposis Combined with Hepatocellular Carcinoma

Familial adenomatous polyposis (FAP) is an autosomal dominant disease characterized by formation of multiple colorectal adenomas with nearly 100 percent potential for malignant transformation. FAP is a rare condition with an incidence of 1 in 10,000 live births. Germline mutations in the adenomatous polyposis coli gene (APC) located on chromosome 5q21 have been founded in many patients with FAP. Patients with FAP can have extracolonic manifestations of their disease. These include tumors of the upper gastrointestinal tract (hamartomatous polyps, adenomas, carcinomas), small intestine adenomas or cacinoma, bile duct adenomas, papillary thyroid carcinoma, osteomas of the mandible, skull, and long bones, a variety of soft tissue lesions, including fibromas, lipomas, and desmoid tumors, congenital hypertrophy of the retinal pigment epithelium (CHRPE) and hepatoblastoma. Hepatocellular carcinoma combined with FAP is a very rare condition. Just 8 cases of Hepatocellular carcinoma with a history of FAP have been reported in the literature. We now present a report of a case of Hepatocellular carcinoma with FAP (Gardner's syndrome) in a 19 year-old girl.

Cholangiome-identifying features in the film of cholangiography

40 patients diagnosed as cholangiome of which 9 patients diagnosed by biliary cell, 13 patients diagnosed by CT scanner, and 18 patients diagnosed by operation. The biliary obstruction in the general hepatic tube occurred in 95% of patients in which the lesion involved in the 2 branches of liver was 75%. The image of cholangiome in the film of cholangiography found that biliary fair stenosid (62,5%).

Cholangioscopic Findings of Various Bile Duct Tumors According to Histology / 대한소화기내시경학회지

BACKGROUND/AIMS: The technique of cholangioscopy has been used in the treatment of bile duct stones or for the diagnosis of various bile duct tumors. However, the cholangioscopic characteristics of the various types of bile duct tumors have not yet been clearly described. Therefore, we analyzed the results of our cholangioscopic examinations and classified the cholangioscopic findings according to tumor histology. METHODS: The cholangioscopic finding from 111 patients who had benign or malignant bile duct tumors were reviewed. The mucosal changes, the presence of neovascularization, and the patterns of luminal narrowing were analyzed and compared with the histologic diagnosis. RESULTS: Bile duct adenocarcinoma can be classified into three different types according to the cholangioscopic findings: nodular, papillary, and infiltrative. Bile duct adenoma, hepatocellular carcinoma and other types of bile duct cancer such as mucin-hypersecreting cholangiocarcinoma, biliary cystadenocarcinoma, squamous cell carcinoma also presented with their unique cholangioscopic characteristics. CONCLUSIONS: Bile duct tumors seem to show characteristic cholangioscopic findings according to their histology. Cholangioscopic examination seems to be a useful technique in the differential diagnosis of bile duct tumors.

A Case of Adenoma Arising in a Choledochal Cyst: A case report

Bile duct adenomas are discovered incidentally during surgery or at autopsy. Especially, the occurrence of an adenoma in a choledochal cyst is very rare. Biliary carcinomas are known to be related to choledochal cysts. The association of an adenoma in a choledochal cyst with the carcinoma is not definite. We have experienced a case of a tubular adenoma arising in a choledochal cyst. Recently, a 24-year-old female was admitted with complaints of right upper quadrant abdominal pain and indigestion. Abdominal ultrasonography and ERCP showed a fusiform dilation of the common bile duct. During the operation, a tiny polyp was discovered in the cyst. We performed a cyst excision and a Roux-en-Y hepaticojejunostomy. On microscopic examination, the polyp was diagnosed as a tubular adenoma.

Cystadenoma with mesenchymal stroma mistaken for hepatic hydatid cyst.

Hepatobiliary cystadenoma with mesenchymal stroma occurs uniquely in women, can be associated with other hepatobiliary anomalies, and has the potential for malignant transformation. We describe a case of hepatobiliary cystadenoma with mesenchymal stroma which was initially treated as hepatic hydatid cyst.

Cistoadenoma biliar: reporte de un caso / Biliary cystadenoma: report of a case

El Cistoadenoma biliar es una identidad muy poco frecuente, que afecta fundamentalmente a mujeres jóvenes. Las manifestaciones clínicas incluyen dolor abdominal y obstrucción biliar. El diagnóstico se sospecha mediante la historia clínica y los métodos radiológicos, pero requiere el estudio anatomopatológico. El tratamiento es quirúrgico. Presentamos el caso de una paciente femenina de 30 años, con manifestaciones clínicas de obstrucción biliar. Los estudios ecosonográficos, tomográficos y colangiográficos reportaron una neoplasia localizada en el conducto hepático izquierdo y hepático común, la cual fue removida quirúrgicamente. El estudio histológico correspondió a cistoadenoma biliar. Se discuten los hallazgos clínicos, radiológicos y patológicos

Colestasis neonatal en el instituto de salud del niño: evaluación del síndrome de colangiopatía obstructiva infantil / Neonatal cholestasis in the children national health institute

Se revisaron 52 Historias Clínicas de pacientes que durante el periodo comprendido entre Enero de 1988 a Diciembre de 1992 fueron atendidos en el Servicio de Gastroenterología del Hospital de Niño con el diagnóstico de Colangiopatía Obstructiva Infantil; el objetivo era determinar la existencia de diferencias en el cuadro clínico y los hallazgos de laboratorio entre HGepatitis Neonatal (HN), Atresia de Vias Biliares (AVB) y Quiste Congénito de Colédoco (QCC). Por no tener datos completos se descartaron 14 casos, quedando en estudio 23 casos de AVB: 8 de HN y & de CQQ. A todos los pacientes se les realizó ecografía, gammagrafía y biopsia hepática. Se observbo una tendencia no significativa de predominio de QCC en el sexo femenino en comparación con los otros cuadros clínicos. No hubo diferencia en la sintomatología, e la aprición de ictericia, acolia, coluria (p=.13), como tampoco en el tamaño del hígado y bazo. Las bilirrubinas total y directa fueron mayores en los pacientes con AVB, sin llegar a tener valor estadísticamente significativo; la bilirrubina indirecta tomada aisladamente fue más alta en los pacientes con AVB (p=0.003)

Colangiocarcinoma / Cholangiocarcinoma

El colangiocarcinoma es una neoplasia de baja prevalencia, pero que representa un gran desafío médico, tanto en el diagnóstico como en el tratamiento, en vista de lo insidioso de sus manifestaciones clínicas. Su aparición se ha asociado en su origen celular con otros tumores hepáticos y relacionado con múltiples factores congénitos o adquiridos (infecciones, medicamentos u otras patologías). La variedad histológica más frecuente es el adenocarcinoma y la ubicación más común en el conducto colédeco; las metástasis regionales son un hallazgo usual al momento de la necropsia. Los hallazgos clínicos más frecuentes son: prurito, pérdida de peso, anorexia, acompañados de ictericia y hepatomegalia. Los avances inmunohistoquímicos en cuanto a los oncogenes (ras y C-er B-1) y marcadores tumorales (factor de crecimiento epidérmico o integrinas, entre otros) permiten hacer diagnóstico diferencial con otros cánceres hepáticos y en un futuro proporcionar información valiosa en relación a su biología celular. La aproximación inicial a los pacientes con esta patología se realiza a través de la ecosonografía, que puede asociarse a doopler, la tomografía axial computarizada y la Resonancia Magnética Nuclear tienen similar sensibilidad y especificidad, y se prefieren la anterior en caso de ancianos con historia de pérdida de peso. La colangiografía transhepática percutánea se prefiere cuando es posible, a la pancreatocolangiografía retrógrada endoscópica ya que permite una mayor visualización de las vias biliares. El tratamiento incluye la resección y la colocación de endoprótesis. El primero, asociado a la radioterapia y la quimioterapia, es el que permite alcanzar la mejor sobrevida; la unión de estas modalidades terapeúticas abre una puerta para nuevas estrategias en cuanto al manejo de ésta patología