Surgery.

This chapter provides a comprehensive background from basic to applied knowledge of surgical anatomy which is necessary for the surgical treatment of cholangiocarcinoma (CCA) patients. Significant advances that have been made in the surgical treatment of CCA were examined. For instance, in-depth details are provided for appropriate preoperative assessment and treatment to optimize patient status and to improve the outcome of surgical treatment(s). Comprehensive details are provided for the surgical techniques and outcomes of treatments for each type of CCA with clear illustrations and images. This chapter also describes the role of minimally invasive surgery and liver transplantation in CCA treatment.

Profiling of Bile Microbiome Identifies District Microbial Population between Choledocholithiasis and Cholangiocarcinoma Patients.

OBJECTIVE: Choledocholithiasis (CDL), a potential risk for cholangiocarcinoma (CCA) development, is often a consequence of bacterial infection. Thus, the microbial population that contributes to CDL might also be involved in CCA development. We compared the microbiome in bile fluid of CDL patients and CCA patients. METHODS: Bile samples were collected from CDL (n = 30) and CCA (n =30) patients. Microbial profiling was performed individually by the sequencing of V3-V4 regions of the 16S rRNA gene. RESULTS: Enterobacter, Pseudomonas, and Stenotrophomonas species were much more abundant in bile samples from CCA compared to CDL (p.

Imaging of a glomus tumor of the liver in a child.

Glomus tumors occur preferentially in the subcutaneous tissue of the fingers and toes, but are extremely rare in visceral organs. Although, there have been several reports of glomus tumors in the liver in adult patients, there have yet been no publications reporting glomus tumors of the liver in children. Here, we report a case of an 11-year-old girl who was admitted with a 2-week history of progressive dyspnea on exertion and vomiting. Upon physical examination, she was found to have hypertension and a palpated smooth, firm mass at the epigastrium. Abdominal MRI revealed a well-defined exophytic hypervascular mass with intratumoral hemorrhage at segment 3/4b of the liver. Ultrasound-guided biopsy revealed it to be a glomus tumor. An ultrasound conducted at a 1-month follow-up after preoperative embolization revealed that the mass had decreased in size. A subsequent exploratory laparotomy with left hepatectomy was performed and the histologic results confirmed the diagnosis.

Mediastinal Lymphadenopathy in Patients with Systemic Sclerosis.

BACKGROUND: There are few studies regarding the characteristics of mediastinal lymphadenopathy (MN) in patients with systemic sclerosis (SSc). Understanding its features could help radiologists interpret lung imaging more confidently. OBJECTIVE: To determine the prevalence and characteristics of MLN in patients with SSc and factors associated with MLN. MATERIAL AND METHOD: A retrospective review of medical records and high resolution computed tomography (HRCT) of the lungs of all patients with SSc at Srinagarind Hospital, Khon Kaen University, Thailand between 2009 and 2011 was done. Univariate and multivariate logistic regressions were used to analyze the outcomes. RESULTS: Sixty patients were eligible for the present study; the majority of them was women (71.7%) and had diffuse SSc (71.7%). The prevalence of MLN was 56.7% (36 in 60 cases). The distribution of MLN was mainly found in two or more locations (47.1%) and had isodensity on imaging (61.3%). The median size of nodes was 1.2 cm (inter-quartile range 1, 1.4 cm). Only the pulmonary fibrosis score was significantly associated with MLN with the adjusted odds ratio of 1.2 (95% confidence interval 1.1, 1.4, p = 0.03). There was no association between MLN with other factors. CONCLUSION: MLN was prevalent in patients with SSc. The pulmonary fibrosis score was an independent factor associated with MLN.

Computed tomographic features of adenocarcinoma compared to malignant lymphoma of the stomach.

OBJECTIVE: To compare the CT findings of adenocarcinoma and malignant lymphoma of the stomach. MATERIAL AND METHOD: The authors retrospectively reviewed the computed tomographic images of 21 patients who received a definite pathologic diagnosis of adenocarcinoma or malignant lymphoma of the stomach. The images were taken at Srinagarind Hospital between January 2006 and February 2009. Seventeen patients with gastric adenocarcinoma and four with malignant gastric lymphoma were included in the present study. The pattern of involvement, the location of lesion, the perigastric fat plane, the perigastric lymphadenopathy and the extension of disease on CT images were evaluated and analyzed by Chi-square and Fisher exact tests. RESULTS: There was a statistically significant difference between gastric adenocarcinoma and malignant gastric lymphoma in the pattern of involvement of disease (p = 0.010), the perigastric fat plane (p = 0.002) and the location of disease (p = 0.008). By contrast, there was no respective statistically significant difference in the perigastric lymphadenopathy (p = 0.950) and the extension of disease (p = 0.175) in between gastric adenocarcinoma and malignant gastric lymphoma. CONCLUSION: The CT findings helpful for differentiating gastric adenocarcinoma from malignant gastric lymphoma are the pattern of involvement, the perigastric fat plane, and the location of lesion. Localized involvement of the lesion, abnormal perigastric fat plane and location involving one region of the stomach tend to indicate gastric adenocarcinoma; while diffused involvement of the lesion, preserved perigastric fat plane and location involving more than one region of the stomach tend to indicate malignant gastric lymphoma.

Accuracy of spiral CT in preoperative staging of gastric carcinoma: correlation with surgical and pathological findings.

OBJECTIVE: To assess the accuracy of spiral CT scan in the preoperative staging of gastric carcinoma by comparing it with surgical/pathological staging. MATERIAL AND METHOD: Twenty-eight patients with gastric carcinoma who underwent both preoperative CT scan and surgery were retrospectively studied for TNM classification. All CT scans were reviewed for tumor location, gastric wall thickness, tumor extension, N1 and N2 nodal involvement, and metastases to the liver, peritoneum and lung. RESULTS: Spiral CT staging was correct in 20 of 28 patients (71.4%). The preoperative CT scan had 96.1% sensitivity, 100% specificity and 96.4% accuracy for evaluating serosal invasion. The sensitivity, specificity and accuracy for assessing pathologic lymph node involvement were 73.1, 50.0 and 84.2 percent, respectively. In the present study, peritoneal metastasis could not be identified by CT but CT had 100% sensitivity for evaluating hepatic metastases. CONCLUSION: Spiral CT is a useful modality for preoperative staging of gastric carcinoma with high accuracy for evaluating serosal invasion and hepatic metastases.