Changes in Laboratory Test Results and Diagnostic Imaging Presentation before the Detection of Occupational Cholangiocarcinoma

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  • Kubo Shoji
    Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Takemura Shigekazu
    Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Sakata Chikaharu
    Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Urata Yorihisa
    Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Nishioka Takayoshi
    Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Nozawa Akinori
    Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Kinoshita Masahiko
    Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Hamano Genya
    Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Nakanuma Yasuni
    Department of Human Pathology, Kanazawa University Graduate School of Medicine
  • Endo Ginji
    Department of Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine

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Objectives: A cholangiocarcinoma outbreak among workers of an offset color proof-printing department in a printing company was recently reported. It is important to understand the clinical course leading to occupational cholangiocarcinoma development for investigation of the carcinogenesis process and for surveillance and early detection. We evaluated the changes in laboratory test results and diagnostic imaging presentation before the detection of cholangiocarcinoma. Methods: We investigated the changes in laboratory test results and diagnostic imaging presentation before the detection of cholangiocarcinoma in 2 patients because the data were available. Results The clinical courses observed in the 2 participating patients showed persistent elevation of serum γ-glutamyl transpeptidase levels with or without elevated serum levels of alanine aminotransferase and/or aspartate aminotransferase before cholangiocarcinoma detection. Dilatation of the bile ducts without tumor-induced stenosis was observed several years before cholangiocarcinoma detection and progressed gradually in both patients. The serum concentration of carbohydrate 19-9 also increased prior to cholangiocarcinoma detection in both patients. Eventually, observation of stenosis of the bile duct and a space-occupying lesion strongly suggested cholangiocarcinoma. Pathological examination of the resected specimens showed chronic bile duct injury and neoplastic lesions, such as “biliary intraepithelial neoplasia” and “intraductal papillary neoplasm of the bile duct” in various sites of the bile ducts, particularly in the dilated bile ducts. Conclusions: The changes in laboratory test results and diagnostic imaging might be related to the development of cholangiocarcinoma. It is important to monitor diagnostic imaging presentation and laboratory test results in workers with extended exposure to organic solvents.(J Occup Health 2014; 56: 317-322)

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