BackgroundBiliary intraepithelial neoplasia (BilIN) is often distinguished by what it is not: the precancerous lesions are not mass-forming, are not the cause of bile duct obstruction, and are small enough (less than 5 mm long) to evade detection by the naked eye. Here, we describe an atypical case of BilIN resembling cholangiocarcinoma (CC) that was large enough to be identified by diagnostic imaging and presented with obstructive jaundice caused by a hematoma in the common bile duct (CBD).Case presentationA 64-year-old man presented to our hospital with upper abdominal pain and anorexia. Initial laboratory examinations revealed increased total bilirubin and a computed tomography (CT) scan revealed a dilated CBD. Gastroenterologists performed an endoscopic sphincterotomy (EST), which revealed that the cause of obstructive jaundice was a hematoma in the CBD. Enhanced CT scan and magnetic resonance cholangiopancreatography (MRCP) performed after the hematoma was drained showed improved dilation of the CBD and an enhanced wall thickness of bile duct measuring 25 × 10 mm at the union of the cystic and common hepatic ducts. A cholangioscope detected an elevated tumor covered by sludge in the CBD, and we performed an extrahepatic bile duct resection and cholecystectomy. The postoperative course was uneventful and the pathological examination of the resected tumor revealed that although the ulcerated lesion had inflammatory granulation tissue, it did not contain the components of invasive carcinoma. Many consecutive intraepithelial micropapillary lesions spread around the ulcerated lesion, and the epithelial cells showed an increased nucleus-to-cytoplasm ratio, nuclear hyperchromasia, and architectural atypia. The pathological diagnosis was BilIN-1 to -2. Immunohistochemical staining showed that S100P was slightly expressed and MUC5AC was positive, while MUC1 was negative and p53 was not overexpressed.ConclusionWe experienced an atypical case of BilIN mimicking CC that presented with obstructive jaundice caused by a hematoma in the CBD. Our case suggested that the occurrence of BilIN can be triggered by factors other than inflammation, and can grow to a size large enough to be detected by image analyses.
Objective: Colorectal liver metastases (CRLM) has a relatively high affinity, and sometimes is accompanied by biliary invasion. Generally, small nodular CRLM is indicated for RFA. On the other hand, it was reported that CRLM with biliary invasion requires hepatectomy with enough surgical margin. Therefore, accurate diagnostic imaging on the presence or absence of biliary invasion is important for the appropriate therapeutic choice for CRLM. Methods: A 30-years-old man who underwent a sigmoidectomy and systemic chemotherapy for sigmoid colon cancer with simultaneous multiple liver metastases. Then, we planned Surgery for remaining multiple CRLM. Preoperative CT and MRI showed multiple CRLM with no biliary invasion. We performed contrast enhanced ultrasonography (CEUS) preoperatively for further evaluation. Results: CEUS revealed contrast defect in bile duct (B2 + 3) from portal to Kupffer phase and it was suspected to be a biliary invasion. Therefore, we performed left lobectomy of the liver and it was demonstrated that the lesion was accompanied by biliary invasion in histopathological examination. Conclusion: Although CT and EOB-MRI are goes up to the candidate in the modality to diagnose the CRLM with biliary invasion, they sometimes can't reveal presence of the lesion with biliary invasion, let alone the area of biliary invasion. Preoperative and intraoperative CEUS are very useful not only to diagnose the presense and the area of biliary invasion, but also to select appropriate therapeutics for CRLM.Image 3 Arteriogram after coil embolization. Splenic vein is not visualized.Image 4 CT venous phase on postprocedure day 1. Note thrombus in splenic vein and portal system (blue arrows). Image 5 CT venous phase obtained 4 months after anticoagulation therapy. No thrombus is seen in the splenic vein or portal system. Image 2 Initial arteriogram showing passage of contrast from splenic artery (red arrow) to vein (blue arrow).HPB 2017, 19 (S1), S120eS192 ePoster Abstracts S181
Background: In SABCS 2009, we reported that the high level of serum anti-p53 antibody titers was associated with response to preoperative chemotherapy in cases with primary breast cancer (SABCS 2009). Prognostic meaning of pathological complete response (pCR) after preoperative chemotherapy differs among various subtype, and there is a close relationship between pCR and prognosis in cases with HER2 positive or triple negative disease. The aim of this study is to evaluate the association between the high level of serum anti-p53 antibody titers and pCR in patients with HER2-positive or triple negative breast cancer. Patients and Methods: In this study, we analyzed 196 women with operable early stage breast cancer (T1-T3, N0-1) treated with preoperative chemotherapy and definitive curative surgery since 2002 to 2011. All of the patients received four cycles of FEC (fluorouracil 500 mg/m2, epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2 q3w) followed by four cycles of docetaxel (75 mg/m2 q3w). The serum anti-p53 antibody titers were assessed by ELISA with the anti-p53 EIA Kit II (MESACUP anti-53 Test: MBL) in the pre-treatment serum samples. The test's cut-off value was determined to be 1.3 IU/ml based on reference distribution in healthy control individuals. The association between serum anti-p53 antibody titers and pCR was analyzed. Results: The subtype of tumors of 196 patients were classified to 86 of ER+/HER2−, 24 of ER+/HER2+, 29 of ER−/HER2+ and 57 of ER−/HER2−. The pCR was achieved 49 of 196 patients (25%). The pCR rate were 7%(6/86), 33%(8/24), 48%(14/29) and 37%(21/57) in the subtype of ER+/HER2−, ER+/HER2+, ER−/HER2+ and ER−/HER2− respectively. The range of serum anti-p53 antibody titers in the serum samples of 196 patients was between 0.40 and 5610 (the median was 0.40 and the average was 85.2). Excluding 86 cases with ER+/HER2−, relationship between serum anti-p53 antibody titers and pCR was evaluated. According to serum anti-p53 antibody titers with the patients of pCR, cut-off value of serum anti-p53 antibody titers was set to be 6 IU/ml. The pCR was observed in nine of 12 cases (75%) with high serum anti-p53 antibody titers, which was significantly higher than those with low titers (35%: 34/98; p = 0.01). Multivariate analysis showed that the only high anti-p53 antibody titer was an independent predictive factor for pCR due to preoperative chemotherapy (p = 0.01). Conclusion: p53 mutation analysis using serum anti-p53 antibody titers might be a useful predictive test for response to preoperative chemotherapy in patients especially with HER2 positive or triple negative breast cancer. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-06-26.
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