Down stream involvement of the bile duct in hepatolithiasis.
OBJECTIVE
To evaluate the down stream involvement of the bile duct in hepatolithiasis.


METHODS
Mechanical damage to bile duct epithelia and long standing cholangitis as result of hepatolithiasis play an important role in the carcinogenesis of bile duct epithelia and stricture of the intra- and extra-hepatic bile duct. Macromorphological and microscopic changes in bile duct mucosa of 100 consecutive patients with hepatolithiasis were investigated using intra- or post-operative cholangioscopy. Biopsy specimens of lesions obtained during cholangioscopy were studied with immunohistochemical staining and flow cytometry to determine proliferative activity and DNA content. Five cases of well-proven cholangiocarcinoma were simultaneously studied as controls.


RESULTS
Of the 100 patients, those with chronic cholangitis accounted for 86% (86/100), proliferative lesions 11% (11/100), adenomatous polyps 1% (1/100), and adenocarcinoma 2% (2/100). The obvious mucosal lesion associated with hepatolithiasis was located down-stream of the bile duct, predominantly in the hilar region, e.g. orifices of the right/left hepatic duct and common hepatic duct (73% mucosa lesions in the hilar region). The intensity of cancer embryonic antigen stain and the proliferative cell nuclear antigen index increased with the development of bile duct lesions. Aneuploid DNA presented mainly in the high degree malignant adenocarcinomas (> 80% of cases).


CONCLUSIONS
The obvious mucosal lesions associated with hepatolithiasis were located down-stream of the bile duct, predominantly in the hilar region (73% of mucosal lesions). The proliferative activity of examined bile duct mucosa lesions increased with the development of pathological deterioration, which may contribute to the development of hilar bile duct stricture and hilar cholangiocarcinoma.
Lu
Shichun
S
Department of Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. lushichu@mail.sc.cninfo.net
Yan
Lünan
L
Rao
Linqiang
L
Xia
Tian
T
Gou
Jianlin
J
Zhang
Shiyu
S
Lei
Song
S
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000473:pathology*; D002272:Carcinoembryonic Antigen / Q000032:analysis; D018281:Cholangiocarcinoma / Q000209:etiology; D006801:Humans; D020347:Lithiasis / Q000150:complications / Q000473:pathology*; D008107:Liver Diseases / Q000150:complications / Q000473:pathology*; D008875:Middle Aged; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis
D002272:Carcinoembryonic Antigen; D018809:Proliferating Cell Nuclear Antigen