Search PubMed⌕ Search

Biomedical subjects

M F Chen

Publications and source records attributed to M F Chen.

At least 19 recordsLinked to original sources
PubMed2002

Laparoscopic cholecystectomy in 226 cirrhotic patients. Experience of a single center in Taiwan.

BACKGROUND: Since 1987, laparoscopic cholecystectomy (LC) has been widely used as the favored treatment for gallbladder lesions. However, cirrhosis and portal hypertension have been considered relative or absolute contraindications to LC. This study aimed to assess the safety of LC in cirrhotic patients. METHOD: The medical records of 226 cirrhotic patients with gallbladder lesions who had undergone LC from 1991 to 2000 were reviewed, including demographics, severity of cirrhosis, laboratory data, operative morbidity, operative mortality, and hospital stay. Furthermore, the clinical features and outcomes of 4030 patients with gallbladder lesions without cirrhosis that had undergone LC were also summarized for comparison. RESULTS: Of 4256 patients with gallbladder lesions that had undergone LC, 226 (5.6%) had cirrhotic livers. The cirrhotic group patients clearly exhibited the trends of older age, worse liver function, higher blood loss, and higher mortality compared to the noncirrhotic group patients. CONCLUSIONS: This study presents the clinical features and outcomes of 226 cirrhotic patients who underwent LC. LC, once considered contraindicated in patients with cirrhosis, is a feasible procedure for most Child's A and B patients with cholecystolithiasis. Minor morbidity, an acceptable conversion rate, and shorter hospital stay can be achieved by applying LC to treat cirrhotic patients. However, appropriate preoperative preparations and meticulous operative techniques are required to reduce blood loss during laparoscopy and even mortality.

Adolescent↗
PubMed2002

Hepatic resection for hepatocellular carcinoma in Taiwan.

AIMS: We examined the clinical features and outcome of 80 patients with hepatocellular carcinoma (HCC) who had undergone hepatic resection; 32 patients were under 30 years old (younger-HCC), and 48 patients were over 70 years (elderly-HCC). METHODS: Clinical features of 32 cases of younger-HCC (less than 30 years old) and 48 elderly-HCC (over 70 years old) were reviewed between 1986 and 1999. The clinical features, pathological findings and outcome of the younger and elderly HCC patients were summarized for comparison. RESULTS: Of 573 HCC patients who underwent hepatic resection, 32 were younger than 30 years old and 48 older than 70 years. Less hepatitis B infection, higher hepatitis C infection, more liver cirrhosis development, and a higher ICG 15min retention ratio than the younger group. The younger group tended to have a larger tumor size, more major hepatectomy, more operative blood loss during operation, more perioperative blood transfusion, and more recurrence when compared with the elderly-HCC group. The elderly-HCC group had a significantly better disease-free survival rate than the younger-HCC group. The younger-HCC group had a similar overall survival rate to the elderly-HCC group. CONCLUSIONS: These results seem to indicate a possible difference in the HCC carcinogenesis between younger and elderly patients. The overall survival of the younger HCC patients who undergone hepatic resection was as favorable as that of the elderly.

Adult↗
PubMed2001

Efficacy of cholesterol levels and ratios in predicting future coronary heart disease in a Chinese population.

In this study, we assessed the efficacy of various lipid and lipoprotein measurements at baseline for predicting the risk for coronary heart disease (CHD) and determined the associated risk of CHD in subgroups stratified by different lipid and lipoprotein screening strategies to evaluate the adequacy of current total and low-density lipoprotein (LDL) cholesterol-based approaches in lipid management. We analyzed data from the Chin-Shan Community Cardiovascular Cohort study, a Chinese population-based prospective cohort study that began in 1990. During an 8-year follow-up period, 213 of 3,159 participants (6.7%) without CHD (aged > or =35 years) developed CHD. The total cholesterol/high-density lipoprotein (HDL) cholesterol ratio was the most powerful lipoprotein predictor of future CHD (hazard ratio 1.21 for a 1.0 increment in ratio; p <0.001). Subjects with "high-risk" LDL cholesterol levels (>160 mg/dl) and low total cholesterol/HDL cholesterol ratios (< or =5) had an incidence of CHD similar to those with low levels of both LDL cholesterol (< or =130 mg/dl) and total cholesterol/HDL cholesterol ratios (4.9% vs 4.6%). In contrast, subjects with "low-risk" LDL cholesterol levels (< or =130 mg/dl) and high total cholesterol/HDL cholesterol ratios (>5) had a 2.5-fold higher incidence of CHD than those with similar LDL cholesterol levels but low total cholesterol/HDL cholesterol ratios (p <0.001). Compared with using an LDL cholesterol level of 130 mg/dl as the cut-off point, using a total cholesterol/HDL cholesterol ratio of 5 was associated with superior specificity (73% vs 59%, p <0.001) and accuracy (72% vs 58%, p <0.001), and similar sensitivity (50% vs 53%). Our data indicate that current guidelines for lipid management may misclassify subjects with high levels of HDL and LDL cholesterol as well as those with low levels of HDL and LDL cholesterol. Using the ratio of total to HDL cholesterol as the initial screening tool can obviate this discrepancy.

Adult↗
PubMed2001

Mice deficient in methylenetetrahydrofolate reductase exhibit hyperhomocysteinemia and decreased methylation capacity, with neuropathology and aortic lipid deposition.

Hyperhomocysteinemia, a risk factor for cardiovascular disease, is caused by nutritional and/or genetic disruptions in homocysteine metabolism. The most common genetic cause of hyperhomocysteinemia is the 677C-->T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene. This variant, with mild enzymatic deficiency, is associated with an increased risk for neural tube defects and pregnancy complications and with a decreased risk for colon cancer and leukemia. Although many studies have reported that this variant is also a risk factor for vascular disease, this area of investigation is still controversial. Severe MTHFR deficiency results in homocystinuria, an inborn error of metabolism with neurological and vascular complications. To investigate the in vivo pathogenetic mechanisms of MTHFR deficiency, we generated mice with a knockout of MTHFR: Plasma total homocysteine levels in heterozygous and homozygous knockout mice are 1.6- and 10-fold higher than those in wild-type littermates, respectively. Both heterozygous and homozygous knockouts have either significantly decreased S-adenosylmethionine levels or significantly increased S-adenosylhomocysteine levels, or both, with global DNA hypomethylation. The heterozygous knockout mice appear normal, whereas the homozygotes are smaller and show developmental retardation with cerebellar pathology. Abnormal lipid deposition in the proximal portion of the aorta was observed in older heterozygotes and homozygotes, alluding to an atherogenic effect of hyperhomocysteinemia in these mice.

Animals↗
PubMed2001

Angiomyolipoma of the liver.

BACKGROUND AND OBJECTIVES: Angiomyolipoma is a rare benign tumor that occurs in the liver and other organs. We provide data on eight cases of hepatic angiomyolipoma, regarding clinical presentations, diagnoses, management, and prognosis. METHODS: A retrospective review of medical records of the eight patients with hepatic angiomyolipoma treated at the Chang Gung Memorial Hospital-Taipei between October 1988 and October 1999. RESULTS: Eight female patients with hepatic angiomyolipoma were identified, with ages ranging from 30 to 66 years (mean, 45.3 years). Abdominal pain was the most common symptom, occurring in six of eight patients (75%). Hepatocellular carcinoma was the most common preoperative diagnosis, occurring in three of eight patients (37.5%). Laparotomy was performed in seven of eight patients (87.5%). Among these seven patients, three patients (43%) received hepatic resection with 100% cure rate to date. One of the eight patients (12.5%) was closely follow up after diagnosis made by echo-guided needle biopsy. CONCLUSIONS: Hepatic angiomyolipoma is a rare and benign entity. It has a wide variation and poses a diagnostic challenge clinically, radiologically, and pathologically. Its prognosis is good regardless of management, including hepatic resection or conservative treatment after tissue biopsy by echo-guided needle. To alleviate the mass effect, surgical resection may be needed for hepatic angiomyolipoma in selected cases.

Abdominal Pain↗
PubMed2001

Nonfunctioning malignant pheochromocytoma associated with dermatomyositis: case report and literature review.

A 42-year-old man with dermatomyositis presented with right-upper-quadrant dull pain and normal blood pressure for 10 days. Abdominal ultrasonography, abdominal computed tomography, and angiography revealed a retroperitoneal tumor with direct invasion to the liver and the diaphragm. The diagnosis of nonfunctioning malignant pheochromocytoma was made on the basis of clinical evidence. The tumor was removed en bloc with part of the diaphragm, the right lobe of the liver, the right adrenal gland, and the right kidney. Pathologic examination with immunohistochemical staining revealed a malignant pheochromocytoma growing exophytically from the right adrenal gland and invading the right lobe of the liver and the diaphragm. The postoperative course has been uneventful and no recurrence has been noted over a 6-month follow-up period.

Adrenal Gland Neoplasms↗
PubMed2001

Outcome of pregnancy in women with hereditary thrombophilia.

OBJECTIVES: The aims of this study are to review the outcome of pregnancy in women with thrombophilia, and investigate the possible beneficial effect of heparin therapy in these women. METHODS: We reviewed the hospital records of 126 women who were referred to the high-risk obstetrical hematology clinic between June 1996 and December 1999. The placental histology and outcome of 39 pregnancies in 24 women with hereditary thrombophilia were studied, and pregnancies which were treated with heparin were compared with those without treatment. RESULTS: An adverse pregnancy outcome occurred in 54% of the pregnancies. All seven miscarriages (18%) occurred in pregnancies that were not treated with heparin. However, heparin treatment did not prevent the development of obstetric complications in later pregnancies (odds ratio=0.955, 95% C.I.=0.255-3.577, Fisher's exact test). Excluding miscarriages, 28% of the placentas had thrombotic lesions, and the pregnancies with placental thrombotic lesions were more likely to have complications than those pregnancies without placental abnormalities (P=0.023, C.I.=1.257-5.197, Fisher's exact test). CONCLUSIONS: Pregnancy complications in cases of hereditary thrombophilia may be related to placental abnormalities. Heparin therapy is likely to be useful in preventing miscarriage in cases of hereditary thrombophilia.

Activated Protein C Resistance↗
PubMed2001

Differential lipogenic effects of cilostazol and pentoxifylline in patients with intermittent claudication: potential role for interleukin-6.

Cilostazol, a novel oral phosphodiesterase inhibitor, has shown consistent improvement in exercise tolerance in patients with intermittent claudication (IC). In addition to this effect, cilostazol has previously been shown to have beneficial effects on the dyslipidemia, i.e., combination of high triglycerides with low high-density-lipoprotein cholesterol (HDL-C) levels. Interleukin-6 (IL-6) suppresses the activity of lipoprotein lipase, which modulates the metabolism of triglycerides and HDL-C. To determine whether a reduction of IL-6 contributes to the improvement of lipid profiles, we prospectively investigated the effect of cilostazol (n=16, 100 mg, twice daily) on the changes of lipid profiles and on the association with the changes of IL-6 compared with those of pentoxifylline (n=16, 400 mg, bid) in patients with IC. After eight weeks of administration of cilostazol to patients with IC, walking distances were increased, associated with a 29% decrease in plasma triglycerides and a 13% increase in HDL-C. No significant changes of lipid profiles in the pentoxifylline and placebo groups were observed although a similar improvement in walking distances was achieved in the pentoxifylline group. IL-6 levels were significantly reduced in patients receiving cilostazol as compared with those receiving placebo or pentoxifylline. The cilostazol-induced changes in the IL-6 were positively related to those of triglycerides in the cilostazol group (r=0.63, P<0.05) and negatively related to those of HDL-C (r=-0.55, P<0.05). These findings suggest that in addition to consistent improvement of exercise tolerance, cilostazol may improve lipid profiles by reducing IL-6 release. However, pentoxifylline did not affect lipid profiles although a similar improvement of maximal walking distance (MWD) was achieved.

Aged↗
PubMed2001

Effects of fish oil and vitamin E on the antioxidant defense system in diet-induced hypercholesterolemic rabbits.

This study was designed to investigate the effects of fish oil and vitamin E on the antioxidant defense system in hypercholesterolemic rabbits. A high fat and cholesterol diet, with or without supplement by fish oil and/or a vitamin E supplement, was fed to rabbits for 6 weeks. Compared to the reference diet of regular laboratory rabbit chow, a high fat and cholesterol-enriched diet increased atheroma formation, plasma lipid and peroxide levels, decreased blood glutathione levels, and reduced plasma glutathione reductase, glutathione peroxidase, and catalase activities. Fish oil supplementation significantly reduced atheroma and increased glutathione reductase and glutathione peroxidase activities and blood glutathione levels, but increased plasma lipid peroxide levels. Vitamin E supplementation of the fish oil diet enhanced the beneficial effects by increasing glutathione reductase activity and decreasing peroxide levels. These results indicate that a high fat and cholesterol diet attenuates blood glutathione levels and plasma antioxidant enzyme activities, which may account for some of its atherogenic properties. Consumption of fish oil enhances antioxidative defenses against the oxidative stress imposed by hypercholesterolemia, and vitamin E further enhances these beneficial effects.

Animals↗
PubMed2001

Assessment of the myocardial changes in heart transplant recipients without evident acute myocardial rejection by integrated backscatter: comparison with simultaneous dobutamine stress echocardiography and (201)thallium spect.

Cardiomyocyte hypertrophy and interstitial fibrin deposition develop in cardiac allografts and contribute to the functional changes of transplanted hearts. We hypothesized that integrated backscatter (IBS) can detect these myocardial changes. A total of 32 heart transplant recipients with either no or mild acute rejection (International Society of Heart and Lung Transplantation grade IA) were enrolled in this study. IBS data of myocardium were collected immediately before simultaneous dobutamine stress echocardiography (DSE) and (201)thallium imaging. Coronary angiography and endomyocardial biopsy were also performed. Coronary angiography showed diffuse narrowing in 1 patient who also had abnormal results of IBS, DSE, and thallium results. In the other 31 patients with patent coronary arteries, there were 3 patients (10%) with abnormal DSE results, 19 patients (61%) with abnormal IBS patterns, and 16 patients (52%) with reversible thallium perfusion defects. Of the patients, 44% had cardiomyocyte hypertrophy and 56% interstitial fibrin deposition. There were significant differences in the prevalence of (201)thallium perfusion defects and serum cyclosporine levels between patients with and without abnormal IBS patterns. Pathologic changes were also associated with abnormal IBS patterns (p = 0.01). However, there was no association between abnormal IBS and DSE results. By multiple logistic regression analysis, the abnormal IBS patterns were associated inversely with serum cyclosporine level (p = 0.028). In conclusion, abnormal IBS patterns are associated significantly with perfusion heterogeneity and pathologic changes in heart transplant recipients without evident acute myocardial rejection. There is no association between abnormal IBS patterns and dobutamine-induced dyssynergy in these patients. IBS provides a noninvasive approach for detection of myocardial changes in transplanted hearts without evident acute rejection.

Cardiac Catheterization↗
PubMed2001

Color Doppler ultrasound in breast carcinomas: relationship with hormone receptors, DNA ploidy, S-phase fraction, and histopathology.

Data on 368 patients with breast carcinomas measuring < or = 5 cm were analyzed to study the relationship between the prognostic factors and the flow indices measured by color Doppler ultrasound (US). Vascularity was detected by color Doppler US in 348 (94.6%) of the 368 breast tumors. Tumors without vascularity were significantly (p = 0.0001) smaller than the tumors with vascularity. There was a correlation between Vmax and tumor size. Postmenopausal women had greater values of RI, PI, and V(max). Tumors larger than 2 cm had significantly greater RI, V(max) and number of vessels as compared with the tumors smaller than 2 cm. RI was significantly greater in the nondiploid tumors than in the diploid tumors. RI > or = 0.7 was significantly associated with nondiploid carcinomas and SPF > or = 7%. Tumor size and Vmax significantly predicted axillary lymph node metastases.

Adult↗
PubMed2001

Nerve fibers and histopathology of endometriosis-harboring peritoneum.

STUDY OBJECTIVE: To evaluate the presence of nerve fibers and histopathology of normal peritoneum and endometriosis-harboring peritoneum. DESIGN: Prospective, nonrandomized study (Canadian Task Force classification II-1). SETTING: University hospital. MATERIALS: Peritoneal specimen from 40 women with laparoscopic findings of endometriosis (24 confirmed histopathologically, group H, 16 diagnosed by laparoscopy, group L) and from 9 women with no endometriosis (controls). INTERVENTION: Histopathologic examination of peritoneal specimens with nerve fibers identified by immunocytochemistry staining with an antibody to neurofilament. MEASUREMENTS AND MAIN RESULTS: No differences in mean nerve score were seen among the three groups. Degrees of lymphocytic infiltration and mesothelial hyperplasia were higher in group H than in the other two groups (p <0.01 and <0.05, respectively). The degree of lymphocytic infiltration was significantly higher in group L than in the control group (p <0.05). There were no differences in all measurements between women in group H who experienced chronic pelvic pain and those who did not. CONCLUSION: The presence of nerve fibers in peritoneum is not related to endometriosis. Endometriosis-harboring peritoneum contains more lymphocytic infiltration than normal peritoneum. (J Am Assoc Gynecol Laparosc 8(1):95-98, 2001)

Adult↗
PubMed2001

Gemfibrozil treatment potentiates oxidative resistance of high-density lipoprotein in hypertriglyceridemic patients.

BACKGROUND: Studies suggest that both oxidized low and high density lipoprotein (LDL and HDL) play a role in the pathogenesis of atherosclerosis. Gemfibrozil is widely used and is reported to increase cholesterol of LDL and HDL in hypertriglyceridemic patients. The aim of this study was to investigate the effect of gemfibrozil treatment on the oxidative status of lipoprotein particles in Fredrickson phenotype IV hypertriglyceridemic patients. METHODS: Twenty-two patients, aged 38-64 years, with fasting plasma triglyceride concentrations between 2.90 and 8.97 mmol L(-1), were recruited and were given gemfibrozil 300 mg three times daily for 12 weeks. Venous blood samples were collected before gemfibrozil treatment, after 4, 8, or 12 weeks of treatment, and 4 weeks after termination of treatment, and used to analyse the plasma lipid profile, isolate lipoproteins, and analyse the chemical composition and in vitro oxidation of lipoprotein particles. RESULTS: Gemfibrozil treatment resulted in a decrease in plasma total triglyceride levels and the triglyceride content of all lipoproteins. Plasma total cholesterol levels were decreased as a result of a decrease in very low density lipoprotein (VLDL) cholesterol levels. A slight increase in LDL cholesterol levels was observed, whereas the thiobarbituric acid-reactive substances (TBARS) of LDL were decreased and the lag and peak time of LDL to oxidation were unchanged and maximal diene production was decreased. Plasma HDL cholesterol levels, the surface-to-core ratio of HDL particles, and the resistance of HDL to oxidation were increased. CONCLUSION: The decreased TBARS and diene production of LDL, increased HDL cholesterol levels, and increased resistance of HDL to oxidation may, in part, explain why gemfibrozil treatment was found to be generally beneficial in terms of protection against coronary heart disease.

Administration, Oral↗
PubMed2001

Socio-economic disparities in preterm birth: causal pathways and mechanisms.

Preterm birth is the leading cause of infant mortality in industrialised societies. Its incidence is greatly increased among the socially disadvantaged, but the reasons for this excess are unclear and have been relatively unexplored. We hypothesise two distinct sets of causal pathways and mechanisms that may explain social disparities in preterm birth. The first set involves chronic and acute psychosocial stressors, psychological distress caused by those stressors, increased secretion of placental corticotropin releasing hormone (CRH), changes in sexual behaviours or enhanced susceptibility to bacterial vaginosis and chorioamnionitis, cigarette smoking or cocaine use, and decidual vasculopathy. The second hypothesised pathway is a gene-environment interaction based on a highly prevalent mutation in the gene for methylenetetrahydrofolate reductase (MTHFR), combined with low folate intake from the diet and from prenatal vitamin supplements, consequent hyperhomocysteinemia, and decidual vasculopathy. We propose to test these hypothesised pathways and mechanisms in a nested case-control study within a prospectively recruited and followed cohort of pregnant women with singleton pregnancies who deliver at one of four Montreal hospitals that serve an ethnically and socio-economically diverse population. Following recruitment during the late first or early second trimester, participating women are seen at 24-26 weeks, when a research nurse obtains a detailed medical and obstetric history; administers several scales to assess chronic and acute stressors and psychological function; obtains blood samples for CRH, red blood cell and plasma folate, homocysteine, and DNA for the MTHFR mutation; and performs a digital and speculum examination to measure cervical length and vaginal pH and to obtain swabs for bacterial vaginosis and fetal fibronectin. After delivery, each case (delivery at < 37 completed weeks following spontaneous onset of labour or prelabour rupture of membranes) and two controls are selected for placental pathological examination, hair analysis of cotinine, cocaine, and benzoylecgonine, and analysis of stored blood and vaginal specimens. Statistical analysis will be based on multiple logistic regression and structural equation modelling, with sequential construction of models of potential aetiological determinants and covariates to test the hypothesised causal pathways and mechanisms. The research we propose should improve understanding of the factors and processes that mediate social disparities in preterm birth. This improved understanding should help not only in developing strategies to reduce the disparities but also in suggesting preventive interventions applicable across the entire socio-economic spectrum.

Adult↗
PubMed2001

Increased levels of tissue plasminogen activator antigen and factor VIII activity in nonvalvular atrial fibrillation: relation to predictors of thromboembolism.

INTRODUCTION: Given that nonvalvular atrial fibrillation (AF)-associated stroke can be either cardioembolic or atherothrombotic, we investigated the relationships between nonvalvular AF and hemostatic factors reflecting intrinsic thrombogenic and atherogenic potentials (tissue plasminogen activator [t-PA] antigen, plasminogen activator inhibitor-1, and factor VIII activity). We also evaluated the clinical applicability of these hemostatic factors by examining whether AF subjects with established clinical or echocardiographic predictors of thromboembolism had higher levels of these factors. METHODS AND RESULTS: Of the 3,212 participants of a Chinese population-based study, 53 subjects (1.7%) with AF were identified. Among the hemostatic factors measured, t-PA antigen (median 12.8 vs 8.1 ng/mL; P < 0.01) and factor VIII activity (median 155% vs 133%; P < 0.05) were significantly higher in AF subjects after adjustment for age and sex. In multivariate analysis, features independently associated with t-PA antigen levels were AF, sex, body mass index, systolic blood pressure, total cholesterol, triglycerides, and left ventricular systolic dysfunction. Features independently associated with factor VIII activity levels included AF, age, and total cholesterol. Levels of both t-PA antigen and factor VIII activity were primarily elevated in AF subjects with predictors of thromboembolism (age > 75 years, hypertension, diabetes, and left ventricular systolic dysfunction), whereas in AF subjects with no thromboembolic predictors, plasma levels of hemostatic factors examined were similar to those without AF. CONCLUSION: We demonstrated that nonvalvular AF was independently associated with increased peripheral levels of t-PA antigen and factor VIII activity. Levels of both hemostatic factors were primarily elevated in AF subjects with predictors of thromboembolism. Whether these hemostatic factors are independently predictive of future thromboembolic events in AF patients requires further investigation.

Adult↗
PubMed2001

Human REG I gene is up-regulated in intrahepatic cholangiocarcinoma and its precursor lesions.

The Reg I gene (regenerating gene) and its product (Reg protein) are a regenerating and/or proliferating factor(s) of pancreatic islet cells. The ectopic expression of REG Ialpha was shown in colorectal carcinomas, suggesting that REG Ialpha is related to their carcinogenesis. In this study, we examined the expression of REG I in intrahepatic cholangiocarcinoma (ICC) and its precursor lesion (biliary dysplasia). By polymerase chain reaction and in situ hybridization (ISH) studies using a total of 16 fresh liver specimens, REG Ialpha mRNA was demonstrated in 6 of 11 (55%) ICC cases, but in 0 of 5 (0%) normal livers. Immunohistochemistry for REG I protein was performed in 100 formalin-fixed, paraffin-embedded sections obtained from the 18 cases of ICC alone, 45 hepatolithiasis with ICC (n = 19) or biliary dysplasia (n = 26), 21 hepatolithiasis alone (all with hyperplasia), and 16 normal livers. In ICC, the expression of REG I protein was significantly dependent on the histologic differentiation; 12 of 13 (92%) cases in papillary and well-differentiated, 6 of 16 (38%) cases in moderately differentiated, and 0 of 8 (0%) cases in poorly differentiated types. Moreover, in the lesions of hyperplasia, low-grade dysplasia, and high-grade dysplasia in hepatolithiasis, REG I protein was expressed in 4 of 21 (19%), 7 of 12 (58%), and 13 of 14 (93%) cases, respectively. In normal liver, intrahepatic bile ducts were constantly negative for REG I protein. These findings suggest that neoexpression of REG I is a good marker for biliary mucosa at risk for development of ICC, and also that REG I plays a role in the early stages of biliary carcinogenesis, probably via a cell-proliferative effect.

Bile Duct Neoplasms↗
PubMed2001

Intraductal papillary neoplasia of the liver associated with hepatolithiasis.

Intraductal papillary growth of neoplastic biliary epithelia with a fine fibrovascular stalk (intraductal papillary neoplasia of liver [IPN-L]) resembling intraductal papillary mucinous neoplasm of pancreas is occasionally associated with hepatolithiasis. In this study, 136 cases of hepatolithiasis in Taiwan, between January 1998 and March 2000, and an additional 21 cases of IPN-L before December 1998, were examined histologically. IPN-L was found in 41 of 136 hepatolithiasis cases (30.1%). Sixty-two IPN-L cases (42 women and 20 men; age range, 59.8 +/- 10 years) were divided into 4 types (type 1, IPN-L with low-grade dysplasia, 23 cases; type 2, IPN-L with high grade dysplasia, 11 cases; type 3, IPN-L with in situ and microinvasive carcinoma, 13 cases; and type 4, IPN-L of types 2 and 3 with distinct invasive carcinoma, 15 cases). Intraductal spreading and glandular involvement were commonly observed in all types. About half of types 3 and 4 cases had mucobilia, and mucinous carcinoma was variably found in two thirds of group 4 patients. IPN-L frequently showed variable gastroenteric differentiation such as goblet cells and foveolar and colon-like metaplasia. IPN-L with goblet cells and colon-like metaplasia was frequently associated with overproduction of mucin and mucobilia (P <.01). In Japan, IPN-L was not frequent in hepatolithiasis (12 of 135 cases). In conclusion, IPN-L forms a spectrum of biliary neoplasm in hepatolithiasis. It often displays variable gastroenteric metaplasia and significant intraductal spread. IPN-L tends to progress to mucinous carcinoma. Formerly reported "mucin-producing intrahepatic cholangiocarcinoma" with a favorable prognosis is included in IPN-L.

Adult↗