We collected 51 cases of stricture in the upper portion of the biliary tract and discussed the pathogenesis and the clinical significance of the strictures. All 51 patients had congenital cystic dilatation of the common bile duct (CCDB): 2 had infant-type cysts which involved the choledochus and/or the common hepatic duct, and 49 had adult-type cysts which included the entire extrahepatic bile duct and/or the main intrahepatic bile ducts. Thirty-five of the latter 49 had intrahepatic bile duct stones proximal to the stricture. Considering the location and the clinical features, the strictures may have been formed congenitally. Furthermore, adult-type cysts of the common bile duct with strictures in the upper portion of the biliary tract are thought to be the basis for the formation of primary intrahepatic bile duct stones.

No abstract

Some colorectal adenomas show non-polypoid features endoscopically, e.g. nodule-aggregation or lateral spreading. To understand the developmental mechanism of non-polypoid adenomas better, we evaluated apoptosis indices in the upper and lower parts of 26 colorectal adenomas of non-polypoid appearance using TUNEL or single-stranded DNA (ssDNA) immunohistochemical staining. Regression analysis showed an extremely strong positive correlation between the apoptosis index (AI) values generated using each method. The AI of the lower section of lesion (4.54 +/- 1.86) was significantly higher than that of the upper part (1.21 +/- 1.47). In conclusion, ssDNA immunostaining is as useful as the TUNEL method in the evaluation of apoptosis in colorectal adenomas. It seems that vertical growth in non-polypoid adenomas is inhibited by apoptosis allowing horizontal growth to dominate and resulting in the characteristic, laterally spreading morphology.

Large non-polypoid colorectal adenomas that spread over the mucosa and morphologically flat lesions are included in a group called granule-aggregating tumours. These are uncommon in the West. We aimed to clarify the biological differences between granule-aggregating tumours and colorectal polypoid adenomas. We evaluated the extent of apoptotic cell loss and expression of bcl-2 and p53 oncoproteins in 26 granule-aggregating tumours and 19 polypoid adenomas. The mean apoptosis index value of granule-aggregating tumours was significantly higher than that of polypoid adenomas. Only two (7.7%) granule-aggregating tumours and 13 (68.4%) polypoid colorectal adenomas expressed bcl-2, while 12 (46.2%) granule-aggregating tumours and six (31.6%) polypoid colorectal adenomas were p53-positive. Our results show that the higher apoptosis index and frequent expression of bcl-2 oncoprotein differentiates granule-aggregating tumours from polypoid colorectal adenomas. We propose that large non-polypoid granule-aggregating tumours of the colorectum are a biologically distinct entity.

A total of 7 (4 males and 3 females) patients were included in this retrospective study to determine the sensitivity of radioimmunoscintigraphy with I-131 labeled anti CEA/CA 19-9 monoclonal antibodies. Out of 7 patients 2 had ascending colon cancer, one had sigmoid colon cancer, one had rectal cancer and one had adenocarcinoma in the CBD and the remaining two had metastatic tumor (one in the lungs and the other in the liver). Whole body as well as spot images showed a 72% (5/7) positive scan. But post operative specimen counts and imaging showed a high tumor to non-tumor ratio and a good tumor to non-tumor contrast of activity of I-131 labeled monoclonal antibody. We did not find any relation between CEA/CA 19-9 levels and scan findings. A case of liver metastasis was also detected by this radioimmunoscintigraphy.