Gülten Can SEZGİN, Alper YURCİ, Eylem SEVİNÇ, Kemal DENİZ, Derya KARADEMİR, Zeki YILMAZ

Koledok kistlerinden kaynaklanan kolanjiokarsinom: Olgu Sunumları

Koledok kistleri safra kanallarının doğuştan dilatasyonudur ve aralıklı safra tıkanıklığına neden olabilir. Erken tanı ve tedavi edilmediğinde safra akı-mının bozulmasına; kronik karaciğer hasarı, fibrozis ve sonuçta biliyer siroza neden olabilir. Genellikle pediatrik popülasyonda tanısı konulmasına rağmen, %20-30 oranında erişkin yaş grubunda tespit edilebilir. Kadınlarda daha sık görülmektedir. Rezeke edilmeyen koledok kistlerinde kolanjiyokarsinom riski artmıştır. Tedavi koledok kistinin çıkarılması ve bilioenterik anastomozu içerir. Bu makalede rezeke edilmemiş koledok kistine bağlı geli-şen kolanjiyokarsinomlu iki olgu bildirildi.

Anahtar Kelimeler:

Kolanjiokarsinom, koledok kisti, sarılık

Cholangiocarcinoma arising in choledochal cysts: Case reports

Choledochal cysts are congenital dilations of the biliary ducts that may be associated with intermittent biliary obstruction. If the condition goes unrecognized and uncorrected, the impaired bile outflow can lead to chronic hepatic injury, fibrosis, and ultimately, biliary cirrhosis. Although typically diagnosed in the pediatric population, as many as 20-30% of choledochal cysts can be discovered in adulthood. There is a female predominance. Unresected choledochal cyst is clearly associated with increased risk of cholangiocarcinoma. Treatment includes surgical removal of the choledochal cyst and bilioenteric anastomosis. In this article, we report two cases of cholangiocarcinoma occurring in an unresected choledochal cyst.

Keywords:

Cholangiocarcinoma, choledochal cyst, jaundice,

PDF

___

Mahendra SB, Hasmukh BV, Venugopal HG. Choledochal cysts: a re- view of literature. Saudi J Gastroenterol 2012;18:230-6.
Miyano T, Yamataka A. Choledochal cysts. Curr Opin Pediatr 1997;9:283-8.
Kim HJ, Kim MH, Lee SK, et al. Normal structure, variations, and anom- alies of the pancreaticobiliary ducts of Koreans: a nationwide coopera- tive prospective study. Gastrointest Endosc 2002;55:889-96.
Lipsett PA, Pitt HA, Colombani PM, et al. Choledochal cyst disease. A changing pattern of presentation. Ann Surg. 1994;220:644-52.
Jan F, Michael LN, Jon BM. Choledochal cyst cholangiocarcinoma aris- ing from adenoma: case report and a review of the literature. Curr Surg 2006;63:281-4.
Lenriot JP, Gigot JF, Segol P, et al. Bile duct cysts in adults: a multi-insti- tutional retrospective study. French Associations for Surgical Research. Ann Surg 1998;228:159-66.
Singham J, Schaeffer D, Yoshida E, et al. Choledochal cysts: analysis of disease pattern and optimal treatment in adult and paediatric patients. HPB. (Oxford) 2007;9:383-7.
Alonso-Lej F, Rever WB, Pessagno DJ. Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases. Int Abstr Surg 1959;108:1-30.
Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts: clas- sification, operative procedures, and review of thirty-seven cases includ- ing cancer arising from choledochal cyst. Am J Surg. 1977;134:263-9.
Miyano T, Yamataka A, Kato Y, et al. Hepaticoenterostomy after excision of choledochal cyst in children: a 30-year experience with 180 cases. J Pediatr Surg 1996;31:1417-21.
Atkinson HDE, Fischer CP, Jong CHC, et al. Choledochal cysts in adults and their complications. HPB (Oxford) 2003;5:105-10.
Gong L, Qu Q, Xiang X, et al. Clinical analysis of 221 cases of adult choledochal cysts. Am Surg 2012;78:414-8.
Germani M, Liberto D, Elmo G, et al. Choledochal cyst in pediatric pa- tients: a 10-year single institution experience. Acta Gastroenterol Lati- noam 2011;41:302-7.
Chaturvedi A, Singh JP, Rastogi V. Case report: cholangiocarcinoma in a choledochal cyst. Indian J Radiol Imaging 2008;18:236-8.
Chiang L, Chui CH, Low Y, et al. Perforation: a rare complication of choledochal cysts in children. Pediatr Surg Int 2011;27:823-7.
Shimotakahara A, Yamataka A, Yanai T, et al. Roux-en-Y hepaticojeju- nostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst: which is better? Pediatr Surg Int 2005;21:5-7.
Ulas M, Polat E, Karaman K, et al. Management of choledochal cysts in adults: a retrospective analysis of 23 patients.Hepatogastroenterology 2011;2:115-6.
Lee HL, Yeung CY, Fang SB, et al. Biliary cysts in children – long-term follow-up in Taiwan. J Formosan Med Assoc 2006;105:118-24.
Rattan KN, Magu S, Ratan S, et al. Choledochal cyst in children: 15 year experience. Ind J Gastroenterol 2005;24:178.
Ananda U, Rajeev N, Priyadarshib BK. A giant type IVA choledochal cyst. Case report. Ann Gastroenterol 2011;24:1-3.
Tyson GL, ElSerag HB. Risk factors for cholangiocarcinoma. Hepatology 2011;54:173-84.
Jordan PH, Goss JA, Rosenberg WR, et al. Some considerations for man- agement of choledochal cysts. Am J Surg 2004;187:790-5.
Fitoz S, Erden A, Boruban S. Magnetic resonance cholangiopancrea- tography of biliary system abnormalities in children. Clin Imaging 2007;31:93-101.
Slattery JM, Sahani DV. What is the current state-of-the-art imaging for detection and staging of cholangiocarcinoma? Oncologist 2006;11:913- 22.
Price L, Kozarek R, Agoff N. Squamous cell carcinoma arising within a choledochal cyst. Dig Dis Sci 2008;53:2822-5.
Lee TS, Kim HK, Ahn HM, et al. A case of early bile duct cancer aris- ing from villous adenoma in choledochal cyst. Korean J Gastroenterol 2009;54:55-9.
Jan YY, Chen HM, Chen MF. Malignancy in choledochal cysts. Hepato- gastroenterology 2000;47:337-40.
Witzigmann H,Lang H, Lauer H. Guidelines for palliative surgery of cholangiocarcinoma. HPB (Oxford) 2008;10:154-60.
Witzigmann H, Berr F, Ringel U, et al. Surgical and palliative manage- ment and outcome in 184 patients with hilar cholangiocarcinoma: pal- liative photodynamic therapy plus stenting is comparable to r1/r2 resec- tion. Ann Surg 2006;244:230-9.
Boland B, Kim A, Nissen N, et al. Cholangiocarcinoma: aggressive surgi- cal intervention remains justified. Am Surg 2012;78:157-60.