title: Cholangiocellular carcinoma depending on the kind of intrahepatic calculi in patients with hepatolithiasis.
abstract: OBJECTIVE
  Association of cholangiocellular carcinoma in patients with hepatolithiasis has been reported. However, its incidence depending on the kind of stones is obscure. The aim was to examine the association rate of cholangiocellular carcinoma in patients with hepatolithiasis with a special reference to the kind of intrahepatic stones.
  
  
  METHODS
  One hundred and thirty-nine patients with hepatolithiasis who have been treated from 1973 to 1997 were retrospectively reviewed to examine the characteristics of cholangiocellular carcinoma. The type and location of intrahepatic calculi were analyzed.
  
  
  RESULTS
  Cholangiocellular carcinoma was found in 8 of 139 patients, the incidence being 5.8%. The incidence of carcinoma was more than twice in patients whose stones were located in intrahepatic bile duct only (9.3%; 5/54) than in those located in both intrahepatic and extrahepatic bile duct (3.5%; 3/85). Of 121 patients excluding 18 whose calculi were not available for classification, the kind of intrahepatic calculi was brown pigment in 106 patients (87.6%), cholesterol in 10 (8.3%), black pigment in 4, and fatty acid calcium in one. Cholangiocellular carcinoma was associated in 3 (2.8%) of 106 patients with brown pigment stones, 3 (30%) of 10 with cholesterol stones, in one with fatty acid calcium stones, and one patient whose stone was not available for analysis. The association rate of cancer was significantly (P < 0.01) higher in patients with cholesterol stones than those with brown pigment stones. One patient survived for 24 months after left lobectomy but the others died within six months.
  
  
  CONCLUSIONS
  An early and attentive evaluation for the possible presence of cholangiocellular carcinoma is mandatory not only in patients with brown pigment stones but also in those with intrahepatic cholesterol stones.
authors.affiliation: Department of Surgery 1, Kyushu University Faculty of Medicine, Fukuoka, 812-8582, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chijiiwa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ohtani
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Noshiro
authors.forename: Toru
authors.initials: T
authors.lastname: Yamasaki
authors.forename: Shuji
authors.initials: S
authors.lastname: Shimizu
authors.forename: Koji
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002769:Cholelithiasis / Q000737:chemistry / Q000145:classification* / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002784:Cholesterol / Q000032:analysis; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D002784:Cholesterol