Parasites and Biliary stones

Hepatolithiasis ٨٧
characterized by non obstructive saccular or fusiform dilatation of large
intra hepatic bile ducts. Cholangitis, liver cirrhosis, and
cholangiocarcinoma are its potential complications. The diagnosis depend
on demonstrating that cystic lesions are incontinuity with the biliary tree
by US, CT, ERCP and MRCP (Yonem and Bayraktor, 2007).
In contrast, acquired risk factors include postoperative biliary
strictures caused after cholecystectomy, partial hepatectomy, and liver
transplantation, and as well as benign and malignant bile-duct stenosis.
Benign strictures can also occur after chemo-embolization of hepatic
tumours and chronic pancreatitis. They are implicated in the cause of
intrahepatic stones (Nakayama et al., 1986).
Pathology:
Intrahepatic stones are found mainly in the intrahepatic ducts and the
segmental branch ducts. The stones and the corresponding strictures are
found more commonly in the left hepatic ductal system (Leung and
Cotton, 1991). The histological changes of the bile ducts are results of
recurrent cholangitis. These include increased fibrous tissue in the portal
tracts, proliferation of bile ducts, chronic granulomatous changes,
glandular proliferation and round cell and neutrophil infiltration
extending from the portal triads into the liver parenchyma. Tumors of the
bile ducts can range from precancerous dysplasia to cholangiocarcinoma.
Atypical epithetlial hyperplasia and mucosal dysplasia are considered to
be precancerous lesions. The histology of cholangiocarcinoma varies
from a periductal spreading type to a massive type. Cellular
differentiation ranges from early papillary adenocarcinoma to poorly
differentiated carcinoma (Leung, 1997).