extrahepatic location, such as a subdiaphragm, a transthoracic transdiaphragmatic approach via thoracoscopy is feasible. Since the technique has the advantage of better intrathoracic exposure avoiding severe adhesiolysis, liver mobilization and possible hepatic congestion. We report a case of extrahepatic metastatic hepatocellular carcinoma that was successfully resected by transthoracic thoracoscopic metastasectomy. Methods: A 68-year-old male patient who has undergone posterior sectinectomy with caudate lobectomy (S1,6,7) and cholecystectomy under a diagnosis of hepatocellular carcinoma at 3 years ago, was admitted to our hospital for further evaluation of extrahepatic metastatic tumor. On liver dynamic computed tomography revealed a welldefined mass of 3.5 cm in diameter, in right subphrenic space with invading diaphragm and rt. adrenal gland. The imaging findings suggested an extrahepatic hepatocellular carcinoma that metastasized to the diaphragm. LFT was normal and AFP revealed 94.14 ng/ml. Results: We performed transthoracic thoracoscopic metastasectomy for subdiaphragmatic metastases of HCC and partial diaphragmatic resection and repair. The operation time was 3 hour 30 minutes and blood loss was 100 ml. The patient started a diet POD 1 day and discharged POD 11days due to chest tube. The postoperative course was uneventful, and the patient was discharged without any complications. Conclusions: Transthoracic thoracoscopic metastasectomy can be feasible even if the recurrent tumors located in segments VII and VIII or extrahepatic location, such as a diaphragm.
EGFR expression occurred in 28.6% of the cases studied and was associated with lower survival.
Introduction: Overexpression of epidermal growth factor receptor (EGFR) in tumor cells has been associated with a poor prognosis, but also offers the therapeutic option of pharmacologically targeting these receptors. The role of EGFR in hepatic malignancies is not clearly understood. The aim of this study was to analyze the expression of the EGFR in gallbladder cancer and cholangiocarcinomas. Methods: Paraffin-embedded samples from 60 patients with carcinomas of the biliary tract were studied. Clinicopathologic features were assessed. The immunohistochemical for EGFR were performed and scored independently by two pathologists. Results: The age of patients was 59 years (range, 28e83). From the 60 patients examined 22 (36.6%) had gallbladder cancer (GB) and 38 (63.3%) cholangiocarcinoma, 9 (23.7%) had intrahepatic, 22 (57.9) perihilar, and 7(18.4%) distal cholangiocarcinomas. Intraductal growth type was identified in 14 (36.8%) cases of cholangiocarcinomas. EFGR was positive in 44% of the GB cancer, and 50% of the cholangiocarcinomas. Conclusions: EGFR was positive in about half of the biliary tract cancer.
The authors conducted a revisional study of intraepithelial papillary lesions of the bile ducts, characterized by being a kind of rare, intraductal growing cholangiocarcinoma. Articles published in the last 10 years were reviewed. The authors considered that the adenoma-carcinoma development is an important feature to warrant prophylactic measures through excisions. The histological type and biomolecular behavior may have relevance in the postoperative course of such lesions, which have a better prognosis when compared with other histological types.
Introduction: The difficulty to set a histopathological diagnosis in patients with cholangiocarcinoma is a challenge Methods: We present 7 cases of cholangiocarcinoma for witch was performed an excisional biopsy of ganglion 5. For this patients the histopathological diagnosis was not able to be performed neither by endoscopic of ecoendoscopic maneuver. 5 cases were made by laparoscopic approach and 2 by open procedure. Results: All the results from the biopsies were inconclusive and indicated inflammation Conclusions: Although the mini series was not on a large number of cases, the examination of ganglion 5 was not edifying in establishing the histopathological results in patients with cholangiocarcinoma and present metastasis.
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