Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

US and direct cholangiography have considerably simplified the diagnostic workup of mechanical icterus. These procedures allow diagnosis of choledocholithiasis in most cases. We analyze the possible additional role of CT in the diagnostic workup of malignant jaundice in a retrospective study. Between January 1986 and December 1989. ERCP was performed in 37 patients with malignant jaundice. 21 of the lesions were located in the pancreas, 7 in the papilla and 6 in the bile duct; in 2 cases the choledochus was compressed by metastases and in one chronic pancreatitis was present. In 34 of 37 patients (92%), ERCP alone permitted a definite diagnosis. 22 patients underwent CT as the primary diagnostic procedure. In only 9 of these (41%) was an unequivocal diagnosis possible, as opposed to ERCP (19 of 22 or 86%). No complications of ERCP were observed. We therefore conclude that the diagnosis of malignant jaundice can be based on history, physical examination, laboratory results, US and ERCP alone. In the vast majority of cases CT is unnecessary.
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PMID:[The value of computerized tomography and endoscopic retrograde cholangiopancreatography in the assessment of malignant jaundice]. 186 11

An eighty-six-year old woman was submitted to simple cholecystectomy and choledocholithotomy for acute obstructive cholangitis due to cholecysto-choledocholithiasis. At the operation, neither lymphogenic nor hematogenic metastasis was observed. Grossly, a protuberant lesion with an uneven surface and obscure borders was seen spread over the fundus and the body of the resected gallbladder. Histologically, it was a well-differentiated adenocarcinoma with slight invasion to the muscular layer. The patient died of recurrent carcinoma three years and eight months after the operation. At autopsy, multiple metastatic tumors were found in both lobes of the liver, and many lymph node metastases around the hilus of the liver, hepatoduodenal ligament and pancreas were also observed. It is strongly believed that gallbladder carcinomas that infiltrate the muscular layer should be classified as early-stage carcinomas with a fair prognosis, together with mucosal carcinomas. However, on the basis of the present case of relapse following simple cholecystectomy as described above, radical cholecystectomy including a wedge resection of the liver and dissection of the regional lymph nodes would seem necessary even for gallbladder carcinoma with infiltration into the muscular layer.
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PMID:A case of gallbladder carcinoma with infiltration into the muscular layer that resulted in relapse and death from metastasis to the liver and lymph nodes. 231 46

Biliary-enteric anastomoses to duodenum or jejunum are a laparoscopic reality and will find a place in the management of complicated choledocholithiasis or malignant strictures of the bile duct. Staging by laparoscopy in pancreatic malignancy is an ideal strategy, with some operators able to complete a definitive laparoscopic palliative bypass in the same sitting. Intraoperative laparoscopic sonography is an advancing technique and has great potential in the evaluation of choledocholithiasis, hepatic metastases and staging of pancreatic cancer. Innovative options exist to deal with bile duct calculi, including antegrade sphincterotomy and intraoperative stent placement.
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PMID:Current laparoscopic approaches to pancreatico-biliary disease. 928 69

A 64-year-old man underwent gastrectomy and partial liver resection for gastric cancer and liver metastasis, and was administered intra-arterial infusion chemotherapy for metastases of the remnant liver. This treatment was very effective against the liver metastases, but 13 months after the operation obstructive jaundice occurred. An examination revealed obstruction of the bile duct and choledocholithiasis. The choledocholithiasis was treated using a percutaneous transhepatic cholangio-scope, and choledocho-duodenostomy was performed for the obstruction of the bile duct. Findings from the operation suggested that the obstruction was caused by the intra-arterial infusion chemotherapy. At present, 2 years after the first operation, the patient is alive without the regrowth of the liver metastasis.
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PMID:[A case of gastric cancer with liver metastasis in which obstruction of the bile duct and choledocholithiasis was caused by intra-hepatic arterial infusion chemotherapy]. 1272 86

Intra-hepatic cholangiocarcinoma (IHCC) is a rare tumor which arises from the epithelial cells of the intra-hepatic bile ducts; it may develop in a healthy liver and bile ducts or in bile ducts with malignant predisposition (Caroli's syndrome, primary sclerosing cholangitis). It has the worst prognosis of any tumor arising in the liver. Unlike hepatocellular carcinoma, no predisposing factors or high-risk populations have been demonstrated for cholangiocarcinoma other than intraphepatic choledocholithiasis such as is seen in east Asian populations. The most common clinical sign is a palpable tumor mass emphasizing that the tumor is usually detected at an advanced stage. CT scanning yields much clinical information but ultrasound-guided needle biopsy is necessary for diagnosis. Aggressive surgical resection is the only treatment modality which has afforded even slight prolongation of survival; hepatic resection must be large with uninvolved resection margins. When an IHCC is deemed resectable (localized tumor without hepatic metastases or intrahepatic or extrahepatic lymph node spread), pre-operative tumor embolization may be useful; when jaundice is present, percutaneous drainage of the dilated biliary system of the liver to be spared may also be necessary. Neither adjuvant nor neo-adjuvant chemotherapy or radiotherapy have shown proof of efficacity. Cholangiocarcinoma complicates sclerosing cholangitis in 10-15% of cases and is very difficult to diagnose. IHCC may also develop in Caroli's syndrome, where it is commonly found incidentally on pathologic examination of a resection specimen after surgery for a complication of the disease.
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PMID:[Intra-hepatic cholangiocarcinoma]. 1549 65

Spontaneous regression of hepatocellular carcinoma is rare phenomenon. A 74-year-old man was found to have a hepatocellular carcinoma with intrahepatic metastases in the lateral segment of the liver. Before surgery, he developed severe cholangitis due to choledocholithiasis and was treated endoscopically. The tumor marker level decreased markedly, and hepatectomy was performed. The resected tumor demonstrated complete necrosis.
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PMID:Spontaneous regression of hepatocellular carcinoma with complete necrosis: case report. 1625 50

The ovary is a relatively frequent site of metastases from malignant neoplasia arising elsewhere in the body, the majority of these originating from the gastrointestinal tract. The best-known tumor of this type is signet ring cell adenocarcinoma (Krukenberg tumor) of gastric origin and large bowel. The gall bladder and bile ducts are extremely rare sources of these metastases. The casuistic describes a female patient, presented with pelvic mass and jaundice. While clinical and imaging results suggested a primary ovarian carcinoma with incidental cholelithiasis and choledocholithiasis, the final diagnosis was obtained on the basis of histopathologic findings of resected specimen.
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PMID:A case of ovarian metastasis of gall bladder carcinoma simulating primary ovarian neoplasm: diagnostic pitfalls and review of literature. 1651 13

Endoscopic ultrasonography (EUS) is an accurate technique for the diagnosis and staging of benign and malignant lesions in the gastrointestinal tract and the mediastinum. EUS overcomes the limitations of other imaging diagnostic methods and gives the possibility to obtain tissue for histologic diagnosis (EUS guided FNA). The most useful indications of EUS are differentiation of submucosal tumors, staging for neoplasia, examination of the pancreato-biliary system and therapeutics. EUS can distinguish extrinsic compressions from intramural lesions and defines their nature (solid, cystic or vascular) and origin. EUS is useful for local staging of esophageal, gastric, duodenal, and rectal cancer using the TNM (tumor, node, metastases) system, as well as for diagnosing and staging of pancreatic lesions. The addition of EUS-guided FNA has improved the ability to detect malignant lymph node invasion. EUS is also highly sensitive for the diagnosis of choledocholithiasis, avoiding unnecessary danger of diagnostic ERCP. New therapeutic indications of EUS include drainage of pancreatic pseudocysts and abscesses and celiac plexus block and neurolysis. EUS has become an indispensable diagnostic method in gastroenterological everyday practice and should be part of most endoscopy units.
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PMID:Endoscopic ultrasound in clinical practice. 1869 9

Carotid body paragangliomas are neuroendocrine cell tumors. Most invade locally to surrounding tissues with metastases being less commonly encountered than with other tumors: a minority of tumors metastasizes to distal sites. Spread is more unusual after surgical removal of the primary tumor. Hepatic spread is very rare but has been documented. We report a case of a clinically silent metastatic paraganglioma identified during an evaluation for choledocholithiasis. We describe a 70-year-old female presenting with symptoms of abdominal pain who was found to have cholelithiasis and choledocholithiasis. MRI imaging performed during evaluation revealed enhancing liver and lung lesions suspicious for metastasis. FNA of a hepatic lesion showed paraganglioma. She had a remote history of bilateral carotid body tumors, of which the left tumor was resected in 2005. This is a rare case of metastatic carotid body paraganglioma. Primary tumor source was a resected tumor or a smaller sized nodule that was managed with serial imaging. The subject's lack of symptoms and her disease extent with confirmed hepatic and presumed pulmonary spread is unique.
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PMID:Metastatic carotid body paraganglioma detected during evaluation for biliary stone disease. 2461 Jul 53

Bile duct strictures in adults are secondary to a wide spectrum of benign and malignant pathologic conditions. Benign causes of bile duct strictures include iatrogenic causes, acute or chronic pancreatitis, choledocholithiasis, primary sclerosing cholangitis, IgG4-related sclerosing cholangitis, liver transplantation, recurrent pyogenic cholangitis, Mirizzi syndrome, acquired immunodeficiency syndrome cholangiopathy, and sphincter of Oddi dysfunction. Malignant causes include cholangiocarcinoma, pancreatic adenocarcinoma, and periampullary carcinomas. Rare causes include biliary inflammatory pseudotumor, gallbladder carcinoma, hepatocellular carcinoma, metastases to bile ducts, and extrinsic bile duct compression secondary to periportal or peripancreatic lymphadenopathy. Contrast material-enhanced magnetic resonance (MR) imaging with MR cholangiopancreatography is extremely helpful in the noninvasive evaluation of patients with obstructive jaundice, an obstructive pattern of liver function, or incidentally detected biliary duct dilatation. Some of these conditions may show characteristic findings at MR imaging-MR cholangiopancreatography that help in making a definitive diagnosis. Although endoscopic retrograde cholangiopancreatography with tissue biopsy or surgery is needed for the definitive diagnosis of many of these strictures, certain MR imaging characteristics of the narrowed segment (eg, thickened wall, long-segment involvement, asymmetry, indistinct outer margin, luminal irregularity, hyperenhancement relative to the liver parenchyma) may favor a malignant cause. Awareness of the various causes of bile duct strictures in adults and familiarity with their appearances at MR imaging-MR cholangiopancreatography are important for accurate diagnosis and optimal patient management.
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PMID:Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. 2481 82


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