Purpose: The aim of this study was to determine the impact of the presence of carcinoma in situ at the bile duct stump on postoperative survival in patients who underwent resection of extrahepatic bile duct carcinoma. Methods:The patients with resected extrahepatic bile duct carcinoma were divided into three groups according to resected margin status: no evidence of residual carcinoma (Negative group, n=96); carcinoma in situ at the bile duct stump (CIS group, n=10); and invasive carcinoma at any surgical margin (Invasive group, n=19). Cause-specific survival for these groups was compared statistically.Results: Surgical margin status was identified as a prognostic factor on univariate analysis (p=0.005) and was an independent prognostic factor on multivariate analysis (p=0.018). The CIS group displayed significantly better survival than the Invasive group (p=0.006), and the survival was comparable to that for the Negative group (p=0.533). Two of three patients in the CIS group with local recurrence died >5 years after surgical resection. Conclusions:Patients with positive ductal margins of carcinoma in situ of the extrahepatic bile duct do not appear to show different survival after resection compared to patients with negative margins, but remnant carcinoma in situ is likely to develop late local recurrence.

Abstract

We report herein the first case of intraductal oncocytic papillary neoplasm of the bile duct arising from a peribiliary gland of the left hepatic duct. The patient was a 63-year-old Japanese man. Radiological and cholangioscopic examinations revealed intraductal tumor of the left hepatic duct. After pathological diagnosis of adenocarcinoma by cholangioscopic biopsy, a surgical hepatobiliary resection was performed. Pathological examination revealed papillary tumor in the left hepatic duct. Histologically, the tumor was identified as papillary neoplasm comprising oncocytic cells and delicate fibrovascular cores. Interestingly, this tumor originated from the cystic space in the bile duct wall. This cystic space was histologically identified as a cystically dilated peribiliary gland. Carcinoma in situ was observed in this cystic peribiliary gland at the bottom of the tumor, but not on any areas of biliary epithelium. This case suggests that intraductal papillary neoplasm can arise from both biliary epithelium and peribiliary glands.

Occult cancer cells were present in regional lymph nodes of 22% patients with regional node-negative biliary cancer, and were associated with significantly worse survival. Patients with micrometastases should be treated as carefully as node-positive patients.

In patients with regional node-positive and para-aortic node-negative biliary cancer, and occult cancer cells in para-aortic lymph nodes, prognosis was significantly worse in those with micrometastases than in patients with only ITCs. An efficient method of intraoperative detection of para-aortic lymph node micrometastases larger than 0.2 mm is needed.

bile duct of the hepatic hilusRunning title: Spindle cell carcinoma of the common bile duct Nakanishi 2 AbstractSpindle cell-type undifferentiated carcinoma arising from the extrahepatic bile duct is extremely rare. We report herein a case of this type of carcinoma in the common bile duct of the hepatic hilus. A 59-year-old man was admitted to our hospital complaining of jaundice. Laboratory data revealed elevation of serum CA 19-9. Cholangiography revealed complete obliteration of the left hepatic bile duct and stenosis of the bile duct from the superior to the right hepatic bile duct. Computed tomography showed the tumor, measuring 15×12 mm, in the hepatic hilus, obliteration of the right to main trunk of the portal vein and a lymph node in the hepato-duodenum ligament swelling.Arteriography revealed a kink of the right hepatic artery, so encasement of the right hepatic artery was suspected. We preoperatively diagnosed hilus bile duct carcinoma and scheduled right trisection hepatectomy. Intraoperative frozen sections taken from the tumor and tissues around hepatic arteries showed spindle cells and inflammatory cells, so inflammatory pseudotumor was diagnosed intraoperatively. Because the right hepatic bile duct was occluded, right lobe hepatectomy was performed. However, permanent section revealed both spindle cells and poorly differentiated tubular adenocarcinoma cells positive for CAM5.2, AE1/AE3 and vimentin. Based on these findings, the tumor was finally diagnosed as spindle cell-type undifferentiated carcinoma. The patient died of pulmonary infarction 11 days after the operation.

A 68-year-old woman with a history of renal cell carcinoma (RCC)

We report an unusual case of goblet cell carcinoid (GCC) of the rectum. A 75-year-old man was admitted to our hospital with anal bleeding, and a hard tumor was felt on the anterior wall of the lower rectum during rectal examination. We performed colonoscopy, and found a 30-mm type 2 tumor in the lower rectum and anal canal. Histological examination of biopsies revealed rectal adenocarcinoma. Based on these findings, we diagnosed rectal adenocarcinoma and performed Miles' operation with lymph node dissection. Histological examination revealed an invasive lesion composed of signet-ring-like cells. Seven regional lymph node metastases were seen microscopically. The tumor produced copious mucin, which was stained with Alcian blue. Immunohistochemistry was positive for synaptophysin, chromogranin A, CD56, carcinoembryonic antigen, p53, Ki-67, E-cadherin, and cytokeratin 20. The final diagnosis was GCC of the rectum.