Biliary malignancies occurring in choledochal cysts.

Yoshida, Hideo; Itai, Y; Minami, Masaki; Kokubo, T; Ohtomo, Kuni; Kuroda, Akira

doi:10.1148/radiology.173.2.2678253

Cited by 58 publications

(31 citation statements)

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“…In children, incidental biliary ascites was reported after spontaneous or traumatic perforation of a choledochal cyst [6]. Biliary carcinoma occurs in 2.5-39.4% of patients with biliary cysts [7,8]: the degenerated mucosa of a choledochal cyst increases the risk for carcinomatous development due to chronic irritation, ulceration and subsequent regeneration of cyst epithelium [9].…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance cholangiopancreatography diagnosis of choledochal cyst involving the cystic duct: report of three cases

Yoon¹

2011

BJR

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ABSTRACT. Here we describe three cases of choledochal cyst involving the cystic duct or isolated dilatation of the cystic duct. All cases were visualised on MR cholangiopancreatography (MRCP) imaging. We report findings of ultrasonography, CT and MRCP. These cases are extremely rare; nine cases have been reported in the English-language literature. This anomaly was not included in Todani's classifications of choledochal cysts, a system that is accepted worldwide. We think that this variant anomaly will be included in this classification system in the near future. ; normal range ,10 ng ml -1 ) was noted. Initial work-up included a transabdominal ultrasonography, which showed a hypoechoic mass replacing the fundal portion of the gallbladder ( Figure 1a). On abdominal CT, a soft-tissue mass was noted in the fundus of the gallbladder with suspicion of hepatic invasion ( Figure 1b); multiple enlarged lymph nodes were identified in the peripancreatic, portocaval, aortocaval, and left paraaortic regions ( Figure 1b), suggesting the possibility of malignancy.Focal fusiform dilatation of the cystic duct without a definite cause of obstruction was identified and was about 22 mm in diameter and 34 mm in length (Figure 1c).The extrahepatic bile duct and common bile duct were of normal diameter.MR cholangiopancreatography (MRCP) was performed for further evaluation. On thick-slab coronal oblique MRCP imaging, fusiform dilatation of the cystic duct with normal diameters for the intrahepatic and extrahepatic bile ducts was seen (Figure 1d).There was no evidence of bile duct stone or stenosis in the transitional portion of the cystic duct. Also, there was no evidence of definite anomalous union of the pancreaticobile duct (AUPBD). This patient was diagnosed with advanced gallbladder cancer with lymph nodes metastasis combined with choledochal cyst involving the cystic duct only. Case 2A 48-year-old woman was transferred from a local clinic because of bile duct dilatation. The patient complained of intermittent dyspepsia and mild abdominal pain for 6 weeks. But there was no definite tender point or Murphy's sign on physical examination. On CT scan performed at an outside institution, mild wall thickening of the gallbladder was identified with luminal contraction and suspicion of gallbladder stones. Demonstrable dilatation of the common bile duct was present with normal appearance of the intrahepatic bile duct and pancreatic duct. The laboratory findings showed an increased level of total bilirubin (1.2 mg dl ); other laboratory results including serum tumour markers were within normal limits. Abdominal MRI (Figure 2a) and MRCP ( Figure 2b) were performed, showing fusiform dilatation of the common bile duct and cystic duct of about 7 cm in length and 3 cm in diameter; the ducts were joined by a wide opening, but no visible cause of obstruction was identified. There was no evidence of definite AUPBD. After 1 week of clinical observation, the total bilirubin level returned to normal. The patient was conservatively treated for 5 ye...

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance cholangiopancreatography diagnosis of choledochal cyst involving the cystic duct: report of three cases

Yoon¹

2011

BJR

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“…3 The frequency of these malignancies increases with age, but has been reported in patients as young as 12 years old. 4 The lifetime risk of malignancy is 25-40%.…”

Section: Denouement and Discussionmentioning

confidence: 99%

“…Because of this risk of malignancy, the definitive surgical treatment should be resection of the entire choledochal cyst and as much of the biliary system as possible. 3 Although 86% of cases present before 16 years of age, neonatal presentation is uncommon. 5 The most common presentation of these lesions is jaundice, pain and a RUQ mass.…”

Section: Denouement and Discussionmentioning

confidence: 99%

Neonatal type 1 choledochal cyst

Herman

Siegel

2007

J Perinatol

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“…In the preoperative diagnosis of bile duct carcinoma arising in choledochal cyst, one false-positive and one false-negative result were reported in 5 cases of bile duct carcinoma out of 35 choledochal cysts using the CT scan and endoscopic or percutaneous cholangiography; resec tion was performed in 2 patients, 1 of whom subsequently survived although the preoperative diagnosis was no ma lignancy [13], Nagorney et al [11] reported that no carci noma was discovered at the time of the first cyst operation in 3 of 8 patients with bile duct carcinomas in choledochal cysts. Thus, it seems that detection of a complicating malignancy in a choledochal cyst is difficult at a relatively early stage, and that prognosis after surgery is dismal, even if bile duct carcinoma is successfully diagnosed preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Hepatopancreatoduodenectomy for Diffuse Bile Duct Carcinoma Arising in Choledochal Cyst

et al. 1993

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We report a 66-year-old man with diffuse bile duct carcinoma arising in a choledochal cyst, who underwent right portal venous branch embolization to minimize the hepatic deficit that would result from extended right lobectomy. After recovery of liver function parameters, extended right lobectomy with caudate lobectomy and pancreatoduodenectomy together with lymphadenectomy and total resection of the extrahepatic bile duct were performed. Currently, there is no evidence of recurrence 24 months after surgery. To our knowledge, this is the first report of resection of a diffuse bile duct carcinoma arising in a choledochal cyst with hepatopancreatoduodenectomy. Surgical issues related to advanced biliary malignancy are also discussed.

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Biliary malignancies occurring in choledochal cysts.

Cited by 58 publications

References 0 publications

Magnetic resonance cholangiopancreatography diagnosis of choledochal cyst involving the cystic duct: report of three cases

Magnetic resonance cholangiopancreatography diagnosis of choledochal cyst involving the cystic duct: report of three cases

Neonatal type 1 choledochal cyst

Hepatopancreatoduodenectomy for Diffuse Bile Duct Carcinoma Arising in Choledochal Cyst

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