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Caution for diagnosis and surgical treatment of recurrent cholangitis: lessons from 5 cases of bile duct tumor thrombus without a detectable intrahepatic tumor.

Wu Z, Guo K, Sun H, Yu L, Lv Y, Wang B - Medicine (Baltimore) (2014)

Bottom Line: The diagnosis, treatment, and outcome of the patients are discussed.The prognosis of HCC patients with BDTT is dismal.Identification of this type of patient is clinically important, because surgical treatment may be beneficial.

View Article: PubMed Central - PubMed

Affiliation: Department of Hepatobiliary Surgery (ZW, KG, HS, LY, YL, BW), First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.

ABSTRACT
The hepatocellular carcinoma (HCC) patients with bile duct tumor thrombus (BDTT) usually have no specific clinical symptoms at early stages. HCC with BDTT was usually misdiagnosed when the intrahepatic tumor was small, even undetectable. In this study, 5 cases of HCC with BDTT misdiagnosed as choledocholithiasis and cholangitis in the local hospital are described. We analyzed retrospectively and summarized our experiences of these 5 HCC patients with BDTT misdiagnosed in the local hospital during the past 5 years. The diagnosis, treatment, and outcome of the patients are discussed. Three patients underwent hepatectomy with thrombectomy and T-tube drainage. One patient underwent hepatectomy with the resection of the common bile duct and hepatojejunostomy, and palliative surgery was performed in 1 patient with portal vein tumor thrombus and intrahepatic metastasis. The patients were followed for 6-22 months; 4 patients died of tumor recurrence and metastasis or hepatic failure, despite 3 of these patients having received transhepatic arterial chemotherapy and embolization or radiofrequency ablation therapy. Early and accurate diagnosis of HCC with BDTT is very important. When patients have a history of abnormal recurrent cholangitis, HCC with BDTT should be highly suspected. Intraductal ultrasonography (US), intraoperative US, and histopathological examination are very valuable for the diagnosis. The prognosis of HCC patients with BDTT is dismal. Identification of this type of patient is clinically important, because surgical treatment may be beneficial.

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T-Tube cholangiography showing bile duct tumor thrombus (yellow arrow).
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Figure 1: T-Tube cholangiography showing bile duct tumor thrombus (yellow arrow).

Mentions: All five patients received emergency treatment in the local hospital when they were misdiagnosed as choledocholithiasis and cholangitis. Three patients received choledocholithotomy and T-tube drainage therapy and 2 of them were confirmed as BDTT pathologically after the operation. BDTT was detected again by T-Tube cholangiography after the patient was admitted to our hospital (Figure 1). These 2 patients underwent hepatectomy with thrombectomy and T-tube drainage after 14 and 20 days, respectively. The other patient was admitted to our hospital 4 months after the first treatment and only received percutaneous transhepatic biliary drainage (PTBD) therapy because of the portal vein tumor thrombus and intrahepatic metastasis. Two of 5 patients received emergency ENBD drainage, and 1 case was confirmed as BDTT after thrombus extraction during ERCP and then transferred to our hospital in 7 days. This patient underwent segments VII and VIII bisegmentectomy with thrombectomy and T-tube drainage. The last patient received plastic stent placement after ENBD drainage, and further received choledocholithotomy and choledochojejunostomy in the local hospital. This patient underwent left hemihepatectomy and hepatojejunostomy 92 days after the first treatment. The determination of resectability was based on tumor characteristics, remnant liver volume, liver function, and general status of the patients (Table 3).


Caution for diagnosis and surgical treatment of recurrent cholangitis: lessons from 5 cases of bile duct tumor thrombus without a detectable intrahepatic tumor.

Wu Z, Guo K, Sun H, Yu L, Lv Y, Wang B - Medicine (Baltimore) (2014)

T-Tube cholangiography showing bile duct tumor thrombus (yellow arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4616276&req=5

Figure 1: T-Tube cholangiography showing bile duct tumor thrombus (yellow arrow).
Mentions: All five patients received emergency treatment in the local hospital when they were misdiagnosed as choledocholithiasis and cholangitis. Three patients received choledocholithotomy and T-tube drainage therapy and 2 of them were confirmed as BDTT pathologically after the operation. BDTT was detected again by T-Tube cholangiography after the patient was admitted to our hospital (Figure 1). These 2 patients underwent hepatectomy with thrombectomy and T-tube drainage after 14 and 20 days, respectively. The other patient was admitted to our hospital 4 months after the first treatment and only received percutaneous transhepatic biliary drainage (PTBD) therapy because of the portal vein tumor thrombus and intrahepatic metastasis. Two of 5 patients received emergency ENBD drainage, and 1 case was confirmed as BDTT after thrombus extraction during ERCP and then transferred to our hospital in 7 days. This patient underwent segments VII and VIII bisegmentectomy with thrombectomy and T-tube drainage. The last patient received plastic stent placement after ENBD drainage, and further received choledocholithotomy and choledochojejunostomy in the local hospital. This patient underwent left hemihepatectomy and hepatojejunostomy 92 days after the first treatment. The determination of resectability was based on tumor characteristics, remnant liver volume, liver function, and general status of the patients (Table 3).

Bottom Line: The diagnosis, treatment, and outcome of the patients are discussed.The prognosis of HCC patients with BDTT is dismal.Identification of this type of patient is clinically important, because surgical treatment may be beneficial.

View Article: PubMed Central - PubMed

Affiliation: Department of Hepatobiliary Surgery (ZW, KG, HS, LY, YL, BW), First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.

ABSTRACT
The hepatocellular carcinoma (HCC) patients with bile duct tumor thrombus (BDTT) usually have no specific clinical symptoms at early stages. HCC with BDTT was usually misdiagnosed when the intrahepatic tumor was small, even undetectable. In this study, 5 cases of HCC with BDTT misdiagnosed as choledocholithiasis and cholangitis in the local hospital are described. We analyzed retrospectively and summarized our experiences of these 5 HCC patients with BDTT misdiagnosed in the local hospital during the past 5 years. The diagnosis, treatment, and outcome of the patients are discussed. Three patients underwent hepatectomy with thrombectomy and T-tube drainage. One patient underwent hepatectomy with the resection of the common bile duct and hepatojejunostomy, and palliative surgery was performed in 1 patient with portal vein tumor thrombus and intrahepatic metastasis. The patients were followed for 6-22 months; 4 patients died of tumor recurrence and metastasis or hepatic failure, despite 3 of these patients having received transhepatic arterial chemotherapy and embolization or radiofrequency ablation therapy. Early and accurate diagnosis of HCC with BDTT is very important. When patients have a history of abnormal recurrent cholangitis, HCC with BDTT should be highly suspected. Intraductal ultrasonography (US), intraoperative US, and histopathological examination are very valuable for the diagnosis. The prognosis of HCC patients with BDTT is dismal. Identification of this type of patient is clinically important, because surgical treatment may be beneficial.

Show MeSH
Related in: MedlinePlus