Malignant melanoma metastatic to the common bile duct

Metastatic melanoma is renowned for its propensity to spread to almost every organ of the body; however, symptomatic metastases within the biliary tree are very rare. We report two cases of bile duct obstruction from metastatic melanoma. The first case was caused by an intraluminal metastatic melanoma to the common bile duct, while the second case was caused by extraluminal involvement. The unique aspects of these cases include clinical presentations masquerading as biliary colic, cholangitis and obstructive jaundice. Management and follow up for 3 years is presented. Aspects of medical and surgical management, as well as a review of the world's literature are discussed.     

Primary malignant melanoma of the common bile duct: a case report and literature review

Primary malignant melanoma of the common bile duct is rare. Only seven cases have been described in the literature. Diagnosis is based on failure to find another primary site, histological examination with electron microscopy, and immunohistochemical tests. We describe a new case of primary malignant melanoma of the biliary tract and present a review of previous reports.     

Primary malignant peripheral nerve-sheath tumor of the common bile duct

Primary malignant peripheral nerve-sheath tumors of the common bile duct are extremely rare. To our knowledge, the published literature contains no previous case report of this disease. Here we report on a 58-year-old Japanese woman with a primary malignant peripheral nerve-sheath tumor of the common bile duct, which was completely resected. A hypoechoic mass was identified in the hepatic hilus, using ultrasonography and computed tomography. Endoscopic retrograde cholangiography revealed a smooth stricture and deviation of the common bile duct. Laparotomy exposed a firm mass around the common bile duct that had not invaded the surrounding tissues. Partial resection of the common bile duct and cholecystectomy were performed as the treatment of choice. The final histopathological diagnosis was malignant peripheral nerve-sheath tumor arising from the wall of the common bile duct.     

Malignant metastatic melanoma of common bile duct: virtual CT cholangioscopy findings

Metastases from melanoma to biliary ducts are little known but not so rare, although only a few cases have been previously described. A case of metastasis from amelanotic melanoma to the common bile duct, appearing as a vegetating lesion and diagnosed by spiral computed tomography, using also computed tomography virtual cholangioscopy, is described. The clinical role of computed tomography virtual cholangioscopy is discussed. Metastases from melanoma are recommended to be considered in differential diagnosis of endoluminal soft masses in the biliary ducts.     

Sinistroposition of the gallbladder and the common bile duct

A left lateral bisegmentectomy was performed in a 29-year-old man presenting a primary lymphoma of the liver. Surgical exploration revealed a left-side gallbladder, located under the left lobe of the liver. During hepatic parenchyma dissection, performed strictly at the left of the round ligament and the umbilical portion of the left portal vein, common bile duct was injured. Complete separation of hepatic pedicle structures showed that the upper biliary convergence passed on the left side of the umbilical portion of the left portal vein before reaching the hepatoduodenal ligament. This case report discusses the embryological mechanism that could explain this uncommon bile duct abnormality, focusing on its consequences during left ruled lobectomy.     

Primary lymphoma of the common bile duct

Primary lymphoma of the common bile duct is an extremely rare disease. Only two detailed case reports have been published in the literature. In the present paper, a 68-year-old female with obstructive jaundice and a primary lymphoma of the common bile duct, which was resected, is described in detail because of the rarity of the lesion in the literature. The cholangiogram demonstrated stricture of the common bile duct. The findings at angiography and computed tomography were non-specific, but a hypo-echoic mass filling the lumen of the bile duct was demonstrated by ultrasonography. Subtotal resection of the common bile duct and cholecystectomy was performed as the method of choice, although the frozen section examination was not definitive. The final histological diagnosis was malignant lymphoma of the diffuse, small cleaved cell type. There was no metastasis to dissected regional lymph nodes. External irradiation was effective when recurrent tumors were found six months later. However, the patient developed generalized disease one year after resection. Although combination chemotherapy was effective this time for her lymphadenopathy, she died of pneumonia one year and four months after surgery. It can be postulated that ultrasound would be useful in diagnosing this rare entity, and that adjunctive radiotherapy after resection would be preferable to prevent progression of the disease.     

Primary closure of the common bile duct in open laparotomy for common bile duct stones

It is common these days to treat common bile duct (CBD) stones using endoscopic techniques. However, severe complications sometimes lead to death despite the great benefit of these techniques. If the patient has many and/or large stones, it can take considerable time for duct clearance, and this is associated with high costs. Therefore, we do not hesitate to choose surgical procedures when necessary. In this study, our aim was to evaluate the usefulness of primary closure of the CBD in open laparotomy for CBD stones. Thirty-four patients with CBD stones were operated on by open laparotomy; primary closure was done in 17 patients (group PC), and T-tube insertion was done in 17 (group TT). We compared the patients' medical records, clinical features, laboratory data, complications, and postoperative hospital admission days. There were no significant intergroup differences in patients' medical records, clinical features, or laboratory data, except for the number of CBD stones. There were no differences in complications. All complications were minor and needed no extra care. The number of postoperative hospital admission days showed a significant difference: 18.3 days in group PC and 31.5 in group TT. There are so many methods to treat CBD stones now that the selection of the procedure can be important for the patient's benefit. We prefer primary closure, to get better quality of life postoperatively and to avoid further operations and any severe complications.     

Primary common bile duct carcinoid.

Endoscopic retrograde cholangiography was performed in a 32-year-old man with recurrent episodes of painless jaundice. There was demonstration of a large intraluminal mass causing partial obstruction of the common bile duct. The lesion proved to be a primary carcinoid tumor of the bile duct.     

A solitary tumor of the common bile duct: case report of a metastatic melanoma

Primary malignant melanoma of the bile duct is very rare. We report a case of a malignant melanoma involving the common bile duct in a 41-year-old man. The patient presented to the hospital with an isolated jaundice and underwent pancreaticoduodenectomy. Absolute exclusion of a metastatic tumor is not entirely possible.     

Metachronous double cancer of the gallbladder and common bile duct

We report a rare case of metachronous double cancer of the biliary tract. At age 59 years, a man had undergone a cholecystectomy and resection of the liver bed for gallbladder cancer pathologically diagnosed as papillary adenocarcinoma, in 1997. Four years later, he was admitted to our hospital with jaundice. At first, we suspected lymph node metastasis of the gallbladder cancer along the common bile duct. But abdominal computed tomography demonstrated circular wall thickness of the common bile duct, so primary bile duct cancer was strongly suspected. Thus, extended right hepatectomy and pancreaticoduodenectomy were performed after right portal vein embolization. The pathological diagnosis of the resected specimen was well-differentiated tubular adenocarcinoma, and this case was clarified to be metachronous double cancer. A review of the literature regarding double cancer of the biliary tract is presented following this case report. We showed that half of 30 cases of double cancer of the biliary tract were not associated with pancreaticobiliary maljunction, including all 6 metachronous cases.     

Primary T-cell lymphoma of the common bile duct

Involvement of the gastrointestinal tract is frequently reported among the extranodal sites of non-Hodgkin's lymphoma, but primary lymphoma of the common bile duct is extremely rare. We report the case of a 29-year-old man who presented with obstructive jaundice, leading to the diagnosis of high-grade primary non Hodgkin's T-cell lymphoma, originating from the extrahepatic biliary tract, and confirmed by endosonography and magnetic resonance cholangiography. This patient was treated by sequential chemotherapy without resection and remained in complete remission after one year.     

Primary carcinoma of the gallbladder and the extrahepatic bile duct

The clinical records of 68 patients with primary carcinoma of the gallbladder (39 cases) and the extrahepatic biliary tracts (29 cases) were comparatively reviewed. The survivals with carcinoma of the gallbladder were limited to five patients operated upon because of cholelithiasis and/or cholecystitis. The majority of the cases preoperatively diagnosed as cancer of the gallbladder were not able to undergo radical cholecystectomy. Of seven patients with radically resected tumors among 29 cases with carcinoma of the extrahepatic biliary tracts, only two patients survived and other five died with locally recurrent tumors. This experience reemphasizes the inadequacy of the present diagnosing approaches to the diseases. Therefore, for discovery of the early cases with primary carcinoma of the gallbladder and the extrahepatic biliary tracts, it may be far more important to make more aggressive measures by using newly developed diagnosing tools.     

两种手术方案治疗胆囊结石合并胆总管结石患者效果比较研究

目的 比较开腹手术与腔镜联合手术方案治疗胆囊结石合并胆总管结石患者的疗效。 方法 2015年6月~2017年6月我科收治的胆囊结石合并胆总管结石患者120例,采用随机数字表法将其分为开腹手术治疗60例和腔镜联合胆道镜探查手术治疗60例。 结果 60例开腹组患者均一次性清除结石,而腔镜组1例患者因胆总管结石嵌顿,无法取出,采取体外冲击波碎石后,再行胆道镜取石成功;腔镜组患者手术时间、术中失血量、术后胃肠功能恢复时间和住院时间分别为（110.57±10.87） min、（32.90±3.79） ml、（1.47±0.53） d和（6.72±1.74） d,均显著优于开腹组的（132.73±25.20） min、（84.33±8.31） ml、（3.51±1.05）d和（13.67±3.80） d（P<0.05）;腔镜组患者术后并发症发生率为3.3%,显著低于开腹组的20.0%（P<0.05）。 结论 两种手术方案用于治疗胆囊结石合并胆总管结石患者在结石清除效果方面较为接近,但腔镜联合手术方案的应用可有效减少手术创伤,加快术后康复进程。     

Excretion of metroindazole in human bile. Investigations of hepatic bile, common duct bile, and gallbladder bile

Excretion of metronidazole (MNZ) in the normal and in the diseased biliary tract was investigated in 58 patients after oral or intravenous administration of MNZ. After oral administration MNZ appeared rapidly in hepatic bile, and throughout the period of absorption and elimination almost identical concentrations of MNZ were found in serum and hepatic bile. After intravenous administration no significant differences were found between concentrations of MNZ in common duct bile and serum in the non-obstructed common duct; in common duct obstruction, concentrations of MNZ in common duct bile were 56--99 per cent of corresponding concentrations in serum. MNZ was concentrated in normal gallbladders. In patients with gallbladder stones and preserved function of the gallbladder and in patients with no function of the gallbladder but a patent cystic duct, no significant differences were found between concentrations of MNZ in gallbladder bile, common duct bile, and serum. In most gallbladders with the cystic duct blocked by a stone, no MNZ was found in gallbladder bile.