title: Case series of 17 patients with cholangiocarcinoma among young adult workers of a printing company in Japan.
abstract: BACKGROUND
  An outbreak of cholangiocarcinoma occurred among workers in the offset color proof-printing department at a printing company in Japan. The aim of this study was to clarify the characteristics of the patients with cholangiocarcinoma.
  
  
  METHODS
  This was a retrospective study conducted in 13 Japanese hospitals between 1996 to 2013. The clinicopathological findings of cholangiocarcinoma developed in 17 of 111 former or current workers in the department were investigated. Most workers were relatively young.
  
  
  RESULTS
  The cholangiocarcinoma was diagnosed at 25-45 years old. They were exposed to chemicals, including dichloromethane and 1,2-dichloropropane. The serum γ-glutamyl transpeptidase activity was elevated in all patients. Dilated intrahepatic bile ducts without tumor-induced obstruction were observed in five patients. The cholangiocarcinomas arose from the large bile ducts. The precancerous or early cancerous lesions, such as biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile ducts, as well as non-specific bile duct injuries, such as fibrosis, were observed in various sites of the bile ducts in all eight patients for whom operative specimens were available.
  
  
  CONCLUSIONS
  The present results showed that cholangiocarcinomas occurred at a high incidence in relatively young workers of a printing company, who were exposed to chemicals including chlorinated organic solvents.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan. m7696493@msic.med.osaka-cu.ac.jp.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.forename: Yasuni
authors.initials: Y
authors.lastname: Nakanuma
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Chikaharu
authors.initials: C
authors.lastname: Sakata
authors.forename: Yorihisa
authors.initials: Y
authors.lastname: Urata
authors.forename: Akinori
authors.initials: A
authors.lastname: Nozawa
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Nishioka
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Genya
authors.initials: G
authors.lastname: Hamano
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Terajima
authors.forename: Gorou
authors.initials: G
authors.lastname: Tachiyama
authors.forename: Yuji
authors.initials: Y
authors.lastname: Matsumura
authors.forename: Terumasa
authors.initials: T
authors.lastname: Yamada
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Shoji
authors.initials: S
authors.lastname: Nakamori
authors.forename: Akira
authors.initials: A
authors.lastname: Arimoto
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kawada
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fujikawa
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Fujishima
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Hideyoshi
authors.initials: H
authors.lastname: Toyokawa
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kuwae
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ohsawa
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Uehara
authors.forename: Kyoko Kogawa
authors.initials: KK
authors.lastname: Sato
authors.forename: Tomoshige
authors.initials: T
authors.lastname: Hayashi
authors.forename: Ginji
authors.initials: G
authors.lastname: Endo
mesh_terms: D000328:Adult; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D017734:Bile Ducts, Extrahepatic / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology*; D011230:Precancerous Conditions / Q000453:epidemiology; D011327:Printing; D012189:Retrospective Studies
keywords: Biliary intraepithelial neoplasia; Cholangiocarcinoma; Intraductal papillary neoplasm of the bile duct; Organic solvent; Printing company