Bile duct dysplasia in the setting of chronic hepatitis C and alcohol cirrhosis
Bile duct dysplasia in the setting of chronic hepatitis C and alcohol cirrhosis
复制标题
DOI：
10.1097/pas.0b013e318053d122
复制
发表时间：
2007-09-01
影响因子：
5.6
通讯作者：
Abraham, Susan C.
中科院分区：
文献类型：
--
作者：
Torbenson, Michael;Yeh, Matthew M.;Abraham, Susan C.
肝内胆管细胞癌是罕见的，其危险因素仍不完全清楚，但最近确定的一个潜在的危险因素是慢性丙型肝炎（HCV）感染。为了进一步研究这种潜在的联系，我们在慢性HCV病例和对照组中寻找了自体肝移植肝脏中肝内胆管的异型增生。排除慢性胆道疾病病例。共审查了1058例外植体：HCV（511例）、单纯酒精（112例）、HCV和酒精（85例）、HBV（67例）、其他原因导致的肝硬化（149例）和非炎性肝脏，例如，因急性肝功能衰竭而移植的病例（134例）。19/1058例（1.8%）病例中观察到肝内胆管发育不良，与慢性HCV感染和饮酒相关，P = 0.01。19例异型增生中有10例是慢性HCV感染，5/19例是单纯酒精感染，其余4/19例是HCV和酒精联合感染。19例中17例为低度异型增生，2例为高度异型增生。在所有发育不良病例中，病变均为多灶性，累及间隔大小的胆管。在16/19例中，异型增生为乳头状，而在3/19例中，异型增生为扁平状。总之，在慢性HCV肝硬化的肝内胆管内可以发现异型增生，支持最近的流行病学研究确定慢性HCV是肝内胆管癌的主要危险因素。酒精似乎也是一个危险因素。发育异常改变是多灶性的，累及间隔大小的胆管，典型的是乳头状的。
Intrahepatic cholangiocarcinomas are rare and risk factors remain incompletely understood, but one recently identified potential risk factor is chronic hepatitis C (HCV) infection. To further study this potential association, we searched for dysplasia in the intrahepatic bile ducts in native explanted livers in cases of chronic HCV and control groups. Cases of chronic biliary tract disease were excluded. A total of 1058 explants were reviewed: HCV (511), alcohol alone (112), HCV and alcohol (85), HBV (67), cirrhosis from other causes (149), and noncirrhotic livers, for example, cases transplanted for acute liver failure (134). Dysplasia of the intrahepatic bile ducts was seen in 19/1058 (1.8%) of cases and was associated with chronic HCV infection and alcohol use, P = 0.01. Ten out of 19 cases of dysplasia were in the setting of chronic HCV, 5/19 were in the setting of alcohol alone, and the remaining 4/19 were in the setting of combined HCV and alcohol. Seventeen out of 19 cases were classified as low-grade dysplasia and 2/19 as high-grade dysplasia. In all cases of dysplasia, the lesions were multifocal and involved septal-sized bile ducts. In 16/19 cases, the dysplasia was papillary whereas in 3/19 cases the dysplasia was flat. In conclusion, dysplasia can be found within the intrahepatic bile ducts in chronic HCV cirrhosis, supporting recent epidemiologic studies identifying chronic HCV as a major risk factor for intrahepatic cholangiocarcinoma. Alcohol also seems to be a risk factor. The dysplastic changes are multifocal, involve septal sized bile ducts, and are typically papillary.