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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

MR imaging has a distinct role to play in two areas of hepatobiliary imaging that continue to challenge the radiologist--evaluation of the gallbladder and evaluation of the jaundiced patient. The distinction between primary gallbladder carcinoma and chronic cholecystitis remains a diagnostic dilemma for all cross-sectional imaging modalities. MR imaging may be useful in detection of local invasion or metastatic disease. Gallstones are commonly seen coincidentally on cross-sectional imaging studies; the imaging characteristics of gallstones must be well-understood for the interpretation of routine abdominal MR examinations. The evaluation of jaundice is a multimodality process, often requiring three or four separate imaging techniques to determine the cause of biliary obstruction. MR may supplant more invasive techniques for anatomic depiction prior to therapeutic intervention.
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PMID:MR imaging of the biliary system. 776 42

Although clear cell carcinomas have been described in numerous anatomic sites, their occurrence in the gallbladder and extrahepatic bile ducts (EHBD) is practically unknown. We report 10 such cases. Seven arose in the gallbladder and three in the EHBD; all patients with gallbladder tumors were females with cholelithiasis whose ages ranged from 56 to 68 years. Patients with EHBD tumors were younger (38 and 40 years of age) and had extrahepatic biliary obstruction and abdominal pain. Two patients with gallbladder carcinomas had elevated serum carcinoembryonic antigen (CEA) levels, and another without hepatic involvement had markedly elevated circulating levels of alpha-fetoprotein (AFP). Histologically, nine tumors were adenocarcinomas and one was a squamous cell carcinoma. Seven adenocarcinomas consisted of cords, sheets, nests, papillae, and trabeculae of clear cells with well-defined cytoplasmic borders. Two were composed predominantly of glands and papillary structures. The cells contained PAS-positive diastase-labile granules and were cytokeratin- and EMA-positive and immunoreactive for erythropoiesis-associated antigen. One gallbladder tumor contained areas of hepatoid differentiation, a feature described in gallbladder neoplasms only once before. These areas were AFP-positive and immunoreactive for CEA. By electron microscopy, they showed hepatoid differentiation with formation of bile canaliculi. In two gallbladder tumors, neoplastic cells contained subnuclear vacuoles reminiscent of early secretory endometrium. Foci of conventional adenocarcinoma or mucinous carcinoma were recognized in all nine tumors. The squamous cell carcinoma showed only foci of squamous differentiation with keratinization. The clear cells of this neoplasm had a trabecular and solid growth pattern. These clear cell neoplasms of the gallbladder and EHBD must be differentiated from metastatic renal cell carcinoma, based upon the presence of areas of conventional adenocarcinoma or foci of squamous differentiation since results of special stains and immunohistochemistry are similar in both neoplasms. One of the patients with EHBD carcinoma is alive and symptom-free 6 years following right hepatic lobectomy. Five patients with gallbladder tumors had direct extension into the liver and died with metastases. Two are living with metastases.
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PMID:Clear cell carcinomas of the gallbladder and extrahepatic bile ducts. 780 41

The authors report the second case to date of metastatic carcinoma of the common bile-duct from renal cell cancer presenting as an intraluminal polypoid mass. Obstructive jaundice developed in a 55-year old woman 14 years after nephrectomy for renal cell carcinoma. The diagnosis of polypoid tumor of the common bile-duct was established by sonography, endoscopic retrograde cholangiopancreatography and CT-scan. Palliative resection was performed. Postoperative histological examination revealed the resected tumor to be identical to the clear cell type of renal cell carcinoma. The postoperative course was marked by the development of distant metastases 6 months later. Diagnosis and therapeutic features of metastatic malignant biliary obstruction are discussed.
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PMID:[Intraluminal polyp of the common bile duct corresponding to a metastasis of cancer of the kidney]. 819 15

The history, clinical signs and radiographic and ultrasonographic findings in 16 dogs with pancreatic neoplasia were reviewed retrospectively. Thirteen of the dogs had islet cell carcinoma compatible with insulinoma, one had a pancreatic adenocarcinoma and two had secondary invasion of the pancreas, one by a gastric carcinoma and one by an intestinal lymphoma. The clinical signs in the 13 dogs with insulinoma included collapse in 10 dogs, ataxia in seven, weakness in five, and seizures in two. Two of the 16 dogs had jaundice due to biliary obstruction by the primary tumour or metastases. The sensitivities for pancreatic neoplasia were three of 16 (19 per cent) for radiography and 12 of 16 (75 per cent) for ultrasonography; the sensitivities for metastasis were two of 11 (18 per cent) for radiography and six of 11 (55 per cent) for ultrasonography. Biliary obstruction was detected by ultrasonography in both affected dogs.
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PMID:Ultrasonography of pancreatic neoplasia in the dog: a retrospective review of 16 cases. 853 34

Nineteen consecutive patients with malignant hilar obstruction were imaged with angiography, CT portography, and ultrasonography with color and spectral Doppler technique; all had surgical pathologic correlation. At surgery, 12 of 19 patients (63%) were found to have portal vein involvement; 15 of 19 (79%) had parenchymal invasion; and 11 of 19 (58%) had lobar atrophy. Level of biliary obstruction was determined in seven of 19 patients (37%) without drainage catheters. No difference was found between ultrasonography and angiography with CT portography for diagnosis of atrophy, level of bile duct obstruction, hepatic involvement, or venous invasion. Extrahepatic metastases in nine of 19 patients (47%) were poorly predicted by both CT portography and ultrasonography.
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PMID:Malignant hepatic hilar tumors: can ultrasonography be used as an alternative to angiography with CT arterial portography for determination of resectability? 866 82

Patient with pancreatic have a median age of 78 years and without treatment an average survival of only a few months. Tumor stage and patient will determine the therapy. Patients with metastases or a high surgical risk are treated symptomatically. Jaundice, nausea, pain, and anorexia are the most relevant symptoms. The main symptom requiring treatment are jaundice and pruritus due to extrahepatic biliary obstruction which can be relieved in most cases by endoscopic placement of a biliary endoprosthesis. Pancreatic cancer may be a highly painful disease. Therapeutic modalities include, in addition to antitumoral treatment, narcotic and nonnarcotic analgesics, neurolytic celiac blockage, psychological support, and the treatment of associated symptoms such as emesis and constipation. Although radio- or chemotherapy show positive responses in a subgroup of patients, average survival remains unchanged with monotherapy. In contrast, improved median survival following combined radio-and chemotherapy has been demonstrated both in patients with locally unresectable pancreatic cancer and in patients after curative tumor resection.
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PMID:[Pancreatic carcinoma: conservative and adjuvant therapy]. 868 57

Bronchobiliary fistula is an uncommon but remarkable complication after hepatic resection. The case reported illustrates the clinical presentation and preferred initial management of these fistulae. A 61-year-old white male underwent two wedge resections for colorectal metastases to the liver with removal of a portion of the right diaphragm. Four years later, he developed obstructive jaundice secondary to tumor recurrence in the porta hepatis, which required endoscopic stent placement, radiation, and chemotherapy. Almost 2 years later, he developed frank biliptysis. Percutaneous transhepatic cholangiography (PTC) revealed occlusion of the common hepatic duct stent and a bronchobiliary fistula. With adequate reestablishment of common duct drainage, the patient rapidly improved and was discharged free of symptoms. Bronchobiliary fistulae are rare complications of hepatic resection that can present from days to years after operation. Endoscopic retrograde cholangiopancreatography and PTC are the diagnostic studies of choice and offer the possibility of therapeutic intervention. Although large series in the literature emphasize the surgical management of bronchobiliary fistulae, the reoperative procedures tend to be complicated, with a significant morbidity and mortality. Nonsurgical interventions via endoscopic retrograde cholangiopancreatography or PTC are more recently notably successful when resolution of a distal biliary obstruction is accomplished. Only after aggressive attempts at nonoperative, interventional techniques have failed should operative approaches be entertained.
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PMID:Management of bronchobiliary fistula as a late complication of hepatic resection. 973 17

The preferred method of biliary bypass and the need for prophylactic gastroenterostomy in unresectable pancreatic carcinoma are dependent on the length of survival of the patient. From 1980 through 1996, 60 patients with biopsy-proven pancreatic cancer were found to be unresectable at exploration. The reasons for unresectability included major vascular involvement in 21 patients (35%), liver metastases in 16 (26.7%), celiac or portal lymph node metastases in 13 (21.7%), carcinomatosis in 5 (8.3%), and advanced age and/or comorbid medical condition in 4 patients (6.7%). One patient refused pancreaticoduodenectomy. Nine patients (15%) underwent Roux-en-Y choledochojejunostomy, and 51 (85%) underwent choledochoduodenostomy. Prophylactic gastroenterostomy was not performed routinely; however, in 9 patients (15%), gastrojejunostomy was performed for impending duodenal obstruction. Late biliary obstruction did not occur. Late gastric obstruction occurred in 6 of 51 patients (11.7%), at a median of 13.5 months after initial operation (range, 5-26 months). However, late gastric obstruction primarily occurred in 5 of 31 patients (16%) with locally advanced disease (major vessel involvement or lymph node metastases). The median survival was 12.0 months (range, 3.5-62 months) for patients with major vessel involvement, 11.5 months (range, 3-42 months) for patients with lymph node metastases, 4.5 months (range 0.5-24 months) for patients with liver metastases, 5.0 months (range, 4-7 months) for patients with carcinomatosis, and 9.0 months (range 2-27 months) for patients with significant comorbid medical illness and/or advanced age. Patients with liver metastases and carcinomatosis do not survive long enough to develop late obstruction. On the other hand, patients with locally advanced pancreatic carcinoma have a longer median survival and could be considered for prophylactic gastroenterostomy to avoid late gastric obstruction. Choledochoduodenostomy offers effective palliation for biliary obstruction.
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PMID:Unresectable pancreatic carcinoma: correlating length of survival with choice of palliative bypass. 1051 42

Thirty-two consecutive patients with adenocarcinoma of the ampulla of Vater who had curative resection by pancreaticoduodenectomy were analyzed to determine the accuracy of preoperative investigations and factors that influenced survival. Obstructive jaundice was present in 31 patients, and most patients had pain and weight loss. Ultrasound was more useful than CT in identifying biliary obstruction, whereas CT was more accurate in demonstrating pancreatic duct dilatation and an ampullary mass. Endoscopic retrograde cholangiopancreatography with biopsy and brush cytology was the most accurate investigation and proved or was suspicious of carcinoma in all patients. Nineteen patients had postoperative complications, three of whom died (9.4%)-two of sepsis and one from aspiration following hematemesis. Actuarial 5-year survival was 46 per cent. Stage of disease was the strongest predictor of survival. All patients with T1 lesions are alive more than 5 years after resection. Patients with lymph node metastases had a significantly shorter survival than node-negative patients (P = 0.00087). Pancreaticoduodenectomy is advocated for ampullary carcinoma in good-risk patients, with the anticipation of prolonged survival in those with early (T1) lesions and node-negative disease.
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PMID:Pancreaticoduodenectomy of ampullary carcinoma. 1055 54

Ultrasound (US) remains an excellent first line investigation of the gallbladder and for indicating diagnoses and defining levels of extrahepatic biliary obstruction and screening for liver metastases. It is extremely useful in assisting interventional procedures and assessing the status of hepatic vessels. As a nonoperative procedure, endoscopic ultrasound (EUS) can accurately locate and locally stage pathology of the pancreas and periampullary region and even provide reliable biopsy evidence in experienced hands. A limitation, of course, is its field-of-view restriction, which prevents identification of distant metastatic disease. This restriction is not present with laparoscopic ultrasound (LUS), which apart from being an operative procedure, has all the other advantages of EUS and in addition can identify nodal, hepatic, and extrahepatic metastatic spread. Greater use of intraoperative biopsy should assist in identifying nodal disease but requires the readily available services of a pathologist. Local disease may be even more definable using the newer technology of intraductal ultrasound (IDUS). Intraoperative ultrasound (IOUS), whether direct or via the laparoscope, is now an indispensable tool for all surgeons who want to perform hepatobiliary-pancreatic surgery at the highest level.
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PMID:Ultrasound of the hepatobiliary-pancreatic system. 1063 43


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