1IgG4 reactions consisting of marked infiltration by immunoglobulin G4 (IgG4)-positive plasma cells in affected organs is found in cancer patients as well as patients with IgG4-related diseases. Notably, extrahepatic cholangiocarcinomas accompanying marked IgG4 reactions clinicopathologically mimic IgG4-related sclerosing cholangitis. The regulatory cytokine interleukin (IL)-10 is thought to induce the differentiation of IgG4-positive cells. In this study, to clarify the mechanism of the IgG4 reaction in extrahepatic cholangiocarcinoma, we investigated nonprofessional antigen-presenting cells (APCs) generating IL-10-producing regulatory T cells (anergy T cells) and Foxp3-positive regulatory cells producing IL-10. Immunohistochemistry targeting IgG4, HLA-DR, CD80, CD86, and Foxp3 was performed using 54 cholangiocarcinoma specimens from 24 patients with gallbladder cancer, 22 patients with common bile duct cancer, and eight patients with cancer of the Papilla of Vater. Moreover, a molecular analysis of Foxp3 and IL-10 was performed using a cultured human cholangiocarcinoma cell line. Consequently, 43% of the cholangiocarcinomas were found to be abundant in IgG4. Those expressing HLA-DR but lacking costimulatory molecules (CD80 and CD86) and those expressing Foxp3 detected by an antibody recognizing the N terminus accounted for 54% and 39% of cases, respectively. Moreover, the number of IgG4-positive cells was larger in these cases than in other groups. In cultured cells, the presence of a splicing variant of Foxp3 messenger RNA and the expression of IL-10 were demonstrated. Conclusion: Extrahepatic cholangiocarcinoma is often accompanied by significant infiltration of IgG4-positive cells. Cholangiocarcinoma cells could play the role of nonprofessional APCs and Foxp3-positive regulatory cells, inducing IgG4 reactions via the production of IL-10 indirectly and directly, respectively. (HEPATOLOGY 2012;56:157-164) B iliary tract cancers can be anatomically divided into intrahepatic and extrahepatic cholangiocarcinomas, the latter including hepatic hilar cancer, common bile duct cancer, gallbladder cancer, and cancer of the Papilla of Vater. The biological behavior and carcinogenesis of each cancer differ, but the histology of most biliary tract cancers is the same as that of ordinary adenocarcinomas. In addition to neoplastic lesions, several types of cholangitis causing biliary stenosis are important in the differential diagnosis of biliary diseases. Particularly, primary sclerosing cholangitis and a complication of immunoglobulin G4 (IgG4)-related systemic diseases, IgG4-related sclerosing cholangitis, clinicopathologically mimic extrahepatic cholangiocarcinomas.IgG4 is a minor immunoglobulin subtype composing 3%-6% of all the IgG circulating in adults, 1 but is important for a systemic disorder, IgG4-related disease, that features elevated serum IgG4 levels and abundant