Mucosal dysplasia of the liver and the intraductal variant of peripheral cholangiocarcinoma in hepatholithiasis

Article Abstract:

Gallstones may be composed either of fatty material or calcium-containing proteinaceous masses. As their name implies, these ''stones'' develop in the gall bladder, which stores bile produced in the liver. In western countries, it is uncommon for stones to develop in the ducts that carry bile from the liver tissue itself into the gallbladder. However, in nations of eastern Asia, such as China and Japan, hepatolithiasis, ''liver stones'' as it were, is actually more common and is found in 3 to 6 percent of all cases involving gallstones. Gallstones are generally thought to contribute to the development of gallbladder cancer; this is most likely due to the obstruction of bile flow and the subsequent chronic irritation of gallbladder tissues. Less is known, however, about the potential relationship between hepatolithiasis and cancer. A study was undertaken to closely examine surgical specimens obtained from 32 cases of hepatolithiasis. In four cases, cholangiocarcinoma could be identified. (Cholangiocarcinoma is a not particularly common form of liver cancer that develops in the bile ducts.) These cancers were identified in the very duct that contained the stone and were spreading not by invasion but rather along the inner wall of the duct. Dysplasia, or abnormal tissue structure, was observed in the mucosal lining of the ducts of the cancerous specimens. In addition, six of the specimens in which actual cancer could not be identified contained regions of dysplasia, and thus may have been precancerous. The authors suggest that the biochemical changes in the bile which accompany stone formation may lead to the development of dysplasia. This, in turn, may undergo malignant transformation into cancer in some patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Liver, Dysplasia, Gallbladder cancer

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Etiologic and clinical characteristics of peripheral and hilar cholangiocarcinoma

Article Abstract:

Cholangiocarcinoma is a cancer of the bile ducts within the liver. It is a relatively uncommon form of liver cancer and accounts for 10 to 20 percent of primary liver cancers. Cholangiocarcinomas may be grouped by the location of their occurrence; peripheral cholangiocarcinomas originate in the smaller bile ducts within the liver, while hilar cholangiocarcinomas are in the major hepatic ducts or near the junction of major ducts. A review of 112 patients with cholangiocarcinoma reveals that while there are some differences between the cancers arising in these two areas, the two areas have many features in common as well. Birth control pills may contribute to the development of peripheral cholangiocarcinoma; 35 percent of the women with peripheral disease used oral contraceptives in contrast to 4 percent of the women with hilar cancer. The initial symptoms for patients with peripheral cancer were abdominal pain and weight loss. The patients with hilar cancer generally had symptoms of obstructive jaundice, that is, the symptoms that normally result when the flow of bile is obstructed. These symptoms include pale stools and dark urine. High alcohol consumption was related to both peripheral and hilar cholangiocarcinoma, and was a characteristic in 45 percent of the hilar cancer cases and 37 percent of the peripheral. Cholangiocarcinoma has a generally poor prognosis, and in the present series of cases the median survival was 12 months, regardless of the location of the cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects

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Clinical experience in 20 hepatic resections for peripheral cholangiocarcinoma

Article Abstract:

Peripheral cholangiocarcinoma (PCC) is a cancerous tumor derived from the cells lining the small bile ducts of the liver. Cholangiocarcinoma is associated with the formation of stones in the liver ducts. Treatment includes the surgical removal, hepatic resection, of the diseased sections of the liver. Over a ten year period, hepatic resection was performed on nine men and 11 women with PCC. A history of liver stones, hepatolithiasis, was present in 80 percent of the patients. Additional surgery was performed because of recurrent inflammation due to liver stones or other space-occupying tumors on liver scans. Twelve patients had surgery for liver stones when PCC was diagnosed. The surgical mortality rate was low and few complications developed in patients with liver stones. Infection was the most common complication. Patients with PCC survived an average of 20.5 months. Four patients survived three years and one more than five years after surgery. There seems to be an association between liver stones and PCC. It is suggested that the chronic inflammation and infection associated with liver stones cause changes in the cells lining the ducts. Early diagnosis of liver stones is advised. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Surgery, Adenoma, Cholangitis

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