Colangiocarcinoma y hepatocolangiocarcinoma combinado en pacientes con cirrosis / Cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma in cirrhotic patients

Background: Cholangiocarcinoma (CCA) is a primary hepatic tumor, frequently found in patients with liver cirrhosis and biliary tract diseases. Its varieties include isolated CCA or "combined hepatocellular-cholangiocarcinoma" (cHCC-CCA). The latter is uncommon, with poorly defined diagnostic criteria and natural history. Aim: To characterize patients with cirrhosis with a pathological diagnosis of CCA and cHCC-CCA. Material and Methods: Forty-nine liver biopsies with a pathological diagnosis of CCA were reviewed. The clinical records of patients were reviewed to fetch demographic variables, etiology of cirrhosis and clinical presentation. Results: Eight of the 49 patients had cirrhosis (16% of CCA biopsies reviewed). Their median age was 64 (27-71) years and five were females. Four patients had CCA, three patients cHCC-CCA and one had a bifocal tumor. Patients in the CCA group were more commonly symptomatic. Alpha-fetoprotein and CA 19-9 levels were elevated in one of eight and four of six patients, respectively. Within 12 months from diagnosis, five of eight patients died. Conclusions: In most of these cases, the diagnosis of cHCC-CCA and CCA was made in the liver explant study without previous imaging diagnosis. This reinforces the usefulness of the histological study, in specific cases, prior to liver transplantation and emphasizes the importance of systematic explant exploration in these cases.

[Cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma in cirrhotic patients]. / Colangiocarcinoma y hepatocolangiocarcinoma combinado en pacientes con cirrosis.

BACKGROUND: Cholangiocarcinoma (CCA) is a primary hepatic tumor, frequently found in patients with liver cirrhosis and biliary tract diseases. Its varieties include isolated CCA or "combined hepatocellular-cholangiocarcinoma" (cHCC-CCA). The latter is uncommon, with poorly defined diagnostic criteria and natural history. AIM: To characterize patients with cirrhosis with a pathological diagnosis of CCA and cHCC-CCA. MATERIAL AND METHODS: Forty-nine liver biopsies with a pathological diagnosis of CCA were reviewed. The clinical records of patients were reviewed to fetch demographic variables, etiology of cirrhosis and clinical presentation. RESULTS: Eight of the 49 patients had cirrhosis (16% of CCA biopsies reviewed). Their median age was 64 (27-71) years and five were females. Four patients had CCA, three patients cHCC-CCA and one had a bifocal tumor. Patients in the CCA group were more commonly symptomatic. Alpha-fetoprotein and CA 19-9 levels were elevated in one of eight and four of six patients, respectively. Within 12 months from diagnosis, five of eight patients died. CONCLUSIONS: In most of these cases, the diagnosis of cHCC-CCA and CCA was made in the liver explant study without previous imaging diagnosis. This reinforces the usefulness of the histological study, in specific cases, prior to liver transplantation and emphasizes the importance of systematic explant exploration in these cases.

A causal inference explanation for enhancement of multisensory integration by co-articulation.

The McGurk effect is a popular assay of multisensory integration in which participants report the illusory percept of "da" when presented with incongruent auditory "ba" and visual "ga" (AbaVga). While the original publication describing the effect found that 98% of participants perceived it, later studies reported much lower prevalence, ranging from 17% to 81%. Understanding the source of this variability is important for interpreting the panoply of studies that examine McGurk prevalence between groups, including clinical populations such as individuals with autism or schizophrenia. The original publication used stimuli consisting of multiple repetitions of a co-articulated syllable (three repetitions, AgagaVbaba). Later studies used stimuli without repetition or co-articulation (AbaVga) and used congruent syllables from the same talker as a control. In three experiments, we tested how stimulus repetition, co-articulation, and talker repetition affect McGurk prevalence. Repetition with co-articulation increased prevalence by 20%, while repetition without co-articulation and talker repetition had no effect. A fourth experiment compared the effect of the on-line testing used in the first three experiments with the in-person testing used in the original publication; no differences were observed. We interpret our results in the framework of causal inference: co-articulation increases the evidence that auditory and visual speech tokens arise from the same talker, increasing tolerance for content disparity and likelihood of integration. The results provide a principled explanation for how co-articulation aids multisensory integration and can explain the high prevalence of the McGurk effect in the initial publication.