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Endoscopic Examinations of the Biliary and Pancreatic Ducts: Eighth Report : Cytologic Examination of the Biliary Tract under Direct Vision A. Nishimura 1 , N. Den 1 , H. Sato 1 12nd Dept. of Surgery, Faculty of Medicine, Chiba University pp.1233-1243
Published Date 1972/9/25
DOI https://doi.org/10.11477/mf.1403109161
  • Abstract
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 So far reports are not so many for cytology of bile in the diagnosis of diseases in the biliary tract. Mostly diagnosis was attempted by transoral suction of duodenal juice, so that such problems as contamination of cells taken out of extrahepatobiliary tissue or their destruction by bile still remain unsettled. Only recently new experiments on biliary cytology have been reported through application of gallbladder puncture during peritoneoscopy and examination of bile aspirated during percutaneous transhepatic cholangiography.

 In the past we have sought to improve the efficiency of choledochoscope by eliminating bile during the examination. First, a balloontipped choledochoscope was devised to remove bile, assuring at the same time a reasonable distance for clear vision in the bile ducts. Then, a newly improved choledochoscope equipped with an irrigation tube was tried not only to prevent extrabiliary leakage of irrigation fluid but, more important, to collect it as well. The fluid, first drained out of the abdomen and then collected in a bottle after circulating the bile duct, is employed for cytological examination during surgical intervention.

 By this improved method we have studied 12 cases of benign diseases of the bile ducts, consisting of 11 of stones in the common bile duct and one choledochal obstruction due to a pancreatic cyst. We have also examined six carcinomas of the biliary tract : two carcinomas of the common bile duct; three of the papilla and one choledochal invasion originating from carcinoma of the head of the pancreas. Cytologic changes of all 18 cases are presented in the paper. Cytological diagnosis was accurate in 4 (67%) out of 6 cases of biliary tract carcinoma.

 Of two false negative cases, one was classified as class Ⅱ, because carcinoma of the papilla later confirmed in this case had chiefly spread within the submucosa, and scarcely any ulceration was found on the choledochal wall. The other was classified as class Ⅲ, later to be confirmed histopathologically as adenocarcinoma papillare. Cytological examination was after all of no avail in this case. This fact probably suggest its limitation as a diagnostic measure in such a case.

 Morphology of malignant cells in the biliary tract is characterized by prominent nucleolus, enlargement of nucleus with some atypia of it.


Copyright © 1972, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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