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)

Cholangiocarcinoma of the main hepatic duct junction is best treated by curative resection, although this is not often possible as most lesions are associated with local infiltration, portal vein invasion or metastases. For unresectable lesions, we advocate the use of a wide bore U tube followed by radiotherapy. Placement of the U tube must be accurate and meticulous. This paper describes a simplified method allowing accurate intraoperative transhepatic U tube placement.
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PMID:Accurate intraoperative transhepatic U tube placement. 171 1

Cholangiocarcinoma is very common in areas endemic for the liver fluke Opisthorchis viverrini. Survival after surgical treatment of cholangiocarcinoma associated with opisthorchiasis was studied prospectively in 30 patients, all of whom resided in an endemic area. The median age was 52 (range 32-69) years and twenty-five patients were men. Seven patients had their tumours removed, four with concomitant liver resection. Twenty-two patients underwent palliative biliary bypass procedures to a segmental duct. Laparotomy with biopsy of metastatic lesions was undertaken in one patient with multiple lymph node metastases and peritoneal seedlings. No patient received postoperative chemotherapy or radiation treatment. Patients were followed for 2 years or until death. The 1-year survival rate after tumour resection was 86 per cent and the 2-year survival rate 43 per cent. After palliative procedures the 1-year survival rate was 26 per cent; no patient reached 2 years and the median survival time was 8 months. Survival after surgical treatment of cholangiocarcinoma in patients with opisthorchiasis is broadly similar to that reported for cholangiocarcinoma without liver fluke infestation.
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PMID:Cholangiocarcinoma in patients with opisthorchiasis. 886 3

Cholangiocarcinoma is the second most common primary tumor of the liver after hepatocellular carcinoma and accounts for 5 to 25% of primary hepatic malignancies. Patients with intrahepatic or peripheral cholangiocarcinoma (ICC) most often present at an advanced stage leading to a poor prognosis. A review of the literature has produced only 10 patients who have survived over five years. We review the case of a young woman with a large cholangiocarcinoma, who has been disease free for eight years. The patient was treated with a right hepatic lobectomy, and received 4 cycles of 5-fluorouracil and levamisole postoperatively. Known factors associated with longer survival in patients with ICC include lack of evidence of local invasion (i.e. capsular, lymphatic, or vascular), negative margins, mucoblia, and well differentiation of the tumor, as well as the absence of lymph node metastases. Our patient had negative margins and lymph nodes, and showed no local invasion. However, no mucobilia was noted, and the tumor was only moderately differentiated. Young age has never been associated with increased survival. ICC remains a relatively uncommon tumor with an insidious onset and late presentation contributing to poor survival. Surgical resection remains the only therapeutic option. Since few patients are potentially resectable at the time of presentation, efforts at early diagnosis and options for adjuvant therapy are imperative.
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PMID:Long-term survival of a young woman with peripheral cholangiocarcinoma: a case report. 991 72

Cholangiocarcinoma is a primary liver tumor arising from the small bile ducts within the liver. According to its different location, clinical features, frequency of metastases, treatment modalities and prognosis, intrahepatic cholangiocarcinoma should well be differentiated from proximal bile duct carcinoma. To date, there is no therapeutic measure with curative potential apart from surgical treatment. Partial hepatectomy is the treatment of choice. It is of overriding importance to achieve microscopically tumor-free margins. However, only few patients treated in an early stage have a prolonged recurrence-free survival or a chance for cure. Liver transplantation is not an alternative therapeutic option for unresectable cholangiocarcinoma, due to early tumor recurrence in almost all recipients. Liver transplantation has a place in preventing cholangiocarcinoma in primary sclerosing cholangitis, although the timing of replacement is still a matter of debate. Results of surgery need further improvement by adjuvant or neoadjuvant treatment protocols.
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PMID:Surgical treatment of cholangiocellular carcinoma. 1041 81

Cholangiocarcinoma is a rare tumor of the bile duct system known to frequently metastasize to the axial skeleton, lungs, adrenal glands, brain, and lymphatic system. Spread to the long bones has not previously been reported in the literature partly because of the short life expectancies of patients with this disease. We discuss a case of a pathologic humerus fracture due to metastatic cholangiocarcinoma.
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PMID:Pathologic fracture of the humerus due to metastatic cholangiocarcinoma. 1062 19

Magnetic resonance cholangiopancreatography (MRCP) is a relatively new, noninvasive cholangiographic technique that is comparable with invasive endoscopic retrograde cholangiopancreatography (ERCP) in the detection and characterization of extrahepatic bile duct abnormalities. The role of MRCP in evaluation of the intrahepatic bile ducts, especially in patients with primary or secondary sclerosing cholangitis, is under investigation. The key cholangiographic features of primary sclerosing cholangitis are randomly distributed annular strictures out of proportion to upstream dilatation. As the fibrosing process worsens, strictures increase and the ducts become obliterated, and the peripheral ducts cannot be visualized to the periphery of the liver at ERCP. In addition, the acute angles formed with the central ducts become more obtuse. With further progression, strictures of the central ducts prevent peripheral ductal opacification at ERCP. Cholangiocarcinoma occurs in 10%-15% of patients with primary sclerosing cholangitis; cholangiographic features that suggest cholangiocarcinoma include irregular high-grade ductal narrowing with shouldered margins, rapid progression of strictures, marked ductal dilatation proximal to strictures, and polypoid lesions. Secondary sclerosing and nonsclerosing processes can mimic primary sclerosing cholangitis at cholangiography. These processes include ascending cholangitis, oriental cholangiohepatitis, acquired immunodeficiency syndrome-related cholangitis, chemotherapy-induced cholangitis, ischemic cholangitis after liver transplantation, eosinophilic cholangitis, and metastases.
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PMID:Radiologic manifestations of sclerosing cholangitis with emphasis on MR cholangiopancreatography. 1090 86

The aim of this study was to evaluate capabilities of pulse inversion harmonic imaging (PIHI) in characterization of unifocal liver lesions. We evaluated with PIHI (HDI5000, ATL, Bothell, Wash.) and spiral CT 46 consecutive patients with a single liver lesion identified by fundamental US [7 hepatocellular carcinomas (HCC), 2 cholangiocarcinomas, 7 focal nodular hyperplasias (FNH), 17 hemangiomas and 13 metastases]. The PIHI was performed before and 30 s, 2 and 4 min after bolus administration of Levovist (2.5 g, 300 mg/ml). Scans were digitally stored and reviewed using a dedicated software. Hepatocellular carcinoma was hyperechoic on 30-s scan, and hypoechoic (n = 5) or isoechoic (n = 2) on 2-min scan. Cholangiocarcinoma had inhomogeneous persistent enhancement. Focal nodular hyperplasia was hyperechoic (n = 5) or isoechoic (n = 2) on 30-s scan, hyperechoic (n = 4), isoechoic (n = 2) or slightly hypoechoic (n = 1) on 2-min scan. Large hemangioma revealed peripheral enhancement on 30-s scan which extended centripetally on 2-min scan. Small hemangioma appeared isoechoic on 2-min scan in all but two cases in which they were hypoechoic on 2-min scans and hyperechoic on 4-min scan. Metastasis was hypoechoic on all scans, 70% with rim enhancement. Similar changes in enhancement pattern have been observed at spiral CT. The 30-s and the 2-min scans revealed a conclusive importance in characterization of HCC, cholangiocarcinoma, and large hemangioma. The 2-min scan often furnished enough information for characterization of small hemangioma and metastasis. The 4-min scan allowed characterization of two hemangiomas which appeared hypoechoic on 2-min scans. In the other cases it did not provide further information. Diagnosis of FNH is usually reached with Colour Doppler US; PIHI should be used when colour Doppler is biased by artefacts or when colour Doppler findings are not characteristic. Our results seem to show that PIHI could be a valuable alternative diagnostic approach to spiral CT for unifocal liver lesion characterization. This hypothesis needs to be confirmed with an increased number of lesions.
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PMID:Characterization of unifocal liver lesions with pulse inversion harmonic imaging after Levovist injection: preliminary results. 1099 22

Cholangiocarcinoma is a rare tumor. Many cases are localized while metastatic disease within the liver and abdomen do occur. There is as yet no standard therapy for advanced bile duct tumors. Radiotherapy and chemotherapy are not curative modalities in this condition but are being assessed adjuvantly following surgery, and as palliative treatment in an attempt to either extend progression-free and overall survival or to palliate symptoms. Advances may be made by: (i) The combined use of radiation and chemotherapy, (ii) High dose conformal radiotherapy, (iii) Novel chemotherapeutic agents. Patients should be given the opportunity to participate in clinical trials.
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PMID:Cholangiocarcinoma and the role of radiation and chemotherapy. 1126 97

Cholangiocarcinoma (CCA) is a lethal disease, afflicting many thousands the world over. Human CCA develops through a multi-step progression model, preceded by the onset of dysplasia in the cholangiolar ductal epithelium. An animal model of multi-step carcinogenesis in the biliary tree will enable the study of genetic changes in human CCA, and provide an avenue for chemoprevention strategies. We describe an oral thioacetamide (TAA)-induced model of rat CCA that recapitulates the histologic progression of human CCA. Male Sprague-Dawley (SD) rats (n = 170), weighing 350 +/- 20 g, were used in this study. Drinking water with TAA 300 mg/l was administered orally, and the liver was harvested and examined histologically at weekly intervals, beginning at 5 weeks after initiation of TAA. Harvested tissues were formalin-fixed and paraffin embedded for morphologic and immunohistochemical studies. Multifocal bile ductular proliferation with intestinal metaplasia (presence of goblet cells) and increasing histologic atypia (biliary dysplasia) was observed by the 9th week of TAA administration. Biliary cytokeratin (CK19)-expressing invasive intestinal-type CCA with stromal desmoplasia was evident at the 16th week, and by the 22nd week, the yield rate for CCAs had increased to 100%. Invasive CCAs preceded the development of hepatic cirrhosis by at least 4 weeks; the earliest incidence of hepatic fibrosis was observed beginning at 20 weeks post-TAA administration. The progression from normal cholangioles to biliary dysplasia to invasive CCA was accompanied by up-regulation of the proto-oncogenes c-met and c-erbB-2, tyrosine kinase receptors over-expressed in human CCAs. The study was terminated at 6 months, at which time no systemic metastases or deaths were observed. Oral administration of TAA in drinking water to male SD rats provides a reproducible animal model for development of CCA with a high yield rate. In particular, the presence of biliary dysplasia beginning at the 9th week, which progresses to invasive CCA, mimics the multi-step model of human CCA. The TAA rat model may serve as a powerful pre-clinical platform for therapeutic and chemoprevention strategies for human CCA.
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PMID:Thioacetamide-induced intestinal-type cholangiocarcinoma in rat: an animal model recapitulating the multi-stage progression of human cholangiocarcinoma. 1465 42

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


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