Bile duct tumor

Shibahara H, Tamada S, Goto M, et al. Pathologic features of mucin-producing bile duct tumors two histopathologic categories as counterparts of pancreatic intraductal papillary-mucinous neoplasms. Am J Surg Pathol. 2004 28 327-338. 

In 2-year gavage studies there was some evidence of carcinogenic activity in male rats based on increased incidences of cholangiocar-cinomas and bile duct dysplasia and fibrosis. There was also some evidence of carcinogenicity in female mice based on increased incidences of hepatocellular adenomas. Male mice showed clear evidence of carcinogenicity based on increased incidences of hepatocellular adenomas and carcinomas. The development of liver tumors may be related to the chronic inflammatory effects noted at this site. In another experiment with hamsters, exposure to furfural vapor 7 hours/day, 5 days/week for 1 year caused irritation of the nasal mucosa and growth retardation but no evidence of carcinogenic effects. ... 

No excess of cancer was reported in two follow-up smdies of affected individuals in Turkey about 20-30 years after consumption of contaminated grain had ceased. " In mice, liver tumors were observed after exposure to HCB at 12-24mg/kg/day in the diet, but not at 6mg/kg/day. Hepatomas, hepatocellular carcinomas, bile duct adenomas, and renal cell adenomas were observed in rats after dietary administration." Liver tumors were also observed in 100% of surviving females and 16% of males after dietary administration to rats for 90 weeks. In another study, increased incidence of parathyroid adenomas and adrenal pheochromocytomas were observed in male and female rats and liver neoplastic nodules in females of the Ei generation in a two-generation feeding study. 

In chronic studies rats fed 1000 ppm MOCA in a standard diet for 2 years developed lung tumors there were 2 5 adenomatoses and 48 adenocarcinomas in 88 rats. Accompanying liver changes included hepatocytomegaly, necrosis, bile duct proliferation, and fibrosis. In 88 control animals, there were two lung adenomatoses. MOCA in a low-protein diet caused lung tumors in rats of both sexes, liver tumors in males, and malignant mammary tumors in females. 

Chronic oral exposure of rats and mice to MDA and its dihydrochloride is carcinogenic. Treatment-related increases in the incidences of thyroid follicular cell adenomas and hepatocellular neoplasms were observed in mice after chronic ingestion of MDA in drinking water. In rats, increases in the incidences of thyroid follicular cell carcinoma and hepatic nodules were observed in males and thyroid follicular cell ademonas occurred in females. Although not statistically significant, certain uncommon tumors such as bile duct adenomas, papillomas of the urinary bladder, and granulosa cell tumors of the ovary also were reported. These tumors are of low incidence in historical controls. In another report, MDA acted as a promoter of thyroid tumors in rats. °... 

Tumor limited to the pancreas s 2 cm in greatest dimension Tumor limited to the pancreas > 2 cm in greatest dimension Tumor extends directly into any of the following duodenum, bile duct, peripancreatic tissue Tumor extends directly into any of the following stomach, spleen, colon, adjacent large vessels... 

Obstructive jaundice, as the name implies, is caused by blockage of the bile duct by a gallstone or a tumor (usually of the head of the pancreas). 

Normally there is very little fat in the feces. However, fat content in stools may increase because of various fat malabsorption syndromes. Such increased fat excretion is steatorrhea. Decreased fat absorption may be the result of failure to emulsify food contents because of a deficiency in bile salts, as in liver disease or bile duct obstruction (stone or tumor). Pancreatic insufficiency may result in an inadequate pancreatic lipase supply. Finally, absorption itself may be faulty because of damage to intestinal mucosal cells through allergy or infection. An example of allergy-based malabsorption is celiac disease, which is usually associated with gluten intolerance. Gluten is a wheat protein. An example of intestinal infection is tropical sprue, which is often curable with tetracycline. Various vitamin deficiencies may accompany fat malabsorption syndromes. 

Other enzymes are also useful indices of liver pathology. Serum alkaline phosphatase is often a useful indicator of liver and bone disease. The alkaline phosphatases are a diverse group of enzymes that catalyze reactions in which a phosphate is removed from a phosphate ester, especially at an alkaline pH. Physicians don t care about this. They do care that serum alkaline phosphatase levels often rise with bone breakdown (as in tumor infiltration) and in liver disease, especially where tliere is obstruction of the bile duct. Acid phosphatase is particularly rich in the prostate. A rise in its serum levels provides a test as to the presence of prostate carcinoma. This test has largely been replaced by assay for Prostate Specific Antigen (PSA), a serine protease that is elevated in prostatic carcinoma. 

Blockage of the bile duct caused by problems such as cholesterol-containing gallstones or duodenal or pancreatic tumors can lead to an inadequate concentration of bile salts in the intestine. Digestion and absorption of dietary lipids is diminished. Certain diseases that affect the pancreas can lead to a decrease in bicarbonate and digestive enzymes in the intestinal lumen. (Bicarbonate is required to raise the intestinal pH so that bile salts and digestive enzymes can function.) If dietary fats are not adequately digested, steatorrhea may result. Malabsorption of fats can lead to caloric deficiencies and lack of fat-soluble vitamins and essential fatty acids. 

Chemically induced liver tumors may arise from hepatocytes, bile duct cells, or sinusoidal lining cells (angiosarcoma). Susceptibility to liver tumors differs... 

There is sufficient evidence of carcinogenicity in animals. Repeated dietary administration has produced liver cell tumors in mice and bile duct and liver tumors in rats. Cirrhosis has also been observed in both rats and mice. Thioacetamide is a developmental toxin. 

Despite its ubiquitous distribution, serum NTP activities appear to reflect hepatobiliary disease with considerable specificity. NTP is increased threefold to sixfold in those hepatobiliary diseases in which there is interference with the secretion of the bile. This may be due to extrahepatic causes (a stone or tumor occluding the bile duct), or it may arise from intrahepatic conditions, such as cholestasis caused by chlorpromazine, malignant infiltration of the liver, or bihary cirrhosis. When parenchymal cell damage is predominant, as in infectious hepatitis, serum NTP activity is only moderately elevated. 

Granulomas Primary bdiary cirrhosis Bile duct paucity Tumors... 

Obstruction of the common bile duct by stones or tumors usually leads to hyperphosphatasemia (H14). (See also Section 7.6.1.) Values of between 3 and 10 times the upper reference limit are usually found (see Fig. 10). 

Mesothelin is a 40-kD glycoprotein of unknown function that is strongly expressed in mesothelial cells, ovarian serous cells, and pancreatic-bile duct cells. Using monoclonal antibody 5B2, Ordonez found it to immu-nostain normal mesothelial cells, mesotheliomas, non-mucinous ovarian carcinomas, and occasionally other neoplasms. Ordonez concluded that mesothelin staining could be used to diagnose mesotheliomas, although it was expressed in 14 of 14 ovarian carcinomas, 12 of 14 pancreatic ductal adenocarcinomas, 7 of 12 desmoplastic small round cell tumors, and 9 of 9 synovial sarcomas. Therefore, this antibody should be interpreted carefully. 

Granular cell tumors are not too uncommon in the EHBT, especially in the common bile duct, and may be multicentric or coexist with granular cell tumors in other sites such as skin. These have the characteristic morphologic features of granular cell tumors arising elsewhere and are immunoreactive to S-100, NSE, Leu-7 (CD57), and vimentin. > ... 

Albores-Saavedra J, Henson DE, Klimstra DS. Tumors of the gallbladder, extrahepatic bile ducts and ampulla of Vater. 3rd ed. Washington D.C American Registry of Pathology 2000. 

Barron-Rodriguez LP, Manivel JC, Mendez-Sanchez N, Jessu-run J. Carcinoid tumor of the common bile duct evidence for its origin in metaplastic endocrine cells. Am J Gastroenterol. 1991 86 1073-1076. 

Cytokeratins (CKs) are a family of intracytoplasmic intermediate filament proteins present in almost all epithelia. Expression of each CK molecule depends on cell type and differentiation status, and therefore specific CKs can be used as markers to identify particular types of epithelial tumors (Table 16.5). CK7 is found in a wide variety of epithelia including the columnar and glandular epithelium of the lung, cervix, and breast, as well as in the bile duct, collecting ducts of the kidney, urothelium, and mesothelium, but not in most gastrointestinal epithelium, hepatocytes, proximal and distal tubules of the kidney, and squamous epithelium. In contrast, CK20 shows relatively restricted expression and is present in gastrointestinal epithelium, Merkel cells of the epidermis, and urothelium. 

Cytokeratin 20 (CK20) is a type I acidic low molecular weight cytokeratin that was initially described in 1992. 1 It is found in normal tissues of the stomach, intestine, urothelium, and in Merkel cells. It is found in most adenocarcinomas of the large and small intestines, in mucinous tumors of the ovary, and in Merkel cell carcinomas, and it is frequently present in urothelial carcinoma and in adenocarcinomas of the stomach, pancreas, and bile ducts. It is a useful marker for primary mucinous tumors of the ovary and for various types of metastases that are found in the ovaries. 

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