Prospective evaluation of common hepatic duct histopathology at the time of choledochal cyst excision ranging from children to adults.

Autor: Nikai K; Department of Pediatric Surgery, Juntendo Urayasu Hospital, Chiba, Japan., Koga H; Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. h-koga@juntendo.ac.jp., Suda K; Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan., Miyahara K; Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan., Lane GJ; Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan., Arakawa A; Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan., Fukumura Y; Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan., Saiura A; Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan., Hayashi Y; Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan., Nagakawa Y; Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan., Okazaki T; Department of Pediatric Surgery, Juntendo Urayasu Hospital, Chiba, Japan., Takishita C; Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.; Department of Surgery, Toda Chuo General Hospital, Saitama, Japan., Yanai T; Department of Pediatric Surgery, Ibaraki Children's Hospital, Ibaraki, Japan., Yamataka A; Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Jazyk: angličtina
Zdroj: Pediatric surgery international [Pediatr Surg Int] 2023 Nov 30; Vol. 40 (1), pp. 15. Date of Electronic Publication: 2023 Nov 30.
DOI: 10.1007/s00383-023-05589-6
Abstrakt: Purpose: To evaluate common hepatic duct just distal to the HE anastomosis (d-CHD) prospectively for mucosal damage, inflammation, fibrosis, dysplasia, carcinoma in situ, malignant transformation, effects of serum amylase, and symptoms at presentation in CC cases ranging from children to adults.
Methods: Cross-sections of d-CHD obtained at cyst excision 2018-2023 from 65 CC patients; 40 children (< 15 years old), 25 adults (≥ 15) were examined with hematoxylin and eosin, Ki-67, S100P, IMP3, p53, and Masson's trichrome to determine an inflammation score (IS), fibrosis score (FS), and damaged mucosa rate (DMR; damaged mucosa expressed as a percentage of the internal circumference).
Results: Mean age at cyst excision ("age") was 18.2 years (range: 3 months-74 years). Significant inverse correlations were found for age and DMR (p = 0.002), age and IS (p = 0.011), and age and Ki-67 (p = 0.01). FS did not correlate with age (p = 0.32) despite significantly increased IS in children. Dysplasia was identified in a 4-month-old girl with cystic CC. Serum amylase was elevated in high DMR subjects.
Conclusions: High DMR, high IS, and evidence of dysplasia in pediatric CC suggest children are at risk for serious sequelae best managed by precise histopathology, protocolized follow-up, and awareness that premalignant histopathology can arise in infancy.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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