Plasma Lipidomics as a Tool for Diagnosis of Extrahepatic Cholangiocarcinoma in Biliary Strictures: a Pilot Study

Prachayakul, Varayu,Thearavathanasingha, Phataraphong,Thuwajit, Chanitra,Roytrakul, Sittiruk,Jaresitthikunchai, Janthima,Thuwajit, Peti Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.8

Biliary obstruction is a common clinical manifestation of various conditions, including extrahepatic cholangiocarcinoma. However, a screening test for diagnosis of extrahepatic cholangiocarcinoma in patients with biliary obstruction is not yet available. According to the rationale that the biliary system plays a major role in lipid metabolism, biliary obstruction may interfere with lipid profiles in the body. Therefore, plasma lipidomics may help indicate the presence or status of disease in biliary obstruction suspected extrahepatic cholangiocarcinoma. This study aimed to use plasma lipidomics for diagnosis of extrahepatic cholangiocarcinoma in patients with biliary obstruction. Plasma from healthy volunteers, patients with benign biliary obstruction extrahepatic cholangiocarcinoma, and other related cancers were used in this study. Plasma lipids were extracted and lipidomic analysis was performed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Lipid profiles from extrahepatic cholangiocarcinoma patients showed significant differences from both normal and benign biliary obstruction conditions, with no distinction between the latter two. Relative intensity of the selected lipid mass was able to successfully differentiate all extrahepatic cholangiocarcinoma samples from patient samples taken from healthy volunteers, patients with benign biliary obstruction, and patients with other related cancers. In conclusion, lipidomics is a non-invasive method with high sensitivity and specificity for identification of extrahepatic cholangiocarcinoma in patients with biliary obstruction.

간외담관 초음파검사의 주사방법 개선과 교육 후 주사 습득효과에 관한 연구

이인자(In-Ja Lee),강대현(Dae-Hyun Kang),김보영(Bo-Young Kim) 대한방사선과학회(구 대한방사선기술학회) 2008 방사선기술과학 Vol.31 No.2

목 적: 지금까지의 경복부 초음파를 이용한 간외담관에 대한 검사는 주로 담낭과 간외 담도, 즉 총수담관(CBD)만을 확인하는 수준의 검사가 전부인 것처럼 여겨져 왔다. 그러나 저자들은 임상에서의 다양한 경험을 바탕으로 간외담도의 비정상 확장에 대해 분석할 수 있고, 담도질환 유무 및 관련성을 평가하는데 필요한 기술적 접근 방법에 대한 새로운 이론적 토대를 마련하였다. 이 새로운 이론을 기본으로 신뢰성 있는 검사 성적을 얻기 위하여 일정기간 교육 후 scanning 훈련을 시켜 그 효과를 평가함으로서 담관질환 검사의 새로운 기준을 정립코자 한다. 대상 및 방법: 초음파 교육생 30명을 대상으로 간외담관에 대한 새로운 이론에 근거하여 기술적 접근 방법에 대한 교육을 전수한 후 학생 1인당 3시간(30분×6회)을 배당하여 scanning 훈련을 집중하였다. 교육 방법은 강사와 학생 1:1 방식으로 하였다. Scanning 훈련 후 평가 기준으로 모든 학생에게 5분 내에 간외담관 중에서 좌우 담관으로부터 ① 담낭관 합류부(간외담관 및 담낭관), ② 췌장 상부담관, ③ 췌두부내 담관, ④ 유두부내 공통관 등 네 분절을 명확하게 구분된 개념으로 scan하게 한 후 정확도를 평가하였다. 결 과: 기존의 교육과 훈련 방식은 간외담관에 대한 경복부 초음파검사의 신뢰도가 매우 낮고, 췌장 상부 담관에만 국한적으로 영상화할 수 있었다. 그러나 새로운 이론에 근거한 교육과 훈련을 마친 후 성적의 평가는 모든 학생(30명)이 ① 담낭관 합류부(간외담관 및 담낭관), ② 췌장 상부담관까지 객관성 있게 접근하였다. 24명의 학생이 ③ 췌두부내 담관 말단까지 접근하였으며, 1명의 학생만이 ④ 유두부내 공통관까지 영상화할 수 있었다. 결 론: 간내외 담관의 평가는 간내인성, 담관성 그리고 병태생리학적 다면 평가가 이뤄져야 하지만, 경복부 초음파검사에 의해 간외담관을 유두부내 공통관까지 객관적이고 신뢰성 있게 영상화시킬 수 있다면 단순 감별진단 목적으로 시행하는 ERCP같은 환자에게 고통이 수반된 침습적인 검사를 대폭 줄일 수 있을 것이다. 따라서 저자들이 제시한 새로운 검사방법으로 간외 담관에 대한 기술적 접근 방법을 scanning 훈련하여 임상에 적용하게 된다면 초음파의 객관적인 신뢰도를 높일 수 있을 것으로 생각된다. The purposes of this study are to analyze abnormal dilatation of the extrahepatic bile ducts by using transabdominal ultrasound, to confirm the existence of bile ducts diseases and their interrelationship, and for it to give a new theoretical basis for the technical access to extrahepatic bile ducts, upon which to analyze the ripple effects of the scan training. After teaching technical access process based on the new theory about extrahepatic bile duct to the thirty students who are studying ultrasonography, we allocated three hours per one student (30mins×6times) to focus on the training of scanning skill. Training has been performed by one-to-one method. For evaluation, all the students have to perform the scans on ① confluence of the right and left hepatic ducts(extrahepatic bile ducts and cystic duct), ② the suprapancreatic bile duct, ③ the intrapancreatic bile duct, ④ intrapapilla Duct, based on the clearly divided concept. The existing training and methods have had low confidency about transabdominal ultrasonography of the extrahepatic bile duct and had limitation with which they could image only the suprapancreatic bile duct. The evaluation after finishing the train based on the new theory, however, all the students(30students) can access to ① confluence of the right and left hepatic ducts(extrahepatic bile ducts and cystic duct), ② the suprapancreatic bile duct objectively. 24 students can access to ③ the intrapancreatic bile duct and only one student can even make an image for ④ the intrapapilla Duct Though the evaluation on extrahepatic bile duct has to be performed with multi-sided method considering intrahepatic cause, bile duct cause and pathophysiological cause, only if we can image the extrahepatic bile duct to ampular of Vater objectively and confidently, we can greatly reduce invasive procedure such as ERCP, which is for the purpose of simple differential diagnosis and painful to the patients. Therefore if we concentrate on the scanning train based on the new theory to raise the confidency about ultrasonography, the effect will be doubled.

Extrahepatic Bile Duct Duplication with Intraductal Papillary Neoplasm: A Case Report

전가영,최주완 대한영상의학회 2021 대한영상의학회지 Vol.82 No.4

Extrahepatic duct duplication is an extremely rare congenital anomaly. Hilar cholangiocarcinoma with extrahepatic bile duct duplication was reported; however, intraductal papillary neoplasm of the bile duct (IPNB) with extrahepatic bile duct duplication has not been reported to the best of our knowledge. We report a rare case of IPNB with extrahepatic bile duct duplication of a 64-year-old female. The patient underwent extended right hepatectomy, and the results of a subsequence histopathological examination were consistent with an IPNB with extrahepatic bile duct duplication. We report this rare case with radiologic imaging findings and a brief review of the current literature.

간세포암 근치적 절제 후 발생한 간외 재발암의 위험인자 분석

이형순(Hyung Soon Lee),최기홍(Gi Hong Choi),황호경(Ho Kyung Hwang),강창무(Chang Moo Kang),최진섭(Jin Sub Choi),이우정(Woo Jung Lee) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.4

Purpose: A few studies have been reported on extrahepatic metastasis after curative resection for hepatocellular carcinoma (HCC). We investigated the patterns of extrahepatic recurrence and we identified the risk factors for extrahepatic recurrence after curative resection for HCC. Methods: We retrospectively reviewed 587 patients who underwent surgical resection with a curative aim from January 1998 to December 2007 in the Yonsei University Health Care System. Among the 571 patients, 291 (51.0%) patients developed recurrence. Sixty five patients initially presented with extrahaptic recurrence. The patients with extrahepatic recurrence were divided into Group A (peritoneal recurrence) and Group B (non-peritoneal extrahepatic recurrence). Results: Group A had higher rates of intraoperative bleeding>1,500 ml and perioperative transfusion too. On the multivariate analysis, perioperative transfusion, satellite nodule and the tumor size were the independent risk factors for Group A. The Edmondson-Steiner grade, satellite nodule and the tumor size were the independent risk factors for Group B. The 1, 3 and 5-year overall survival rates after curative resection for the patients with extrahepatic recurence were 83.1%, 48.9% and 27.4%, respectively. The recurrence patterns and treatment modalities did not affect the overall survival after treatment for extrahepatic recurrence. Conclusion: A perioperative transfusion was found to be a different risk factor for peritoneal recurrence, as compared to those risk factors for non-peritoneal extrahepatic recurrence. Therefore, efforts by physicians to decrease intraoperative bleeding may prevent peritoneal recurrence after performing curative resection for HCC.

Ablation therapy for patients with colorectal liver metastases with and without extrahepatic metastases: evaluation of long-term outcomes and prognostic factors

Jeanett Klubien,Jacob Rosenberg,Bjørn Ole Skjoldbye,Torben Lorentzen,Christian Pállson Nolsøe,Hans-Christian Lykkegaard Pommergaard 대한초음파의학회 2023 ULTRASONOGRAPHY Vol.42 No.3

Purpose: Ablation is a valuable treatment alternative to surgery for colorectal liver metastases. This study reports the long-term clinical outcomes in patients treated with ablation for colorectal liver metastases with or without extrahepatic metastases. Methods: Patients with colorectal liver metastases treated with ultrasound-guided ablation at Herlev Hospital, Denmark were included in this retrospective study. Results: This study included 284 patients with 582 metastases. Complete ablation was obtained in 258 patients (91%) evaluated within 6 weeks. During follow-up, 94 patients (33%) developed local recurrence. The median survival for all patients was 31 months, with 1-, 3-, and 5-year survival rates of 82%, 45%, and 21%, respectively. The median survival for patients with extrahepatic metastases (n=49, 17%) was 24 months compared with 33 months for patients without (P=0.142). Propensity score-adjusted Cox regression showed that extrahepatic metastases were associated with increased mortality, with a hazard ratio (HR) of 1.45 (95% confidence interval [CI], 1.02 to 2.05; P=0.039). In multivariate Cox regression analysis for all patients, increased mortality risk was found for a diameter ≥2.6 cm (HR, 1.59; 95% CI, 1.23 to 2.05), >1 metastasis (HR, 1.66; 95% CI, 1.28 to 2.16), and extrahepatic metastases (HR, 1.45; 95% CI, 1.04 to 2.03). Male sex (HR, 0.75; 95% CI, 0.58 to 0.98) and receiving chemotherapy (HR, 0.69; 95% CI, 0.52 to 0.92) were associated with decreased mortality. Conclusion: Ablation for colorectal liver metastases offers acceptable survival rates, including for patients with extrahepatic metastases. In addition, chemotherapy was associated with improved survival for both patients with and without extrahepatic metastases.

Survival Rate of Extrahepatic Cholangiocarcinoma Patients after Surgical Treatment in Thailand

Pattanathien, Pisit,Khuntikeo, Narong,Promthet, Supannee,Kamsa-ard, Supot Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.1

Background: Intra- and extrahepatic cholangiocarcinoma (CCA) is the most common cancer in Thailand, especially in the northeast region. Most extrahepatic CCA patients consult a doctor at a late stage. Surgery is still the best treatment. Objectives: The aim of this study was to evaluate survival rates and factors affecting survival in extrahepatic CCA patients following surgery at Srinagarind Hospital, Khon Kaen University, Thailand. Materials and Methods: A retrospective cohort study was conducted with 58 patients who were diagnosed and treated by surgical resection by the same surgeon at Srinagarind Hospital between 2005 and 2009. The patients were followed up until death or the end of the study (31 December, 2011). Survival rates were calculated by the Kaplan-Meier method, and the Cox proportional hazard model was used to identify independent prognostic factors. Results: The total follow-up time was 1,215 person-months, and the mortality rate was 50 per 100 person-years. The cumulative 1-, 3-, and 5-year survival rates were 62.1%, 21.7% and 10.8%, respectively. The median survival time after resection was 15 months. After adjusting for age, gender, lymph node metastasis and histological type, resection margin remained as a statistically significant prognostic factor for survival following surgery. A positive resection margin was associated with a 2.3-fold higher mortality rate than a negative margin. Conclusions: Resection margins are important prognostic factors affecting survival of extrahepatic CCA patients after surgery. A negative resection margin can reduce the mortality rate by 56%.

Practice guidelines for managing extrahepatic biliary tract cancers

Hyung Sun Kim,Mee Joo Kang,Jingu Kang,Kyubo Kim,Bohyun Kim,Seong-Hun Kim,Soo Jin Kim,Yong-Il Kim,Joo Young Kim,Jin Sil Kim,Haeryoung Kim,Hyo Jung Kim,Ji Hae Nahm,Won Suk Park,Eunkyu Park,Joo Kyung Par The Korean Association of Hepato-Biliary-Pancreati 2024 Annals of hepato-biliary-pancreatic surgery Vol.28 No.2

Backgrounds/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions: The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

간 외 담관의 선편평상피암 1예

박치영(Chi Young Park),임성철(Sung Chul Lim) 조선대학교 의학연구원 2020 The Medical Journal of Chosun University Vol.45 No.1

Adenosquamous cell carcinoma of the extrahepatic bile duct is very rare and has been reported to account for approximately 2% of extrahepatic bile duct carcinomas. Adenosquamous cell carcinoma is more clinically aggressive than adenocarcinoma. Therefore, we present a case of solitary pancreatic metastasis of adenosquamous cell carcinoma of the extrahepatic bile duct. A 69-year old female patient underwent surgery and adjuvant chemoradiotherapy for adenosquamous cell carcinoma of the extrahepatic bile duct. Four years late, she admitted with abdominal pain and pancreatic mass in the abdominal computed tomography. Fine needle aspiration biopsy was consistent with metastatic adenosquamous cell carcinoma of the extrahepatic bile duct.

조기간외담관암의 정의에 관한 검토

한기준(Key Joon Han),강진경(Jin Kyung Kang),송시영(Si Young Song),정재복(Jae Bock Chung),박인서(In Suh Park),이우정(Woo Jung Lee),김병로(Byong Ro Kim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6

N/A Background/Aims: The early gastric cancer has been defined as that in which the depth of invasion is limited to the submucosa regardless of the lymph node(LN) metastasis. However, in the carcinoma of extrahepatic bile duct, the definition of early cancer may be different, because of the differences of histologic features such as lacking of muscularis mucosa and submucosal layer. Recently, Mizumoto et al. Proposed the definition of extrahepatic bile duct cancer, in which invasion limited to mucosa and fibromuscular layer, however there have been no data in Korea. The purpose of this study is to clarify the concept of early carcinoma of extrahepatic bile duct in Korea. Methods: We evaluated the 60 cases underwent radical operation due to extrahepatic bile duct carcinoma at Severance Hospital, Yonsei University from January l980 to December 1993. Results: The invasion limited to the mucosa(Tla) was noted in 2 cases(3.3%), fibromuscular layer(Tlb) in 11 cases(18.4%), adventitia of fibromuscular layer and serosa(T2) in 22 cases(36.77c) and invasion of adjacent organ(T3) in 25 cases(41.6%). The LN metastasis was found in 16 cases(26.7%). No LN metastasis was noted in Tl, however in T2 the LN metastasis was found in 27.3%(all Nl) and 40.0%(N1: 4 cases, N2: 6 cases) in T3. All cases of Tl but one who recurred at 16 months after surgery survived without recurrence. Disease-free survival according to the T stages were: in Tl, 100%, 90.9%, 90.9% at l, 3, and 5 year, respectively; in T2, 80%, 56% and 37%, respectively; in T3, 83%, 58%, 58%, respectively. The survival rate of Tl was significantly higher than that of T2 and T3(p=0.03). The mean survival in patients of T2 without LN metastasis was 50.5 months, which was longer than that of 38.7 months in cases of T2 with LN metastasis. Multivariate analysis revealed that the depth of invasion was the only significant prognostic factor. The polypoid type and papillary adenocarcinoma were frequently encountered in early cancer comparing advanced cancer. Conclusions: Early cancer of the extrahepatic bile duct could be defined as the tumor invaion restricted to the mucosa and fibromuscular layer. (Korean J Gastroenterol 1995;27:690 - 699)

Signet Ring Cell Carcinoma of the Extrahepatic Bile Duct

이은영,김찬,김민주,박정엽,박성우,송시영,Jae-Bock Chung,Hogeun Kim,Seungmin Bang 거트앤리버 소화기연관학회협의회 2010 Gut and Liver Vol.4 No.3

Most tumors affecting the extrahepatic bile duct are adenocarcinomas; the other histologic types occur only rarely. We herein report the extremely rare case of signet ring cell carcinoma (SRCC) originating from the extrahepatic bile duct. A 55-year-old man was hospitalized for jaundice and pruritus. Computed tomography and positron emission tomography suggested the presence of distal extrahepatic bile-duct cancer. He underwent a pylorus preserving pancreaticoduodenectomy. A histologic study confirmed a signet ring cell neoplasm of the distal common bile duct. Because the upper resection margin was invaded by the tumor, he received postoperative concurrent chemoradiotherapy and four cycles of chemotherapy. The patient has survived with no evidence of recurrence for 2 years. This is the second case of primary SRCC of the distal extrahepatic bile duct reported in the literature; further reports of cases are warranted to determine the nature of SRCC in the extrahepatic bile duct.