Assuntos
Adenocarcinoma Papilar/parasitologia , Filariose/parasitologia , Neoplasias Ovarianas/parasitologia , Adenocarcinoma Papilar/complicações , Adenocarcinoma Papilar/patologia , Feminino , Filariose/complicações , Filariose/patologia , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/patologiaRESUMO
OBJECTIVE: Some biliary neoplasms secrete copious mucin into bile ducts, yet the management of mucobilia is not well known. The objective of this study was to analyze 16 patients with copious mucin in the biliary tract stressing the diagnostic and therapeutic aspects of endoscopic retrograde cholangiography (ERC). MATERIAL AND METHODS: Sixteen patients with mucobilia were found among 5635 cases of ERC from October 1999 to October 2006 in our institution. Diagnostic and therapeutic ERC as well as clinical features were retrospectively analyzed. RESULTS: Mucin had a greater impact than the neoplasm itself on the cholangiogram and clinical presentation. ERC failed to show the tumors but a disproportionate or aneurysmal dilatation of the segmental or lobar duct correlated with the tumor-bearing duct was evident. Endoscopic managements included clearance of intraductal mucin and/or endoscopic nasobiliary drainage (ENBD). Three patients were excluded from outcome assessment because of non-specific symptoms or spontaneously subsiding jaundice. Among the 13 patients eligible for assessment, subjective improvement in symptoms and/or a decrease in jaundice along with subsiding cholangitis following ERC was observed in 5 of the 7 patients that underwent both clearance of intraductal mucin and ENBD (ENBD function was poor in all 7 patients), in 1 patient who underwent only clearance of intraductal mucin, and in 3 of the 5 patients who underwent only ENBD. The three patients with progressive jaundice, despite endoscopic management, had advanced disease. CONCLUSIONS: ERC revealed the tumor-bearing duct but not the extent of the disease in most of the patients with mucobilia. When mucobilia is encountered during ERC, the management should include clearance of as much intraductal mucin as possible. ENBD is frequently obstructed by mucin and may be helpful only in selected cases.
Assuntos
Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/metabolismo , Adenocarcinoma Papilar/diagnóstico , Adenocarcinoma Papilar/metabolismo , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/metabolismo , Mucinas/metabolismo , Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Mucinoso/cirurgia , Adenocarcinoma Papilar/parasitologia , Adenocarcinoma Papilar/cirurgia , Idoso , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/metabolismo , Colangiopancreatografia Retrógrada Endoscópica/métodos , Estudos de Coortes , Drenagem/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mucinas/análise , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
A 69-year-old man underwent right middle lobectomy because of the tumor lesion in the right middle lung. He had ever been in Celebes and China (riverside area of the Yangtze), the infected area of schistosomiasis japonica, for military service during the World War II. Resected lung specimen was carefully examined at the department of pathology in our hospital. Several ova of Schistosoma japonicum were discovered scattered in the specimen, and the pathological feature of the lung lesion was revealed to be metastasis of the sigmoid colon cancer which was resected 4 years ago at a certain hospital. The ova of Schistosoma japonicum were also distributed near the colon lesion. Recently in Japan, it is said, acute infected case of schistosomiasis japonica has been ceased, however, in cases of chronic stage of this disease, hepatoma or lower intestinal cancers are still discovered through the careful follow up study.
