title: Changes in laboratory test results and diagnostic imaging presentation before the detection of occupational cholangiocarcinoma.
abstract: OBJECTIVE
  A cholangiocarcinoma outbreak among workers of an offset color proof-printing department in a printing company was recently reported. It is important to understand the clinical course leading to occupational cholangiocarcinoma development for investigation of the carcinogenesis process and for surveillance and early detection. We evaluated the changes in laboratory test results and diagnostic imaging presentation before the detection of cholangiocarcinoma.
  
  
  METHODS
  We investigated the changes in laboratory test results and diagnostic imaging presentation before the detection of cholangiocarcinoma in 2 patients because the data were available. Results The clinical courses observed in the 2 participating patients showed persistent elevation of serum γ-glutamyl transpeptidase levels with or without elevated serum levels of alanine aminotransferase and/or aspartate aminotransferase before cholangiocarcinoma detection. Dilatation of the bile ducts without tumor-induced stenosis was observed several years before cholangiocarcinoma detection and progressed gradually in both patients. The serum concentration of carbohydrate 19-9 also increased prior to cholangiocarcinoma detection in both patients. Eventually, observation of stenosis of the bile duct and a space-occupying lesion strongly suggested cholangiocarcinoma. Pathological examination of the resected specimens showed chronic bile duct injury and neoplastic lesions, such as "biliary intraepithelial neoplasia" and "intraductal papillary neoplasm of the bile duct" in various sites of the bile ducts, particularly in the dilated bile ducts.
  
  
  CONCLUSIONS
  The changes in laboratory test results and diagnostic imaging might be related to the development of cholangiocarcinoma. It is important to monitor diagnostic imaging presentation and laboratory test results in workers with extended exposure to organic solvents.
authors: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine.
authors: Shoji
authors: S
authors: Kubo
authors: Shigekazu
authors: S
authors: Takemura
authors: Chikaharu
authors: C
authors: Sakata
authors: Yorihisa
authors: Y
authors: Urata
authors: Takayoshi
authors: T
authors: Nishioka
authors: Akinori
authors: A
authors: Nozawa
authors: Masahiko
authors: M
authors: Kinoshita
authors: Genya
authors: G
authors: Hamano
authors: Yasuni
authors: Y
authors: Nakanuma
authors: Ginji
authors: G
authors: Endo
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001650:Bile Duct Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001652:Bile Ducts / Q000503:physiopathology; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016273:Occupational Exposure / Q000009:adverse effects; D011327:Printing; D012997:Solvents / Q000009:adverse effects; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D012997:Solvents; C578959:carbohydrate antigen 199, human; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase