Acute myeloid leukemia presenting with obstructive jaundice and granulocytic sarcoma of the common bile duct

A 55-year-old man presented with jaundice and edema of the right leg. Tests of the peripheral blood and bone marrow showed leukocytopenia with 6% blasts and 38.3% of myeloperoxidase-positive blasts, respectively. Computed tomography (CT) scanning disclosed thickening of the common bile duct wall. Granulocytic sarcomas were also found at the left chest wall and the pelvic floor. Endoscopic retrograde cholangiopancreatography confirmed the narrowing of the common bile duct. Biopsy specimens of the common bile duct and pelvic masses revealed myeloblastic infiltration. After placement of a naso-biliary drainage tube, chemotherapy consisting of cytarabine (100 mg/m2/ day for 7 days) and idarubicin (12 mg/m2/ day for 3 days) was commenced. The dose of idarubicin was not modified. No serious complications, including delayed hematopoietic recovery, were observed after chemotherapy, and a complete remission was obtained 35 days later. Jaundice and liver dysfunction also gradually improved. The patient continues to receive consolidation therapy and remains in remission 8 months after the onset of his illness.     

Transpapillary bile duct endoprostheses in obstructive jaundice

12 patients were treated with endoscopic transpapillary biliary endoprosthesis. The indication for biliary drainage was malignant obstructive jaundice in 10 and benign obstructive jaundice in 2 cases. The effectiveness of drainage is indicated by the disappearance of jaundice. The lifetime of the endoprosthesis was maximal 4 months and the survival of the tumor patients maximal 6 months. If the endoprosthesis is occluded replacement by a new one is necessary. Nonsurgical biliary drainage is an alternative method to palliative operation and should be preferred in general inoperability and in patients with irresectable tumors.     

Eosinophilic cholangitis with obstructive jaundice mimicking bile duct carcinoma

A 55-year-old male who presented with obstructive jaundice and radiographically documented extrahepatic biliary tract obstruction is reported. Eosinophilic infiltration of the gallbladder, common bile duct, intrahepatic bile ducts, and bone marrow was observed. Eosinophilic cholangitis, a rare inflammatory condition that clinically resembles a biliary malignancy, should be taken into consideration in the differential diagnosis in the evaluation of presumed neoplasm of the bile ducts.     

Metastatic melanoma to the common bile duct causing obstructive jaundice： A case report

Metastatic melanoma to the common bile duct is very rare with only 18 cases reported so far. We report a 46 year old women who, 18 mo after excision of a skin melanoma, developped a painless progressive obstructive jaundice. At operation a melanoma within the distal third of the common bile duct was found. There were no other secondaries within the abdomen. The common bile duct, including the tumor, was resected and anastomosed with Roux-en-Y jejunal limb. The patient survived 31 mo without any sign of local recurrence and was submitted to three other operations for axillar and brain secondaries, from which she finally died. Radical resection of metastatic melanoma to the common bile duct may result in lifelong relief of obstructive jaundice. It is safe and relatively easy to perform. In other cases, a less aggressive approach, stenting or bypass procedures, should be adopted.     

对阻塞性黄疸行胆道活检的临床研究

目的探索一条胆道活检新途径，依据病理指导临床治疗阻塞性黄疸。方法在经皮肝穿刺胆管引流术(PTCD)过程中，82例阻塞性黄疸经经皮肝穿刺胆道造影术(PTC)途径向胆道内送入8F鞘管，引入活检钳和毛刷对梗阻段胆道钳夹活检和毛刷刷取获得标本，行组织学和细胞学检查。并进行x^2检验。结果82例胆道钳夹组织块的技术成功率为97．6％，活检中未发生严重并发症。82例钳夹活检中72例获得组织学诊断，钳夹病理学敏感率为87．8％。胆管癌钳夹活检敏感率较非胆管恶性肿瘤高(x^2=4．067，P=0．044)。74例毛刷刷取中56例获得细胞学诊断，诊断敏感率为75．7％；钳夹病理学敏感率较毛刷高，差异有显著性(x^2=3．886，P=0．049)，毛刷活检可作为钳夹活检的一种补充。结论PTC下胆道钳夹活检操作简单，技术成功率高，创伤小且并发症少，病理学诊断敏感性高，是值得推广的胆道病理学诊断新途径。     

Neuroma of the common bile duct: a rare cause of jaundice

We report a case of neuroma of the main bile duct arising twenty years after cholecystectomy. The patient, a 82-year-old woman, was admitted for jaundice. Endoscopic retrograde cholangiography showed a regular stenosis of the main bile duct. Histologic examination demonstrated neuroma. Based on the analysis of this and 15 other previously published cases, the following features of bile duct neuroma were outlined: a) variable interval between cholecystectomy and the onset of jaundice (6 months to 35 years); b) the generally complicated postoperative course, c) the various localizations on the biliary tree (cystic, main bile duct, intrahepatic bile duct) and, d) the circumstances of onset.     

Tuberculosis of the bile duct: a rare cause of obstructive jaundice.

Tuberculosis of the bile duct is extremely rare. Patients with this condition usually present with a protracted illness and obstructive jaundice, which may be confused with hepatobiliary malignancies. A retrospective review of hospital records of patients who presented with tuberculosis of the bile duct between January 1986 and December 1996 was undertaken, and data were obtained concerning clinical presentation, investigations, treatment, and follow-up. Four patients (one man and three women) with a mean age of 44.8 years had tuberculosis of the bile duct. Diagnostic imaging techniques showed bile duct dilation in all four patients. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stricture in the proximal common bile duct (CBD) in one patient, a stricture in the distal CBD in one patient, a stricture in the common hepatic duct (CHD) in one patient, and multiple strictures in the CHD and left intrahepatic duct in one patient. Bile cytology and fine-needle aspiration identified correctly the diagnosis in each patient. Two patients underwent laparotomy with the initial suspicion of cholangiocarcinoma; the correct diagnosis was made based on frozen sections taken intraoperatively. One patient was treated with endoscopic stenting and three patients underwent laparotomy for bile duct obstruction. All patients received antituberculous therapy. There were no deaths; all patients remained healthy at a mean follow-up of 36.5 months. It is important to obtain a tissue diagnosis in all patients with obstructive jaundice to avoid missing this rare but curable disease. The treatment of tuberculosis of the bile duct involves relief of the bile duct obstruction and antituberculous therapy.     

A common bile duct web in association with common bile duct stone]

Webs are diagnosed by their characteristic appearance on imaging studies, typically appearing as thin, radiolucent rings with or without dilatation of the organ proximal to it. Like in other organs, the etiology of webs in the common bile duct is controversial. Some webs are thought to be congenital, whereas others occur in the presence of chronic inflammation, suggesting a pathogenic relationship. We report a case of a common bile duct septum in association with numerous large black pigment stones in a 62-year-old woman. The patient was treated by cholecystectomy with T-tube insertion.     

Obstructive jaundice caused by blastomycosis of the lymph nodes around the common bile duct

A case of obstructive jaundice due to granulomatous blastomycosis is presented. The patient had complained of abdominal pain in the right hypochondrium and jaundice. During hospitalization, the laboratory tests showed evidence of obstructive jaundice and complementary tests a distended gallbladder, dilatation of the intra and extrahepatic bile ducts with enlarged lymph nodes of the hepatic hilus. During the operation a cholestatic liver, distended gallbladder and enlarged lymph nodes around the common bile duct were found. Histopathology of the lymph nodes revealed South American blastomycosis. The medical management consisted of amphotericin B. At present the patient is alive and well.     

Obstructive jaundice due to a textiloma mimicking a common bile duct stone

A foreign body is a rare cause of obstructive jaundice. We report a 19-year-old woman with jaundice caused by a surgical gauze in the common bile duct (CBD). Four yours earlier, she had undergone a cholecystectomy and drainage for hydatid disease of the liver. Her postoperative course was complicated by a biliary fistula that healed after 50 days. She now presented with obstructive jaundice of 2 weeks' duration. Magnetic resonance cholangiopancreatography (MRCP) showed a signal-void mass, consistent with a CBD stone. Surgical exploration of the CBD revealed a surgical gauze as the cause of the obstruction. To the best of our knowledge, this is the first case of a surgical gauze obstructing the CBD requiring surgical removal.