An unusual malignant main bile duct stricture: a biliary metastasis of endometrial adenocarcinoma (original) (raw)
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Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting
Mini-invasive Surgery, 2021
Biliary tract malignancies include cancers of the intra-hepatic and extra-hepatic bile ducts. Cholangiocarcinoma is the predominant biliary tract malignancy with nearly 60% of them occurring in the peri-hilar region. They can present with biliary strictures causing jaundice but can be insidious and present late in their clinical course. Recent advances in imaging and other diagnostic modalities help in the earlier identification of these tumors. Diagnosis should be suspected in anyone presenting with jaundice with evidence of biliary ductal dilatation or in patients with primary sclerosing cholangitis with worsening clinical status. The diagnostic approach consists of obtaining tumor markers, mainly CA 19-9, imaging modalities which include computed tomography and/or magnetic resonance imaging to establish the level of biliary obstruction and presence or absence of mass. Tissue sampling is performed with endoscopic retrograde cholangiopancreatography (ERCP) guided cytology and biopsies and with endoscopic ultrasound (EUS) if a mass is visible on imaging. Indeterminate strictures after initial biopsies could be further evaluated by cholangioscopy directed biopsies. Treatment for resectable and distal bile duct cancers involves surgical referral, but palliative biliary drainage is the key for unresectable cancers. Metal stents are generally preferred for distal cancers and plastic stents for proximal cancers. EUS guided biliary drainage can be an alternative approach in patients with failed ERCP.
Cancers, 2022
Differentiating between benign and malignant biliary stenosis (BS) is challenging, where tissue diagnosis plays a crucial role. Endoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling and endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) or biopsy (FNB) are used to obtain tissue specimens from BS. The aim of this retrospective study was to evaluate the diagnostic yield of EUS-FNA/B plus ERCP with brushing or forceps biopsy in BS. All endoscopic procedures performed in patients with BS at our gastroenterology unit were reviewed. The gold standard for diagnosis was histopathology of surgical specimens or the progression of the malignancy at radiological or clinical follow-up. A total of 70 endoscopic procedures were performed in 51 patients with BS. Final endoscopic diagnosis was reached in 96% of the patients and was malignant in 61.7% and benign in 38.3% of cases. Sensitivity, specificity, and diagnostic accuracy were 73.9%, 100%, and 80%, respectivel...
Cureus
Background and objective Patients with suspected malignant biliary strictures frequently undergo endoscopic retrograde cholangiopancreatography (ERCP)-based brush cytology and endoscopic ultrasound (EUS)-guided fineneedle aspiration (FNA) for establishing the diagnosis. The outcomes of these tests aid in the further management of the patient. A comparison of these two modalities in establishing the diagnosis is seldom reported. In light of this, we aimed to compare the diagnostic efficacy between ERCP-based brush cytology and EUS-FNA for tissue diagnosis in malignant biliary obstruction. Our study involved a retrospective audit of all patients admitted to the Vydehi Institute of Medical Sciences and Research Centre for EUS and ERCP from 2015 to 2019. Methodology A Comparative study was conducted in the Department of Medical Gastroenterology at the Vydehi Institute of Medical Sciences and Research Centre over a five-year period. A total of 77 subjects who presented during the study period with biliary obstruction based on clinical presentation with altered liver function test in an obstructive pattern and evidence of biliary obstruction in the form of stricture or pancreaticobiliary mass on cross-sectional imaging were included in the study. All the patients included in the study underwent EUS and ERCP. Results The majority of the patients in the study were in the fifth decade of life with a slight female predominance. The most common CT finding was a periampullary mass with common bile duct (CBD) stricture (59.7%). In the study, EUS-FNA was more sensitive than ERCP-based tissue sampling. The overall sensitivity was 90.63% for EUS-FNA and 65.63% for ERCP sampling. EUS-FNA was found to have diagnostic accuracy of 92.63% in comparison to 71.43% for brush cytology. Conclusions Based on our findings, EUS-FNA is superior to ERCP-based tissue sampling with excellent sensitivity and diagnostic accuracy. Performing EUS before ERCP in all patients with suspected malignant biliary obstruction would definitely improve diagnostic accuracy and thereby help in the management of such cases.
HPB, 2005
Objective. Distinguishing between malignant and benign biliary strictures remains problematic. The aim of this study was to compare and contrast the clinical features of patients with benign and malignant biliary strictures. Methods. Medical records of patients who underwent surgical resection for presumed cholangiocarcinoma were reviewed. Immunohistochemistry for hypoxia inducible factor-1-alpha (HIF-1-alpha) was performed on all bile ductule samples. Results. Twelve patients with benign strictures (group I) were compared to 26 patients with cholangiocarcinoma (group II). Group I was predominantly female (ratio 2 : 1), (p50.01), whereas the gender ratio was 1 : 1 in patients in group II. Bismuth-Corlette type strictures in group I were more likely to be type I/II, whereas type III strictures predominated in group II. The CA 19-9 was 5100 U/ml in 6 and 4100 U/ml in 1 patient of group I and 5100 in 13 and 4100 in 11 patients in group II. Half of the patients in group I had positive immunoreactivity for HIF-1-alpha in bile ductules. Conclusion. Benign biliary strictures masquerading as cholangiocarcinomas occur more often in women, are less often Bismuth-Corlette type III, have serum CA 19-9 values 5100 U/ml, and hypoxia may play a role in a subset of these strictures.
Diagnostic-therapeutic management of bile duct cancer
World Journal of Clinical Cases
Biliary tract cancer, or cholangiocarcinoma, comprises a heterogeneous group of malignant tumors that can emerge at any part of the biliary tree. This group is the second most common type of primary liver cancer. Diagnosis is usually based on symptoms, which may be heterogeneous, and nonspecific biomarkers in serum and biopsy specimens, as well as on imaging techniques. Endoscopy-based diagnosis is essential, since it enables biopsy specimens to be taken. In addition, it can help with locoregional staging of distal tumors. Endoscopic retrograde cholangiopancreatography is a key technique for the evaluation and treatment of malignant biliary tumors. Correct staging of cholangiocarcinoma is essential in order to be able to determine the degree of resectability and assess the results of treatment. The tumor is staged based on the TNM classification of the American Joint Committee on Cancer. The approach will depend on the classification of the tumor. Thus, some patients with early-stage disease could benefit from surgery; complete surgical resection is the cornerstone of cure. However, only a minority of patients are diagnosed in the early stages and are suitable candidates for resection. In the subset of patients diagnosed with locally advanced or metastatic disease, chemotherapy has been used to improve outcome and to delay tumor progression. The approach to biliary tract tumors should be multidisciplinary, involving experienced endoscopists, oncologists, radiologists, and surgeons.
World journal of gastrointestinal endoscopy, 2015
In the last decades many advances have been achieved in endoscopy, in the diagnosis and therapy of cholangiocarcinoma, however blood test, magnetic resonance imaging, computed tomography scan may fail to detect neoplastic disease at early stage, thus the diagnosis of cholangiocarcinoma is achieved usually at unresectable stage. In the last decades the role of endoscopy has moved from a diagnostic role to an invaluable therapeutic tool for patients affected by malignant bile duct obstruction. One of the major issues for cholangiocarcinoma is bile ducts occlusion, leading to jaundice, cholangitis and hepatic failure. Currently, endoscopy has a key role in the work up of cholangiocarcinoma, both in patients amenable to surgical intervention as well as in those unfit for surgery or not amenable to immediate surgical curative resection owing to locally advanced or advanced disease, with palliative intention. Endoscopy allows successful biliary drainage and stenting in more than 90% of pa...
Endoscopic Management of Biliary Malignancy and
2019
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is being used safe therapeutic tool for the palliative management of biliary and pancreatic malignancy. This study was conducted to evaluate the clinical outcome of malignancy admitted to our study hospital after endoscopic stenting. Methods: We retrospectively identified patients who underwent ERCP stenting for biliary and pancreatic malignancy during January 2013 through December, Gastroliver and General Hospital, Dhaka. Results:We identified 311 patients who had biliary and pancreatic malignancy and underwent ERCP for stenting. Among 311, 124 (40%) had periampullary carcinoma, 112 (36%) had cholangiocarcinoma, 43 (14%) had carcinoma gall bladder and 28 (9%) had carcinoma head of the pancreas. Mean age of the patients was 56 years and more than half were male. Of 311, stenting was compete/successful for 274 (88%) and of these free flow of bile was established in 263 (96%) patients. Majority were introduced with sing...