Desouza Lj

Diagnosis of malignant obstructive jaundice by bile cytology: Results improved by dilating the bile duct strictures ☆ ☆☆ ★ ★★ ♢

The disruption of malignant biliary strictures by dilation could enhance the results of bile cytology. To test this hypothesis, we studied the results of bile cytology in 64 consecutive patients undergoing endoscopic biliary drainage for malignant biliary strictures. Patients included 36 men and 28 women, ages 29 to 79 years. In the control group (n = 15), bile was obtained by aspiration without dilating the biliary stricture. In the dilated group (n = 49), bile was aspirated after dilating the biliary stricture to 10F gauge. The bile was centrifuged, and smears were prepared, stained, and interpreted as malignant, suggestive of malignancy, or not malignant. The biliary obstruction was caused by gallbladder cancer in 33, primary bile duct cancer in 14, pancreatic cancer in 11, and metastasis in 6 patients. Forty patients had obstruction at the bifurcation of the hepatic duct. Malignancy was confirmed by surgery in 14, fine-needle aspiration cytology in 9, presence of metastasis in 19, and a combination of clinical and radiologic studies, endoscopic cholangiopancreatography findings, elevated tumor markers, and follow-up in 22 patients. Bile cytology was positive for malignancy in 4 (26.6%) and 31 (63.3%), suggestive in 1 (6.7%) and 6 (12.2%), and negative in 10 (66.7%) and 12 (24.5%) patients in the control group and the dilated group, respectively (p = 0.028, 95% CI 1.15 and 21.03). Cytology was positive in 73% of gallbladder cancers, 62.5% of bile duct cancers, 40% of pancreatic cancers, and 60% of metastasized cancers after dilation. Two patients had hemobilia, 8 had cholangitis, and 2 had pancreatitis after biliary drainage.(ABSTRACT TRUNCATED AT 250 WORDS)

Solitary rectal ulcer syndrome. Twenty cases seen at an oncology center.

A retrospective study of 20 cases of biopsy-proven solitary rectal ulcer syndrome seen at a large oncology hospital which highlight the clinicopathologic features is presented. Thirty five percent of patients were in their sixth decade and there was a male preponderance of 2.3∶1. All patients presented with anorectal symptoms. Eighty five percent had normal abdominal findings and seventy five percent had positive findings on rectal examinations. Fifty four percent had a diagnosis of carcinoma of the rectum on barium enema studies. On sigmoidoscopy, a solitary ulcer was found in 80 percent; 50 percent had lesions between 6 and 10 cm from the anal verge, and 40 percent had the lesion on the anterior rectal wall. All patients were treated conservatively and 35 percent were disease free at the end of five years, while 30 percent had persisting symptoms.

Pancreatic tuberculosis: an elusive diagnosis

Background Pancreatic tuberculosis is a rare disease. Its presenting features are usually vague and non‐specific, while the radiological features mimic pancreatic malignancy in many cases and pancreatitis in others. Ultrasound‐ or CT‐guided fine‐needle aspiration cytology (FNAC) or biopsy may show caseating granulomatous inflammation but microbiological confirmation may not always be possible. Laparotomy may be required if other investigations prove inconclusive. The response to treatment is good. Case outlines We report two young men with pancreatic tuberculosis. The diagnosis was obtained by FNAC in one and laparotomy in the other. Each patient responded to anti‐tuberculous chemotherapy and is now asymptomatic. Conclusion Tuberculosis should be considered in the differential diagnosis of an obscure pancreatic mass, and the condition is readily curable.

Reoperative pancreaticoduodenectomy for periampullary carcinoma

Background:  Potentially resectable periampullary tumours may not be treated appropriately due to lack of local expertise in both assessment of resectability and resection in referring centres. Tata Memorial Hospital is a major referral centre for oncology and these patients are finally referred to this institution. In carefully selected patients, resection can be accomplished. The purpose of the present paper was to determine the perioperative morbidity and mortality for patients undergoing reoperative pancreaticoduodenectomy at a major comprehensive cancer centre.

Leucine amino peptidase a better indicator of carcinoma of liver, biliary tract and pancreas.

Serum levels of leucine amino peptidase (LAP) was studied along with bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyl transpeptidase (GGT), alkaline phosphatase (ALP) and the ratio of AST/ALT and GGT/AST in 25 healthy subjects and 52 patients with hepatobiliary malignancies of which 12 were with hepatocellular carcinoma, 12 with liver metastasis, 6 with obstructive jaundice, 9 with carcinoma of gall bladder, 6 with carcinoma of pancreas and 7 with periampullary carcinoma. 24 Of the 52 patients studied had jaundice and 28 were without jaundice.LAP as compared to the other enzymes AST, ALT, GGT, ALP and AST/ALT ratio and GGT/AST ratio showed 100% elevation in obstructive jaundice, carcinoma of gall bladder and pancreas and periampullary carcinoma, 91.7% elevation in hepatocellular carcinoma and 83.3% elevation in liver metastasis. On comparing the levels of these enzymes in non jaundiced and jaundiced groups, LAP was elevated in both jaundiced and non jaundiced groups in 95.8% and 92.9% cases respectively whereas the other enzymes AST showed increase from 67.9% to 100%, ALT from 21.4% to 83.3%, GGT from 71.4% to 95.4% and ALP from 82.1% to 100% in non jaundiced and jaundiced groups respectively indicating that LAP rises in hepatic dysfunction due to hepatobiliary malignancy whereas the other liver function enzymes showed increased hepatic dysfunction due to hepatobiliary malignancy with the onset of jaundice thereby indicating that LAP is a better indicator of hepatobiliary malignancy as compared to other enzymes.The quantitative methods used for determination are reliable, accurate, simple, rapid and cost effective and therefore have better application in a clinical setting.

Modified method for determination of serum beta-glucuronidase: A comparative study using P-nitrophenyl glucuronide and phenolphthalein glucuronide as substrate in gastrointestinal tract carcinomas.

Serum beta-glucuronidase activity was estimated by our modified method using two substrates phenolphthalein glucuronide and p-nitrophenyl glucoronide in 49 healthy subjects and 94 patients with gastrointestinal tract (GIT) carcinoma. The correlation coefficient using the two substrates was found to be r=0.8383. The method of Gabor Szasz was modified wherein the incubation time was decreased from 5 hours to 2 hours and the incubation temperature was increased from 25°C to 37°C. The increase in beta-glucuronidase activity in GIT carcinoma appears to be a good biochemical marker in patients with such type of carcinomas, a finding not reported in literature to-date.The modified quantitative method used for estimation of beta-glucuronidase is reliable, accurate, simple and rapid.

Studies on serum amylases in carcinoma of liver, biliary tract and pancreas

Total amylase activity, its isoenzymes and pancreatic to salivary ratio were studied in 33 healthy subjects and 52 patients with hepatobiliary and pancreatic malignancies of which 12 were with hepatocellular carcinoma, 12 with liver metastases, 9 with carcinoma of gall bladder, 6 with obstructive jaundice, 7 with periampullary carcinoma and 6 cases with carcinoma of pancreas.Total amylase was found to be elevated in carcinoma of pancreas and periampullary carcinoma compared to normal whereas in obstructive jaundice the values were decreased significantly (p<0.001). P (Pancreatic) fraction was found to be elevated significantly in all except in carcinoma of pancreas and obstructive jaundice. S (Salivary) fraction was decreased significantly in all except in carcinoma of pancreas. P/S ratio was elevated in hepatocellular carcinoma, obstructive jaundice, metastatic liver disease, gall bladder carcinoma and periampullary carcinoma (p<0.001) but in carcinoma of pancreas P/S ratio was low as compared to normal.This simple test of total serum amylase, P fraction and S fraction, P/S ratio can be utilised in differentiating various hepatobiliary and pancreatic malignancies.