Ulcerative colitis and carcinoma of the proximal bile ducts

Abstract

SUMMARY In a review of 103 patients with carcinoma of the proximal bile ducts, eight patients were noted to have had ulcerative colitis also. This finding is strongly suggestive of a specific association between the two diseases. In three of the patients, carcinoma developed several years after proctocolectomy. Seven of the eight patients were significantly younger than the median age of the group as a whole, but no other apparent difference was noted between those with ulcerative colitis and the remainder of the group.During a review of the records of 103 patients with carcinoma of the proximal bile ducts seen at the Lahey Clinic Foundation during a 15-year period (Ross, Braasch, and Warren, 1972), it was noted that eight of these patients had, at some time, also had ulcerative colitis. Parker and Kendall (1954) were the first to record this association but, more recently, a number ofauthors have suggested that carcinoma of the biliary tract may be a rare complication of chronic ulcerative colitis (Rankin, Skyring, and Goulston, 1966;Converse, Reagan, and DeCosse, 1971;Morowitz, Glagov, Dordal, and Kirsener, 1971 occurred only four months after the onset of jaundice. At necropsy the patient was found to have a moderately well differentiated adenocarcinoma involving all the proximal bile ducts with direct spread into the liver. Metastases were discovered in the lymph nodes and in the porta hepatis. The presence of ascites and biliary cirrhosis was also recorded. CASE 2A 23-year-old woman first had symptoms of ulcerative colitis that were partially controlled during the next 20 years with unspecified medical treatment. However, at the age of 43, the patient underwent an emergency operation for a perforation of the colon, and a colostomy was constructed. Two years later, another perforation of the colon developed and this time an ileostomy with subtotal colectomy was carried out, leaving the rectum in place.At the age of46, gastrointestinal symptoms without jaundice developed that led to the performance of a laparotomy. A tumour, 3 cm, was found at the junction of the common hepatic and cystic ducts, and a biopsy showed it to be a poorly differentiated adenocarcinoma. The patient was referred to the Lahey Clinic where the presence of arthritis and a whitish discharge from the rectal stump were noted.

Cholangiocarcinoma in the Distal Bile Duct: A Probable Etiologic Association with Choledocholithiasis

“…Most previous reports have concluded that gallstones, which have been proposed as a definite risk factor for carcinoma of the gallbladder (16), were not a causative factor for cholangiocarcinoma (7,17). Cholelithiasis was observed in 30% to 48.1% of patients with cholangiocarcinoma, and in particular, choledocholithiasis was present in 18.5% to 21.2% of patients with extrahepatic cholangiocarcinomas (13,14,17), which was a surprisingly high incidence. Choledocholithiasis is generally classified as originating from two areas, that is, the bile duct and the gallbladder.…”

“…The overall incidence of cholangiocarcinoma associated with hepatolithiasis is 2.4% to 5.0% (8)(9)(10)(11)(12), and many past reports have suggested that hepatolithiasis-induced chronic bile stasis and bacterial infection may be important etiologic factors for cholangiocarcinoma. On the other hand, although cholelithiasis has been observed in 30% to 48.1% of patients with cholangiocarcinoma (13,14), a definitive cause-and-effect relationship between cholangiocarcinoma and cholelithiasis has not been established.…”

Cancer of the extrahepatic bile ducts

“…The remaining 28 patients had either direct regional invasion (2 1) or hematogenous distant metastases (7). At diagnosis, tumor involvement was detected in the liver (13), periductal lymph nodes (12), gallbladder (7), pancreas (3), colon (2), duodenum (I), stomach (l), and bone marrow (1). The anatomical location of the tumor in the biliary system was limited to hepatic, common hepatic, or cystic duct in 20 patients, and located in the common bile duct in 27 patients.…”

Computed tomography of hilar cholangiocarcinoma: a new sign

“…Although this tumor is considered to have biologic properties that might make it an ideal lesion for resection, resectability rates are generally low [3]. However, resection rates of up to 50% of lesions have been reported with very encouraging results for long-term survival [4].…”