Background: Cholangiocarcinoma (CCA) is an epithelial tumor with features of cholangiocyte differentiation. Most patients suffer from a nonresectable disease since presentation and the exitus occurs within 12 months from diagnosis. Biliary epithelial carcinogenesis is a multistep process that involves the transition from hyperplasia to dysplasia to carcinoma. The clinical approach should be multidisciplinary, and the diagnosis should be considered when there is a histological finding of adenocarcinoma without any other evidences of an extrahepatic primitive neoplasia. Surgical resection with histologically negative margins is the only curative treatment. Nevertheless for unresectable patients, there are several other approaches: systemic chemotherapy is the widely used treatment, but a large proportion of patients could be suitable for liver-directed therapies. These options include transarterial chemoembolization (TACE), radioembolization (TARE), hepatic arterial infusion (HAI), percutaneous ablation, and external beam radiation therapy (EBRT). Conclusion: Intrahepatic cholangiocarcinoma is a relatively rare disease with a poor prognosis. Diagnosis is based on imaging, but pathological anatomy plays an important role. Surgery is still the gold standard treatment; nevertheless, unresectable patients could be treated in a multimodality strategy with a significant improvement in terms of survival.
A case of intraductal papillary neoplasm of the bile duct (IPNB) arising in a patient with hepatitis B-related liver cirrhosis with hepatocellular carcinoma (HCC) is reported. A 76-year-old man was admitted to our hospital with recurrent HCC. Laboratory data showed that levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated. He died of progressive hepatic failure. At autopsy, in addition to HCCs, an intraductal papillary proliferation of malignant cholangiocytes with fibrovascular cores was found in the dilated large bile ducts in the left lobe, and this papillary carcinoma was associated with an invasive mucinous carcinoma (invasive IPNB). Interestingly, extensive intraductal spread of the cholangiocarcinoma was found from the reactive bile ductular level to the interlobular bile ducts and septal bile ducts and to the large bile ducts in the left lobe. Neural cell adhesion molecule, a hepatic progenitor cell marker, was detected in IPNB cells. It seems possible in this case that hepatic progenitor cells located in reactive bile ductules in liver cirrhosis may have been responsible for the development of the cholangiocarcinoma and HCC, and that the former could have spread in the intrahepatic bile ducts and eventually formed grossly visible IPNB.
The US Government concluded Public Law (PL) 480 Title I agreements with Japan in 1955 and. The purpose of this article is to reexamine Japanese market development programs under PL 480. The findings are as follows: (1) Japan was regarded as a potential market for rice and other US commodities as well as wheat; (2) Judging from Japanese and US government documents, USDA officials did not intend to replace Japanese rice with US wheat; (3) Market development plans for US rice had failed due to the damaging effect on diplomatic relations with Southeast Asia and the contradiction with Japan's food policy.Among the crucial factors that decided the market development program results, this article emphasizes the importance of recipient countries' policies and multilateral relations.
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