Hilar cholangiocarcinoma]

Hilar cholangiocarcinoma is defined as a malignant neoplasm involving right and left main hepatic ducts and/or its confluency. The disease is more prevalent in East Asia including Korea than Western countries and it may be due to the facts that hepatolithiasis, clonorchiasis and congenital anomaly of bile ducts are more frequent in this region. In this review, we will discuss about radiologic, endoscopic, and TNM staging along with preoperative assessment for surgical strategy in patients with hilar cholangiocarcinoma.     

Hilar lymphadenopathy associated with Chlamydia pneumoniae infection.

A 27-year-old man with an acute Chlamydia pneumoniae infection and hilar lymph node involvement is reported. Further investigation gave no evidence of sarcoidosis or other known cause of enlarged hilar nodes. Serological tests proved an acute infection with C. pneumoniae Thus, an infection with C. pneumoniae may lead to enlargement of the hilar lymph nodes, and infection with this microorganism should be included in the differential diagnostic considerations in patients with hilar lymphadenopathy.     

Palliation:Hilar cholangiocarcinoma

Hilar cholangiocarcinomas are common tumors of the bile duct that are often unresectable at presentation. Palliation, therefore, remains the goal in the majority of these patients. Palliative treatment is particularly indicated in the presence of cholangitis and pruritus but is often also offered for high-grade jaundice and abdominal pain. Endoscopic drainage by placing stents at endoscopic retrograde cholangio-pancreatography(ERCP) is usually the preferred modality of palliation. However, for advanced disease, percutaneous stenting has been shown to be superior to endoscopic stenting. Endosonography-guided biliary drainage is emerging as an alternative technique, particularly when ERCP is not possible or fails. Metal stents are usually preferred over plastic stents, both for ERCP and for percutaneous bili-ary drainage. There is no consensus as to whether it is necessary to place multiple stents within advanced hi-lar blocks or whether unilateral stenting would suffice. However, recent data have suggested that, contrary to previous belief, it is useful to drain more than 50% of the liver volume for favorable long-term results. In the presence of cholangitis, it is beneficial to drain all of the obstructed biliary segments. Surgical bypass plays a limited role in palliation and is offered primarily as asegment Ⅲ bypass if, during a laparotomy for resec-tion, the tumor is found to be unresectable. Photody-namic therapy and, more recently, radiofrequency abla-tion have been used as adjuvant therapies to improve the results of biliary stenting. The exact technique to be used for palliation is guided by the extent of the bili-ary involvement(Bismuth class) and the availability of local expertise.     

Hilar biliary cystadenocarcinoma: an uncommon hepatic neoplasm.

Biliary cystadenocarcinoma (BCAC) is a rare cystic tumour of the liver; with its benign counterpart, it accounts for <5% of non-parasitic hepatic cysts. Preoperative diagnosis of BCAC is difficult; complete surgical excision is recommended to prevent recurrence or metastasis. We present the case of a 67-year-female with centrally located BCAC involving the right hepatic duct and distorting the hepatic hilum. This report highlights the difficulties in diagnosis, surgical resection, subsequent biliary reconstruction and its outcome.     

Testicular tumours.

With modern methods of diagnosis, staging and treatment, seminoma is a highly curable tumour. The worse results for the treatment of teratomas are likely to improve particularly as methods for detection of the tumour improve and as types of treatment are increasingly combined in a way which takes account of the biology of the tumour and the strength and limitation of each treatment modality. Stage I and II teratoma should receive irradiation after orchidectomy although when bulky retroperitoneal disease is present irradiation alone is rarely capable of securing local tumour control. In these cases chemotherapy may achieve nodal regression preparatory to irradiation. Excision of residual masses after irradiation should be considered in teratoma. Chemotherapy is the treatment of choice for disseminated teratoma but maintaining tumour control poses problems. Whole lung irradiation following chemotherapy is being assessed in selected patients.     

Hilar cholangiocarcinoma associated with clonorchiasis

Pathologic and epidemiologic evidence support the relationship between the liver fluke Clonorchis sinensis and the development of bile duct cancer. We report here a case of cholangiocarcinoma in a Laotian immigrant originally diagnosed with clonorchiasis. This case demonstrates the importance of early recognition and treatment of this disease to prevent subsequent morbidity and mortality. Diagnosis and treatment of clonorchiasis as well as the possible modes of cancer induction are discussed.     

Hilar and mediastinal lymphadenopathy with hypersensitivity pneumonitis induced by penicillin.

A 54-year-old Japanese man demonstrated a sultamicillin-induced hilar and mediastinal lymphadenopathy with hypersensitivity pneumonitis. A positive lymphocyte stimulation test for sultamicillin and a decreased CD4/CD8 ratio of lymphocytes in BAL fluid suggested that an alteration in cell-mediated mechanisms was responsible for the patient's symptoms.     

Hilar inflammatory pseudotumor mimicking hilar cholangiocarcinoma

BACKGROUND:Inflammatory pseudotumor of the biliary tract is a benign disease,and is extremely rare.Its diagnosis often depends on pathological examination after operation. The histopathological examination shows inflammatory lesions with a polymorphous infiltration and variable amounts of fibrous tissue.This study was undertaken to elucidate that an inflammatory pseudotumor in the right hepatic duct is especially difficult to distinguish from hilar cholangiocarcinoma. METHOD:The clinical data of one patient...     

Hilar Cholangiocarcinoma: expert consensus statement

An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists met on 15 January 2014 to review current evidence on the management of hilar cholangiocarcinoma in order to establish practice guidelines and to agree consensus statements. It was established that the treatment of patients with hilar cholangiocarcinoma requires a coordinated, multidisciplinary approach to optimize the chances for both durable survival and effective palliation. An adequate diagnostic and staging work-up includes high-quality cross-sectional imaging; however, pathologic confirmation is not required prior to resection or initiation of a liver transplant trimodal treatment protocol. The ideal treatment for suitable patients with resectable hilar malignancy is resection of the intra- and extrahepatic bile ducts, as well as resection of the involved ipsilateral liver. Preoperative biliary drainage is best achieved with percutaneous transhepatic approaches and may be indicated for patients with cholangitis, malnutrition or hepatic insufficiency. Portal vein embolization is a safe and effective strategy for increasing the future liver remnant (FLR) and is particularly useful for patients with an FLR of <30%. Selected patients with unresectable hilar cholangiocarcinoma should be evaluated for a standard trimodal protocol incorporating external beam and endoluminal radiation therapy, systemic chemotherapy and liver transplantation. Post-resection chemoradiation should be offered to patients who show high-risk features on surgical pathology. Chemoradiation is also recommended for patients with locally advanced, unresectable hilar cancers. For patients with locally recurrent or metastatic hilar cholangiocarcinoma, first-line chemotherapy with gemcitabine and cisplatin is recommended based on multiple Phase II trials and a large randomized controlled trial including a heterogeneous population of patients with biliary cancers.