Clinicopathologic features of the intraductal growth type of peripheral cholangiocarcinoma

Abstract

The clinicopathologic features of the intraductal growth (IG) type of peripheral cholangiocarcinoma (PCC) were examined retrospectively. Out of 112 patients who underwent surgery for PCC at Seoul National University Hospital, Seoul, Korea, between January 1980 and December 1997, 16 were classified as having the IG type. Thirteen were men and 3 were women. Their ages ranged from 38 to 73 years with a mean age of 55.9 years. Abdominal pain was the most common symptom and jaundice was found in 18.8%. Five patients had associated clonorchiasis and 6 patients experienced hepatolithiasis. Tumor sizes ranged from 0.5 cm to 14.0 cm with a mean of 4.3 cm. The tumor was located in the right lobe in 7 cases and the left lobe in 9 cases. Thirteen patients underwent major hepatic resection, and 3 underwent minor resection, involving a subsegmentectomy. Mucin was found in the bile in 4 cases. Pathology showed papillary adenocarcinoma with a background of adenomatous hyperplasia, and the absence of lymph node metastasis in all cases. The tumors were confined to the mucosa in 5 cases. Out of the 16 hepatic resections, 1 was palliative due to a positive margin. In 2 of the patients who underwent minor resections, recurrences developed, and 1 of these died 56 months after resection. Out of the 16 patients, 15 remain alive, ranging from 1 to 13 years, postoperatively. In conclusion, the IG type of PCC should be distinguished from other types of PCC because a favorable prognosis can be expected after complete surgical resection. (HEPATOLOGY 2000;31:12-17.)Intrahepatic or peripheral cholangiocarcinoma (PCC), a primary adenocarcinoma of the liver originating from the intrahepatic bile ducts (IHD), is the second most common primary hepatic malignancy, next to hepatocellular carcinoma. 1 Because the lesion is advanced by the time of diagnosis, 2 the possibility of surgical resection is limited and the prognosis is generally poor. [3][4][5][6][7][8][9] In 1992, Yamamoto et al. 10 classified PCC into 2 types, mass-forming (MF) and periductal-infiltrating (PI), and showed their different clinical behaviors. The MF type creates an apparent lesion in the liver, with frequent remnant hepatic recurrence after resection. The PI type causes a stricture or an obstruction of the IHD without forming a definite mass in the liver. It spreads along the Glisson' s capsule and metastasizes to the hilar lymph nodes. Later, another type, intraductal growth (IG), was added. 11 This type of tumor shows a papillary growth into the lumen of the bile duct. 12 There have been a few scattered reports about the clinical and pathological features of the IG type of PCC. 13,14 Here, we describe the clinical and pathological features of the IG type of PCC in 16 patients who underwent surgical resection at

Altered Expression of β-Catenin without Genetic Mutation in Intrahepatic Cholangiocarcinoma

“…In the current study, the membranous expression of ␤-catenin was well preserved in papillary adenocarcinoma, which showed characteristic intraductal growth with a lesser degree of invasiveness and a favorable prognosis (26), compared with the other invasive type of ICC, with a significant difference (P ϭ .01), These results support the data of Ashida et al who described a reduced membranous expression of ␤-catenin and histological differentiation of ICC (20). Our observations suggest that reduction of membranous ␤-catenin leads to loss of a cell-to-cell adhesion, an event which may contribute to the invasive tendency of ICC (27).…”

Characterization of intrahepatic cholangiocarcinoma of the intraductal growth-type and its precursor lesions

“…1,5,14,15 The mean survival of patients with IPNL types 3 and 4 and non-IG-ICC was 55.5 Ϯ 17.1 months, 36.9 Ϯ 6.3 months, and 15.8 Ϯ 1.8 months, respectively. The survival of patients with IPNL types 3 and 4 was similar (log-rank test, P ϭ .12).…”

“…1 The IG-ICC is the least common type but is associated with the most favorable outcome. 1,5 Biliary papillomatosis, intraductal growth-type cholangiocarcinoma (IG-ICC), and mucin-producing ICC constitute essentially the same disease entity. [5][6][7] This category of papillary biliary neoplasm resembles intraductal papillary mucinous neoplasm of the pancreas histologically.…”

“…1,5 Biliary papillomatosis, intraductal growth-type cholangiocarcinoma (IG-ICC), and mucin-producing ICC constitute essentially the same disease entity. [5][6][7] This category of papillary biliary neoplasm resembles intraductal papillary mucinous neoplasm of the pancreas histologically. 8 We recently proposed the term intraductal papillary neoplasm of the liver (IPNL) for such lesions, which include both IG-ICC and its precursor lesions.…”

Aberrant expression of laminin gamma 2 chain and its prognostic significance in intrahepatic cholangiocarcinoma according to growth morphology

“…21,22 The prognosis of patients with cholangiocarcinoma is generally poor, although a minority subtype of intrahepatic cholangiocarcinoma showing an intraductal growth pattern had a more favorable prognosis when complete tumor resection was performed. 23,24 Intraductal growth type of intrahepatic cholangiocarcinoma frequently preserve basement membrane and are microscopically noninvasive or minimally invasive. It is important to evaluate the basement membrane molecule associated with tumor invasion among intrahepatic cholangiocarcinomas with various degrees of tumor extension.…”