RESUMEN
Biliary cystadenoma is a rare cystic neoplasm and constitutes only 5% of all intrahepatic cysts of biliary origin. We report a case of a 44-year-old woman with huge biliary cystadenoma in the subhepatic space, mimicking a cholecystic lymphangioma. Findings of various imaging modalities including reconstructed CT image are presented and correlated with surgical and pathologic findings.
Asunto(s)
Adenoma de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/diagnóstico , Conductos Biliares Intrahepáticos , Linfangioma Quístico/etiología , Adenoma de los Conductos Biliares/diagnóstico por imagen , Adenoma de los Conductos Biliares/fisiopatología , Adulto , Neoplasias de los Conductos Biliares/diagnóstico por imagen , Neoplasias de los Conductos Biliares/fisiopatología , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , UltrasonografíaRESUMEN
A review of seven hepatic resections in six patients undergoing maintenance hemodialysis is presented. These cases consisted of hepatocellular carcinoma in four, and cholangiocellular carcinoma, myelolipoma and focal nodular hyperplasia in one each. The last preoperative hemodialysis was undertaken within 24 h prior to the operation with heparin. Intraoperatively, infused solutions containing no potassium, along with strict attention to preventing overhydration, allowed us to manage the patients without hemodialysis on the day of the operation. No specific intra-operative complications related to hemodialysis were noted. Postoperative hemodialysis was performed on the first or second day after operation, using nafamstat mesilate, a synthetic protease-inhibiting agent. The morbidity rate in the hemodialyzed patients was 85.7% (6/7), which was significantly higher than that in the non-hemodialyzed patients who underwent hepatic resections in our hospital. Fluid collection in the pleural and/or peritoneal cavities was frequent and difficult to control, but transient. Our experience suggests that hepatic resection is an acceptable procedure for hemodialyzed patients, when used in conjunction with careful perioperative management.
Asunto(s)
Adenoma de los Conductos Biliares/cirugía , Neoplasias de los Conductos Biliares/cirugía , Carcinoma Hepatocelular/cirugía , Neoplasias de la Vesícula Biliar/cirugía , Hemangioma/cirugía , Fallo Renal Crónico/cirugía , Lipoma/cirugía , Neoplasias Hepáticas/cirugía , Diálisis Renal , Adenoma de los Conductos Biliares/mortalidad , Adenoma de los Conductos Biliares/fisiopatología , Adulto , Neoplasias de los Conductos Biliares/mortalidad , Neoplasias de los Conductos Biliares/fisiopatología , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/fisiopatología , Femenino , Estudios de Seguimiento , Neoplasias de la Vesícula Biliar/mortalidad , Neoplasias de la Vesícula Biliar/fisiopatología , Hemangioma/mortalidad , Hemangioma/fisiopatología , Humanos , Riñón/fisiopatología , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/fisiopatología , Pruebas de Función Renal , Lipoma/mortalidad , Lipoma/fisiopatología , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/fisiopatología , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Poliestirenos/administración & dosificación , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Potasio/sangre , Tasa de Supervivencia , Equilibrio Hidroelectrolítico/fisiologíaRESUMEN
Hypouricemia in malignant neoplasms is rarely reported. We present a previously unreported case of cholangiocarcinoma associated with severe persistent hypouricemia (serum uric acid levels ranged from 0.07 to 0.08 mmol/L [1.16 to 1.40 mg/100 mL], and increased urate clearance (50.90 to 57.33 mL/min v a mean value in 20 normal subjects of 9.75 +/- 1.65 mL/min). High fractional urate clearance (Cus/Ccr = 0.50 to 0.58 v 0.09 +/- 0.01 in normals) was suppressed only slightly following pyrazinamide (PZA), to 0.29 versus 0.007, and was surprisingly enhanced by probenecid (PB) to 1.78 versus 0.63 in normals. No other renal tubular or metabolic abnormalities were detected. This previously unreported association of a high PZA-nonsuppressible urate excretion with a postprobenecid urate clearance exceeding glomerular filtration rate suggests that a combined renal tubular defect is responsible for hypouricemia. The patient described here provides evidence to support the presence of a presecretory reabsorptive defect in association with a "relatively high" urate secretion by the renal tubule. This report adds to the list of hypouricemic conditions and presents an important clue to elucidate urate handling mechanisms in man.
Asunto(s)
Adenoma de los Conductos Biliares/fisiopatología , Neoplasias de los Conductos Biliares/fisiopatología , Riñón/fisiopatología , Ácido Úrico/sangre , Adenoma de los Conductos Biliares/sangre , Neoplasias de los Conductos Biliares/sangre , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Probenecid , Pirazinamida , Ácido Úrico/metabolismoRESUMEN
A 100% yield of pancreatic hepatocytes was induced in pancreas tissues of female hamsters treated with twice-repeated sequential administrations of DL-ethionine (ethionine) together with a protein-free diet and then L-methionine (methionine) for 10 weeks. The cells were also found in 40% of hamsters receiving 20 mg/kg body weight of the pancreatic carcinogen, N-nitrosobis(2-oxopropyl)amine (BOP) given twice at the peak of pancreatic regeneration stimulated by methionine after ethionine-induced cell damage. However, BOP at doses of 30, 70, and 100 mg/kg body weight administered before the occurrence of pancreatic regeneration dose-dependently inhibited their appearance, with reduction of the yield to 40%, 25%, and 8.3% respectively, and BOP per se did not induce any development of pancreatic hepatocytes. Stein iodine staining revealed bile pigments in the induced hamster pancreatic eosinophilic cell populations.
Asunto(s)
Carcinógenos/administración & dosificación , Etionina/farmacología , Hígado/citología , Metionina/farmacología , Nitrosaminas/administración & dosificación , Páncreas/fisiología , Desnutrición Proteico-Calórica/fisiopatología , Adenocarcinoma/patología , Adenocarcinoma/fisiopatología , Adenoma de los Conductos Biliares/patología , Adenoma de los Conductos Biliares/fisiopatología , Animales , Cricetinae , Relación Dosis-Respuesta a Droga , Femenino , Inyecciones Subcutáneas , Hígado/efectos de los fármacos , Hígado/fisiología , Mesocricetus , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/fisiopatologíaRESUMEN
Inoperable malignant liver tumors have been treated by radiofrequency hyperthermia at Kyoto University Hospital since 1983. In this study, clinical hyperthermia for malignant liver tumor was evaluated for 67 tumors in which we could measure intratumor temperatures. Of the 67 tumors, 41 were hepatocellular carcinomas (HCC), six cholangiocarcinomas, and 20 metastatic tumors. Cholangiocarcinoma and metastatic tumors were more susceptible to this treatment than HCC. Of the three types of HCC, higher intratumor temperatures were achieved in the diffuse type than in the nodular or massive types. The minimum tumor temperature of HCC stayed below 40 degrees C in 46% of cases, especially in larger tumors. The local response rates (complete remission plus partial remission/all) were 28% and 11% for HCC and non-HCC, respectively, for thermochemotherapy; 86% and 33%, for thermoradiotherapy; and 33% and 89%, for thermotherapy with embolization. No apparent relationship was observed between the intratumor temperatures and local response rate.
Asunto(s)
Adenoma de los Conductos Biliares/terapia , Carcinoma Hepatocelular/terapia , Hipertermia Inducida , Neoplasias Hepáticas/terapia , Ondas de Radio , Adenoma de los Conductos Biliares/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/fisiopatología , Neoplasias del Colon , Terapia Combinada , Doxorrubicina/uso terapéutico , Embolización Terapéutica , Femenino , Humanos , Hipertermia Inducida/instrumentación , Hipertermia Inducida/métodos , Neoplasias Hepáticas/fisiopatología , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Radioterapia de Alta Energía , TemperaturaRESUMEN
The modifying effect of pregnancy and lactation on carcinogenesis induced by single injection of 1,2-dimethylhydrazine to female rats 30 days before mating has been studied. The total incidence of malignant tumours in rats with pseudopregnancy, single pregnancy, pregnancy and lactation, repeated pregnancies was lower in comparison with virgin animals (75, 44, 68, 59 and 93%, respectively). Colon adenocarcinoma incidence in rats with single pregnancy or repeated pregnancies was lower than that in virgin rats (42, 49 and 76%, respectively). Protective effect was observed mainly in descending colon. The mesenchymal kidney tumours were not developed at all in rats with single pregnancy. In virgin animals it was 31%. The inhibition of tumour incidence in the liver (cholangioma, cholangiocellular carcinoma) was observed in rats with single pregnancy or pregnancy and lactation in comparison with virgin control (3, 5 and 24%, respectively).
Asunto(s)
Neoplasias Experimentales/fisiopatología , Embarazo , 1,2-Dimetilhidrazina , Adenocarcinoma/inducido químicamente , Adenocarcinoma/fisiopatología , Adenoma de los Conductos Biliares/inducido químicamente , Adenoma de los Conductos Biliares/fisiopatología , Animales , Neoplasias del Colon/inducido químicamente , Neoplasias del Colon/fisiopatología , Dimetilhidrazinas , Femenino , Neoplasias Renales/inducido químicamente , Neoplasias Renales/fisiopatología , Lactancia , Neoplasias Hepáticas/inducido químicamente , Neoplasias Hepáticas/fisiopatología , Mesenquimoma/inducido químicamente , Mesenquimoma/fisiopatología , Neoplasias Experimentales/inducido químicamente , Paridad , Seudoembarazo , RatasRESUMEN
Exogenous administration of cholecystokinin (CCK) or caerulein inhibits growth of SLU-132, a human cholangiocarcinoma that we have shown to possess receptors for CCK. Chronic administration of cholestyramine, a resin that binds bile salts, increases release of CCK and growth of the pancreas in guinea pigs. Feeding the bile salt, taurocholate, inhibits meal-stimulated release of CCK. The purpose of this study was to determine whether endogenous CCK affects growth of the human cholangiocarcinoma, SLU-132. We implanted SLU-132 subcutaneously into athymic nude mice. The bile salt pool was depleted by feeding 4% cholestyramine for 40 days, either alone or enriched with 0.5% taurocholate for 32 days. When the mice were killed, tumors and pancreas were removed. Cholestyramine significantly inhibited the growth of SLU-132 and stimulated growth of the normal pancreas. Feeding of taurocholate acted to stimulate tumor growth. These results demonstrate that endogenous levels of CCK regulate growth of this human cholangiocarcinoma. Our findings suggest that manipulation of levels of endogenous gut hormones may, in the future, play a role in management of patients with certain gastrointestinal cancers.
Asunto(s)
Adenoma de los Conductos Biliares/patología , Neoplasias de los Conductos Biliares/patología , Colecistoquinina/fisiología , Adenoma de los Conductos Biliares/fisiopatología , Animales , Neoplasias de los Conductos Biliares/fisiopatología , Resina de Colestiramina/farmacología , ADN/metabolismo , Dieta , Humanos , Masculino , Ratones , Ratones Desnudos , Trasplante de Neoplasias , Tamaño de los Órganos , Páncreas/patología , ARN/metabolismo , Ácido Taurocólico/farmacologíaRESUMEN
Hilar cholangiocarcinoma is relatively rare. Typically it spreads locally, the main manifestation being painless jaundice. Exact preoperative staging includes sonography or CT scan, cholangiography, angiography and aspiration cytology. This assessment should delineate the tumor extent and provide an excellent index of tumors which are clearly unresectable. Therapy has two objectives: firstly, if possible, to eliminate the tumor, and secondly, to restore bile flow. Resection of hilar cholangiocarcinoma can be accomplished in some 20% of cases with a 30 day hospital mortality close to zero for local excision and of approximately 10% for hepatic resections. The median time resected patients remain alive is 24 months, and the 5 year survival rate of resected patients is 12%. The mortality rate for palliative relief of biliary obstruction by any method in hilar cholangiocarcinoma is reported at 16-30%. Survival after intubation averages only 3 to 6 months and for surgical bypass about 8 months.
Asunto(s)
Adenoma de los Conductos Biliares/fisiopatología , Neoplasias Hepáticas/fisiopatología , Adenoma de los Conductos Biliares/diagnóstico , Adenoma de los Conductos Biliares/terapia , Colangitis/fisiopatología , Colestasis Intrahepática/fisiopatología , Terapia Combinada , Diagnóstico por Imagen , Humanos , Cirrosis Hepática/fisiopatología , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapiaRESUMEN
Manometric pressure recordings were attempted during percutaneous transhepatic cholangiography (PTC) and after percutaneous biliary drainage (PBD) in 203 cases. Successful readings were achieved at PTC in 85% (104/122) of patients. Pressure measurements were also obtained through 56 biliary drainage catheters, and controlled perfusion challenges were performed in 12 patients (on 18 occasions). Documentation of the occasionally poor correlation between the caliber of ducts and the degree of obstruction (i.e., pressure) was shown, and it was suggested that very high pressures may be predictive of a bile leak after PTC. Adequacy of percutaneous drainage and stricture dilatation were further assessed with these manometric techniques. Pressure and perfusion data aided in detecting and determining the significance of the nondilated obstructed duct, the dilated nonobstructed ductal system, and subtle distal ductal strictures. The knowledge obtained from percutaneous pressure recordings may help to determine appropriate therapy.