Biliary tract cytology in specimens obtained by direct cholangiographic procedures: A study of 74 cases

A retrospective review of bile (BL) and biliary tract brushings (Br) obtained by endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) was undertaken to determine the sensitivity and specificity of cytology in the diagnosis of pancreaticobiliary malignancies. A total of 104 cytologic specimens (PTC-BL 15, PTC-Br 13, ERCP-BL 8, ERCP-Br 68) received between 1990 and mid-1994 from 77 patients who had undergone ERCP and/or PTC primarily for biliary stricture were reviewed. Specimens were unsatisfactory/inadequate in 11 (10.6%), benign in 41 (39.4%), suspicious in 25 (24%), and positive for malignant cells in 27 (26%). Follow-up was available in 74/77 patients; 46 (59.7%) had tissue confirmation while 28 (32.5%) had adequate clinical follow-up based on chart review. Of those with histologic confirmation, there were 32 malignant and 14 benign cases. The overall sensitivity and specificity of PTC- and ERCP-obtained cytologic specimens were 88.9 and 95.7% respectively. There was only one false positive case (ERCP-Br). Overall positive predictive value was 96%, negative predictive value 88%, and accuracy 96%. PTC had a significantly lower sensitivity rate (42.8%) and higher rate for unsatisfactory specimens (21%) compared with ERCP-obtained material (100 and 1.9%). Bile obtained by PTC or ERCP appeared less sensitive in detecting malignancies compared with endoscopic brushing using either technique (BL 50% vs. Br 100%). All three false negative cases were PTC-BL specimens. Of the 17 suspicious cases, eight were confirmed histologically as malignant, four were clinically consistent with malignancy, and five showed marked inflammatory atypia on biopsy. Positive predictive value and accuracy rate of a “suspicious cytology” diagnosis were 69 and 80.5%, respectively. Inadequate specimen, poor cellular preservation, and cells obscured by bile all interfere with proper cytologic evaluation. Experience is necessary to appreciate subtle malignant changes in well differentiated carcinomas. Communication between the cytopathologist and the clinician is critical in the accurate interpretation and proper management of the patients. Diagn Cytopathol 1996;14:334–348. © 1996 Wiley-Liss, Inc.     

Endoscopic bile duct brushing of malignant pancreatic biliary strictures: retrospective study with comparison of conventional smear and ThinPrep techniques

Endoscopic bile duct brushing (EBDB) is carried out to differentiate benign from malignant biliary strictures in patients who have pancreaticobiliary disease. The sensitivity of this method for the diagnosis of malignancy is relatively low. The aim of this study is to analyze the cytomorphologic features that are helpful in increasing the sensitivity of detecting these lesions on cytologic samples. These features are compared with slides prepared with the ThinPrep technique. The study included 142 patients with bile duct obstruction or pancreatic mass who underwent EBDB and follow-up surgery or biopsy between 1997 to 2000. Twenty-five (18%) of these cases were positive for malignancy in both EBDB and follow-up surgical biopsy; 20 of these cases were used as positive controls (PC). Sixty-one (43%) were negative in both EBDB and follow-up surgical biopsy specimens, and 21 of those cases were used as negative controls (NC). Fifty-six (39%) cases were negative/atypical in EBDB cytology but were suspicious or positive in the surgical or biopsy specimens (false-negative). We identified the cytologic criteria that were helpful in differentiating our positive and negative control groups and applied these criteria to our false-negative group to see whether our sensitivity could be increased, using well-defined cytologic criteria alone. Of the 56 false-negative cases, 9 (16%) were upgraded to suspicious/positive based on the presence of the following features: three-dimensional (3D) micropapillae (95% PC vs 19% NC, P < 0.0001), anisonucleosis (90% PC vs 5% NC, P < 0.0001), high nuclear-to-cytoplasmic (N/C) ratio (95% PC vs 9% NC, P < 0.0001), nuclear contour irregularity (65% PC vs 24% NC, P = 0.0079), and prominent nucleoli (70% PC vs 38% NC, P = 0.0406). Cytomorphologic features which were not helpful in distinguishing positive and negative cases were: single naked nuclei (50% PC vs 28% NC, P = 0.1597), chromatin granularity (50% PC vs 62% NC, P = 0.54), and necrosis (10% PC vs 5% NC, P = 0.5197). Improvement in diagnostic sensitivity for carcinoma of pancreaticobiliary tract in EBDB samples may be achieved by identifying the key malignant cytomorphologic features: 3D micropapillae, anisonucleosis, nuclear contour irregularity, prominent nucleoli, and high N/C ratio. The sensitivity in detecting malignant biliary strictures increased from 31% to 42% based on these criteria in our current study.     

塑料与金属胆管支架的材料特征及其生物相容性

背景：经消化内镜塑料及金属胆管支架置入技术是治疗胆道良恶性梗阻的有效手段。尤其是高位梗阻胆管内支架置入治疗,对不能进行外科治疗的胆系肿瘤患者急需消除黄疸,顺应生理性引流,延长生存期,提高生活质量有极大的临床应用价值。 目的：对比经消化内镜置入塑料及金属胆管支架治疗胆道良恶性梗阻的临床效果,并探讨塑料及金属胆管支架与宿主间的生物相容性。 方法：由第一作者以“胆道梗阻,塑料胆管支架,金属胆管支架,生物相容性”为中文检索词,以“cerebrovascular disease,stent,biocompartibility”为英文检索词,在中国期刊全文数据库(CNKI：1989/2009)及Medline(1989/2009)数据库中采用电子检索的方式进行文献检索。排除Meta分析及重复性研究。筛选纳入35篇文献进行评价,探讨塑料及金属胆管支架的治疗现状、并发症和生物相容性。 结果与结论：经内镜置入胆管支架是治疗胆道良恶性梗阻的主要手段。胆管内支架主要包括金属支架和塑料支架两种。金属支架在预防细菌滋生,保持支架持久通畅等方面有很大的优势,但价格昂贵。塑料支架较易细菌附着,胆泥淤积导致支架阻塞,但具有容易更换、价格低廉的优点。塑料及金属胆管支架的生物相容性均有待于提高,对于胆管恶性梗阻的患者,胆管内支架置入与放射治疗相结合有助于预防支架梗阻。对于胆泥的形成,支架的移位和堵塞,以及支架降解产物等问题尚需要进一步的观察和研究。     

Beyond cytomorphology: expanding the diagnostic potential for biliary cytology

Malignancy of the extrahepatic biliary tract is a difficult and crucial diagnosis, both clinically and pathologically. Cytologic evaluation of brushings obtained endoscopically from the biliary tree is currently the standard of care in most institutions. However, bile duct brushing cytology has been plagued by low sensitivity and interpretative difficulties in differentiating reactive from malignant cytology. This review outlines both the difficulties presented by cytomorphology and the potential of new diagnostic techniques that promise to increase sensitivity without sacrificing the high specificity of cytomorphology.     

Biliary stricture due to hepatocellular carcinoma: Diagnosis by bile duct brushing cytology

Bile duct brushing cytology is a useful technique in the diagnosis of malignant biliary strictures. Adenocarcinoma is the usual type of carcinoma diagnosed in these brushing specimens. This report details the bile duct brushing cytology findings in an unusual case of hepatocellular carcinoma which presented with obstructive jaundice due to invasion of the biliary tract. A striking feature of the brushing was the prominent capillary vascular pattern associated with the tumor cells. This is a cytologic feature which has been noted in fine-needle aspirates of hepatocellular carcinoma as well, and is distinct from the expected findings in adenocarcinoma. Diagn. Cytopathol. 16:55–56, 1997. © 1997 Wiley-Liss, Inc.     

In vitro and in vivo assessment of biocompatibility of AZ31 alloy as biliary stents: a preclinical approach

IntroductionBiomaterial technology due to its lack of or minimal side effects in tissues has great potential. Traditionally biomaterials used were cobalt-chromium, stainless steel and nitinol alloys. Biomaterials such as magnesium (Mg) and zinc (Zn) have good biocompatibility and consequently can be a potential material for medical implants. To date, the effects of AZ31 alloy stent on cell apoptosis are still unclear. The current investigation was designed to determine the effect of AZ31 alloy stent on necrosis and apoptosis of common bile duct (CBD) epithelial cells.Material and methodsWe experimented with application of different concentrations of AZ31 alloy stent to primary mouse extrahepatic bile epithelial cells (MEBECs) and estimated the effect on apoptosis and necrotic cells. Apoptosis and pro-apoptosis expression were estimated through real-time PCR. For in vivo protocol, we used rabbits, implanted the AZ31 bile stent, and estimated its effect on the CBD. AZ31 (40%) concentration showed an effect on the apoptotic and necrotic cells.ResultsReal-time PCR revealed that AZ31 (40%) concentration increased the apoptotic genes such as NF-κB, caspase-3, Bax and Bax/Bcl-2 ratio as compared to the control group. In the in vivo experiment, AZ31 alloy stents were implanted into the CBD and showed an effect on the alteration the hematological, hepatic and non-hepatic parameters.ConclusionsTo conclude, it can be stated that AZ31 induces apoptosis via alteration in genes including nuclear factor kappa-B (NF-κB), caspase-3, Bax and Bax/Bcl-2 ratio and improved the hematological, hepatic and non-hepatic parameters.     

MRCP与ERCP鉴别肝外胆管良恶性狭窄的对比研究

目的：探讨肝外胆管良、恶性狭窄患者的磁共振胰胆管成像（magnetic resonance cholangiopan-creatography，MRCP）与内镜逆行胆胰管造戥术（endoscopic retrograde cholangiopancreatography，ERCP）的征象，并比较两种检查方法诊断的准确性。方法：对46例经手术或病理检查明确病因的肝外胆管狭窄患者的术前MRCP和ERCP资料进行回顾性分析，根据图像肝外胆管狭窄的形态描述为边缘不规则或平滑、狭窄不对称或对称、狭窄中断或呈鼠尾状及双管征等，计算MRCP与ERCP诊断的灵敏度、特异度及准确性，用标尺准确测量肝外胆管狭窄的长度，并用t检验来比较。结果：肝外胆管癌表现为不规则边缘和不对称狭窄（92％）较良性狭窄（分别为22％，35％）普遍。MRCP诊断肝外胆管癌与良性狭窄的灵敏度、特异度及准确性分别是84％、71％及78％，ERCP分别是72％、71％及72％。肝外胆管癌引起狭窄长度平均是（30．0±8．5）mm，良性狭窄平均长度是（13．6±9.1）mm（P〈0.001）。结论：MRCP在鉴别诊断肝外胆管良恶性的病变引起胆管狭窄与ERCP相比是较准确的。     

Frequent molecular identification of Campylobacter but not Helicobacter genus in bile and biliary epithelium in hepatolithiasis

Bacterial infection of the biliary tree and bile stasis may be causally related to hepatolithiasis, but which bacterial species are involved and their roles in the pathogenesis of hepatolithiasis have not been ascertained. Recently, the Helicobacter genus was detected in human bile and biliary mucosal samples by molecular techniques, and its association with several biliary diseases has been suggested. The Campylobacter genus, which is closely related to the Helicobacter genus, has also recently been identified as causative of human gastrointestinal diseases. This study attempted to elucidate whether Helicobacter and/or Campylobacter bacteria are present in bile samples and biliary mucosal specimens from hepatolithiasis patients and whether they are involved in the pathogenesis of hepatolithiasis. The 16S rRNA gene of the Helicobacter and of the Campylobacter genus was examined by polymerase chain reaction in DNA samples extracted from bile and/or microdissected biliary epithelium from 69 patients with hepatolithiasis and control patients with choledocholithiasis, cholecystolithiasis, and normal gall bladders. The Helicobacter genus was detected in 1 of 8 (13%) biliary epithelial samples in hepatolithiasis and 1 of 10 (10%) bile samples in choledocholithiasis. The Campylobacter genus was detected in 3 of 14 (21%) bile samples and 5 of 8 (63%) epithelial samples in hepatolithiasis, and in 2 of 15 (13%) bile samples and 1 of 8 (13%) epithelial samples in cholecystolithiasis. The detection rate for Campylobacter in biliary epithelium of hepatolithiasis was significantly higher than in the bile or biliary epithelium of control groups (p<0.05). By a phylogenetic analysis based on nucleotide sequences, the Campylobacter genuses detected in hepatolithiasis were clustered with C. rectus or C. showae. The frequent detection of the Campylobacter 16S rRNA gene in bile, and especially in biliary epithelium of hepatolithiasis, suggests a pathogenetic relationship with Campylobacter infection.     

Distribution of apoptotic cells and expression of apoptosis-related proteins along the intrahepatic biliary tree in normal and non-biliary diseased liver

AIMS: The cell kinetics and homeostasis of biliary epithelial cells may be maintained differently along the biliary tree. In this study, the role of apoptosis in the maintenance and homeostasis of the intrahepatic biliary tree was evaluated. METHODS AND RESULTS: By counting apoptotic biliary cells and by immunostaining apoptosis-related proteins in normal liver, fatty liver, and those with acute viral hepatitis, chronic viral hepatitis, and hepatitis virus-related cirrhosis, it was found that the larger the intrahepatic bile ducts became, the more biliary epithelial cells underwent apoptosis. bcl-2, an inhibitor of apoptosis, was diffusely expressed in the interlobular bile ducts, but rarely detectable in the large and septal bile ducts. bcl-XL and mcl-1, inhibitors of apoptosis, and bax, a promoter of apoptosis, were diffusely expressed along the intrahepatic biliary tree. CD95, a direct inducer of apoptosis, was present in the large and septal bile ducts, but rarely in the interlobular bile ducts. CONCLUSION: The ratio of bax to bcl-2, as well as the expression of CD95 which differed at the interlobular versus large and septal bile ducts, may be responsible for the unique distribution of apoptotic biliary cells and involved in the homeostasis of the intrahepatic biliary tree.     

Ultrastructural changes of bile duct epithelium in primary biliary cirrhosis in relation to progression of bile duct loss

Summary Using wedge liver biopsies from patients with primary biliary cirrhosis (PBC), ultrastructural features of the intrahepatic bile ducts in livers with slight or no bile duct loss were compared with those in livers with advanced bile duct loss and in extrahepatic cholestasis (EHC).Most changes in the biliary epithelium in PBC were similar to those in EHC. Microvillous loss and bleb formation, mitochondrial damage and increase in endoplasmic reticulum and ribosomes were found in PBC irrespective of the degree of bile duct loss, and also in EHC. These changes were present almost equally at any level of the biliary tree, and are presumed to represent a variety of non-specific lesions of biliary epithelial cells. As the loss of bile ducts in PBC progressed, cytoskeletal filaments and cytophagosomes increased in number and basement membranes were more thickened and reduplicated. These changes were more or less conspicuous in smaller branches of the biliary tree, and were also prominent in EHC. They might be causally related to the bile flow disturbance in the liver. Lateral intercellular spaces were irregularly dilated and contained osmiophilic membranous and/or granular material, similar to that found in duct lumena, within and without the basement membrane, and in the cytoplasm of periductal macrophages. Furthermore, pinocytotic vesicles were increased in the biliary cytoplasm facing periphery. These findings suggest possible alteration of the permeability of biliary epithelial cells, probably in the direction from the lumena to the periductal tissue. Such changes were found in PBC livers with virtual absence of bile duct loss, and the significance of this phenomenon is discussed.     

Diagnostic criteria for malignancy in bile cytology and its usefulness

Fifty three bile specimens from 42 patients were reviewed to assess the diagnostic role of the bile cytology and to define more reliable cytologic indicators of malignancy. Forty three bile specimens came from 34 patients with malignant biliary strictures and 10 bile specimens were from eight patients with benign conditions. There were no false positives. The diagnostic specificity of bile cytology was 100% while diagnostic sensitivity was 55.8%. Overall diagnostic accuracy was 64.2%. We identified four key criteria as cytologic indicators of malignancy among 20 variables by using multiple regression analysis: loss of honeycomb arrangement, hyperchromatism, increased N/C ratio, and coarse chromatin. When bile specimens with three or more of these four criteria are thought to represent malignancy, the sensitivity of diagnosis of malignancy was 65.2%, specificity was 90% and diagnostic accuracy was 69.8%.     

恶性胆道梗阻金属支架堵塞后再次置入金属和塑料支架的比较

背景：在堵塞的支架中再次置入金属或塑料支架可解决支架的堵塞问题,然而关于支架间如何搭配组合将使患者受益更大却一直存在着争论。 目的：对比恶性胆道梗阻金属支架堵塞后再次在其内置入不同种类支架之间的临床效果。 方法：收集在南昌大学第二附属医院行经内镜胆道金属支架置入的,且在原支架堵塞后再次在其内置入另一支架的中、低位胆道恶性梗阻患者83例,并根据原支架与再次置入支架的不同搭配组合形式,将以上患者分为3组,即覆膜金属支架组、无覆膜金属支架组和塑料支架组。 结果与结论：在原金属支架堵塞后,再次置入覆膜金属支架的通畅时间显著长于塑料支架(P < 0.05);覆膜金属支架组的支架累计通畅时间显著长于无覆膜金属支架组(P < 0.05-0.01)。提示经内镜置入胆道金属支架治疗中、低位胆道恶性梗阻时,在原金属支架和支架堵塞后再次置入金属支架时,使用≥1根覆膜支架的累计通畅时间显著长于先后2次置入无覆膜金属支架者。     

Intraductal tubular neoplasm of the common bile duct

Recently, biliary neoplasms resembling intraductal neoplasms of the pancreas have been documented. In this report, a rare case of intraductal tubular neoplasm (ITN) arising in the common bile duct is presented. A polypoid mass, 10 mm in diameter, was found in a 67‐year‐old woman in the intrapancreatic part of the common bile duct during the follow up to cholecystolithiasis and choledocholithiasis. Endoscopic polypectomy was performed for the lesion. Histology of the lesion revealed tubular neoplasm, composed of an admixture of tubular glands resembling pyloric gland adenoma with minimal atypia (low‐grade tubular adenoma), and those resembling intestinal type tubular adenoma (high‐grade tubular adenoma). There was no significant formation of papillae or oncocytic cytoplasm. Small foci of carcinoma in situ of the intestinal type were also observed. On immunostaining low‐grade tubular adenoma was positive for MUC5AC and MUC6, and negative for MUC2 and cytokeratin (CK) 20, while high‐grade tubular adenoma and carcinoma in situ were positive for MUC2 and CK20, and negative for MUC5AC. Although more case studies of ITN in the biliary tracts are required to clarify the tumorigenesis and pathological features, the lesion may be the biliary counterpart to pancreatic ITN.     

Non-invasive intraductal papillary neoplasms of the common bile duct: a clinicopathologic study of six cases

Recently, several studies of intraductal papillary neoplasms (IPN) of the biliary tracts have been reported in the liver, but there have been only one study of them in the common bile duct (CBD). The author reviewed 34 archival pathologic materials of surgically resected specimens containing CBD tumors. RESULTS: Six cases (18%) of IPN of the CBD were found. All cases were non-invasive intraductal papillary carcinomas (IPC). The age of the patients with IPC ranged from 49 to 77 years with a mean of 67 years. The male to female ratio was 4:2. The initial symptoms were abdominal pain in 2 cases, abdominal discomfort in 1 case, and obstructive jaundice in 3 cases. Imaging modalities including US, CT, MRI, and ERCP revealed the CBD luminal tumors and biliary dilations in all cases. Surgical procedures were pancreaticoduodenectomy in 4 cases and segmental resection in 2 cases. The survival is relatively good; five patients are now alive, and one died of other disease. Grossly, all the 6 IPC showed intraductal papillary tumors. No mucus was found. Histologically, papillary proliferation of atypical cells with hyperchromatic nuclei regarded as malignant was recognized. The papillary proliferation was accompanied by fine fibrovascular cores in all cases. No stromal invasion was recognized, but lateral non-papillary in situ extension was recognized in 5 cases. Tubular formations were present in some areas in all cases. Goblet cells were present in 5 cases. No mucous hypersecretion was recognized. In one case, the tumor was composed of malignant oncocytes, and was regarded as intraductal oncocytic papillary carcinoma. Immunohistochemically, p53 expression was present in 5 cases, and Ki-67 labeling ranged from 30% to 70%. The author presented clinicopathologic findings of 6 cases of non-invasive IPC of the CBD.     

Brush cytology in malignant biliary obstruction

Tissue diagnosis is essential for the management of patients with malignant biliary obstruction. We prospectively studied brush cytology in 30 patients with malignant biliary obstruction. Wire guided brush cytology was obtained from the stricturous segment during endoscopic retrograde cholangio-pancreatography. The study comprised of 30 patients (16 males, 14 females), with a mean age of 55 years (range 30-75 years). The obstruction was caused by carcinoma gallbladder in 16 cases, carcinoma head of the pancreas in 10 cases, and cholangiocarcinoma in 4 cases. Brush cytology was positive for malignancy in 8 cases (26.7%). Another 3 samples (10.3%), 1 from each group of tumors, were suspicious for malignancy. Cytology was positive in 25% of gallbladder cancers, 50% of pancreatic cancers, and 50% of cholangiocarcinomas. Brush cytology was positive in 6 of 18 (33.3%) proximal and 5 of 12 (41.7%) distal strictures. Brush cytology yielded a sensitivity of 36.7% in the diagnosis of malignant biliary strictures. However, a larger study is required to confirm these findings.     

Carcinoma ex pleomorphic adenoma

Carcinoma ex pleomorphic adenoma is an epithelial malignant neoplasm arising from a primary or recurrent pleomorphic adenoma and is a diagnostic challenge for cytopathologists. Diagnosis requires that elements from the benign pleomorphic adenoma and the malignant component need to be seen. We report a case of carcinoma ex pleomorphic adenoma in a patient presenting with left facial nerve palsy and a painless left parotid lump. Ultrasound imaging revealed a suspicious parotid mass and FNA cytology showed background benign myoepithelial and ductal cells, chondro-myxoid stroma, and overtly malignant epithelial and myoepithelial cells; features consistent with carcinoma ex pleomorphic adenoma. A radical parotidectomy was performed and histology confirmed the diagnosis of invasive salivary duct carcinoma ex pleomorphic adenoma. Early diagnosis of carcinoma ex pleomorphic adenoma is important and cytology plays a key role; however, findings should be correlated with radiology and clinical history and the potential limitations of cytology should be appreciated.     

Clear cell hepatocellular carcinoma diagnosed by bile duct brushing cytology

Clear cell hepatocellular carcinoma (CCHCC) is an uncommon morphologic variant of HCC and rarely invades into the main bile ducts. Here we describe a case of CCHCC that was diagnosed by bile duct brushing cytology. Liquid‐based preparation of brushing specimen showed clusters of atypical epithelial cells with abundant clear cytoplasm, round nuclei, and occasional intranuclear inclusions. The tumor cells were positive for HepPar‐1 and arginase 1, suggestive of their hepatic origin. The overall morphologic and immunophenotypic features were consistent with CCHCC. The cytological diagnosis was confirmed by histopathologic examination of the resected tumor. Diagn. Cytopathol. 2016;44:147–151. © 2015 Wiley Periodicals, Inc.     

Pseudomyxoma peritonei (mucinous carcinoma peritonei) preceded by intraductal papillary neoplasm of the bile duct

Pseudomyxoma peritonei (mucinous carcinoma peritonei) is a rare clinical disease. Although most cases derive from appendiceal mucinous tumors, a few are associated with pancreatic intraductal papillary mucinous neoplasms. Intraductal papillary neoplasms of the bile duct share many similarities with pancreatic intraductal papillary mucinous neoplasms and are thought to be their biliary counterparts. We report a case of low-grade intraductal papillary neoplasm of the bile duct who developed pseudomyxoma peritonei 6 years after surgical treatment of the primary biliary tumor. To the best of our knowledge, this is the first case of pseudomyxoma peritonei associated with intraductal papillary neoplasm of the bile duct. The tumor recurrence in our case may be due to tumor spillage at the time of the first surgery, since there is no recurrent biliary tumor in the preserved liver lobe. Prevention of spillage of epithelial cell-containing mucin during surgical operations is important in treating intraductal papillary neoplasms of the bile duct.     

Management strategy for congenital choledochal cyst with co-existing intrahepatic dilation and aberrant bile duct as well as other complicated biliary anomalies

The purpose of this study was to investigate and discuss imaging methods and management strategies for congenital choledochal cyst with co-existing intrahepatic dilation and aberrant bile duct as well as other complicated biliary anomalies. In this study we reviewed and analyzed 72 patients with congenital choledochal cyst, ranging in age from 15 days to 12 years old and who were seen at our hospital during the past 12 years, from January 1993 to October 2005. The image manifestation and clinical significance of patients with co- existing intrahepatic biliary dilation and aberrant bile duct were carefully examined during operation via MRCP, cholangiography and choledochoscope. Twenty-two cases (30.1%) presented with intrahepatic bile duct dilation and 12 of these were of the cystic type. That is, the orifice of the dilated intrahepatic tract that converged into the common hepatic duct showed membrane or septum-like stenosis. In 10 cases the dilation tapered off from the porta hepatis to the initiating terminals of the intra-hepatic bile ducts and was not accompanied by stenosis. An aberrant bile duct was observed in 2 of the cases. In 3 cases, the right and left hepatic ducts converged at the choledochal cyst. In conclusion, the imaging methods for intrahepatic bile duct dilation possess important clinical significance. Further, for hepatojejunostomy with radical excision of a choledochal cyst, additional operative procedures for intrahepatic stenosis, possible bile duct malformation and pancreaticobiliary common duct calculi can potentially reduce postoperative complications.     

Quantification of the intrahepatic biliary tree during human fetal development

Development and differentiation of bile ducts have been studied for the understanding of pathogenesis of biliary atresia and other diseases of the intrahepatic biliary tree. The aim of this study is to correlate the type of biliary structure with the size of the portal tract and the gestational age. Twenty-four human livers were studied. Fetuses were assigned to four gestational age groups: group I, up to 20 postfecundation weeks (PFW); group II, from 21–26 PFW; group III, from 27–32 PFW; and group IV, from 33–38 PFW. In each specimen, 30 portal tracts were classified as small, medium, or large according to the diameter of the portal vein. In order to identify the bile duct cells, the sections were immunolabeled with anti-cytokeratin antibody, and the biliary structure was classified as absent (bile ducts (BD) = 0), presence of bile duct cells without lumen (BD = 1), or presence of bile duct with lumen (BD = 2). In the small portal tracts, either there were no biliary structures or just a few. There was a substantial increase in the number of medium portal tracts that included a bile duct as a function of gestational age. The majority of large portal tracts exhibited a bile duct. In human fetus up to 20 PFW, it is possible to find 70% of portal tracts without bile ducts, and at 38 PFW it is expected that more than 50% of the portal tract has a BD > 0. We suggest the use of the diameter of the portal vein and the gestational age for the quantification of biliary structures and the evaluation of maturity of intrahepatic biliary tree. Anat. Rec. 251:297–302, 1998. © 1998 Wiley-Liss, Inc.