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ABDOMINAL RADIOLOGY Table of Contents   
Year : 2000  |  Volume : 10  |  Issue : 4  |  Page : 245-246
Sarcoma botryoides of the common bile duct


Dept of Radiology, Lady Hardinge Med College & Associated Smt. Sucheta Kriplani Hospital & Kalawati Saran Children's Hospital, New Delhi 110001, India

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Keywords: rhabdomyosarcoma, bile duct, sarcoma botryoides

How to cite this article:
Mathew M, Narula MK, Chadha R. Sarcoma botryoides of the common bile duct. Indian J Radiol Imaging 2000;10:245-6

How to cite this URL:
Mathew M, Narula MK, Chadha R. Sarcoma botryoides of the common bile duct. Indian J Radiol Imaging [serial online] 2000 [cited 2019 Sep 17];10:245-6. Available from: http://www.ijri.org/text.asp?2000/10/4/245/30571
Embryona rhabdomyosarcoma of the bile duct is a very rare malignancy. Our recent experience with a case of sarcoma botryoides of the common bile duct has prompted us to report this unusual tumor.


   Case Report Top


A five-years-old girl presented with a one-month history of jaundice, fever and progressive abdominal distension. On examination, the child had a palpable lump in the right hypochondrium. Laboratory investigations revealed obstructive jaundice.

On sonographic evaluation, the liver was found to be enlarged, with dilatation of the intrahepatic radicles in the right and left lobes. A large well-defined mass measuring 6x6 cm was seen at the porta hepatis, anterior to the portal vein [Figure - 1]. It was seen to extend from the confluence of the right and left hepatic ducts in the superior position, to the level of the head of pancreas in the inferior position. The common bile duct was not visualized separate from the mass. A small multicystic subhepatic collection was seen adjacent to the gall bladder. Computed tomography, confirmed the findings of a bile duct mass with inferior extension to the level of pancreatic head. The lesion showed mixed attenuation values (40-90 HU) with enhancing polypoidal masses within the common bile duct [Figure - 2].

Ultrasound guided fine needle aspiration cytology revealed few clusters of cells with anisonucleosis, scanty cytoplasm and dispersed chromatin with fibrillary basement membrane material suggestive of a round cell tumor.

The patient subsequently underwent laparotomy. The liver was found to be grossly enlarged. A greenish yellow, of chronic gastritis and benign gastric and duodenal ulcers [1],[2],[3]. It is found in all races, increases in incidence with age [3] and may occur in asymptomatic individuals too [4].

The infection predominantly affects the pyloric antrum where it produces thickened gastric folds. Duodenal bulb abnormalities also have a high positive association with H. pylori infection. The disease can be suspected on barium studies when thickened gastric mucosal folds are found in the antral region [5].

Little has been mentioned about the role of ultrasound in the diagnosis of H. pylori infection. USG, which is often the initial investigation in a case of abdominal pain and loss of appetite, may reveal a thickened pylorus with altered texture and luminal narrowing. This may lead to an erroneous diagnosis of gastric malignancy and put the patient to unnecessary inconvenience. H. pylori infection is much more common than malignancies.

It is, therefore, important for a sonologist to remember this condition as an important cause of predominantly intraluminal pyloric thickening and include it in the differential diagnosis of pathological conditions affecting this region.

These cases need to be followed to exclude associated gastric carcinoma [6] and non Hodgkin's [7] and MALT

lymphoma. While endoscopy and endosonography are no doubt better [8], abdominal ultrasound using appropriate probes is also a valuable diagnostic tool.

We have become wiser after this experience and have arrived at this diagnosis in a number of patients with abdominal pain and intraluminal pyloric mass lesion. In these we observed that though the thickening was not marked, it was apparent even in the non-distended stomach and was predominantly intraluminal. In addition, the striated appearance of the gastric wall was not entirety

lost and there was no perigastric extension of the disease process. The diagnosis was subsequently confirmed by endoscopy and biopsy in many patients.

 
   References Top

1.Marshall B.J. Campylobacter pyloridis and gastritis.J Infect Dis 1986; 153: 650-657.  Back to cited text no. 1  [PUBMED]  
2.Warren J.R. Unidentified curved bacilli on gastric epithelium in chronic active gastritis. Lancet 1983; 1:1273-1275.  Back to cited text no. 2  [PUBMED]  
3.John CD. Helicobacter pylori and peptic ulcer disease. AJR 1995; 164: 283-286.  Back to cited text no. 3    
4.Dooley C, Cohen H, Fitzgibbons PL, et al. Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med 1989; 321:1562-1566.  Back to cited text no. 4    
5.Bender NG,Makuch RS. Double contrast barium examination of the upper gastrointestinal tract with non endoscopic biopsy: findings in 100 patients. Radiology 1997; 202:355-359.  Back to cited text no. 5    
6.Forman D. An International association between Helicobacter pylori infection and gastric cancer. Lancet 1993; 341:1351-1362.  Back to cited text no. 6    
7.Parsonnet J, Hansen S, Rodriguez L, et al. Helicobacter pylori infection and gastric lymphoma. N Engl J Med 1994;. 330:1260-1271.  Back to cited text no. 7    
8.Sackmann M, Morgner A, Rudolph B, et al. Regression of gastric MALT lymphoma after eradication of Helicobacter pylori is predicted by endosonographic staging. Gastroenterology 1997; 113:1087-1090.  Back to cited text no. 8    

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Maria Mathew
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India
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Source of Support: None, Conflict of Interest: None


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