Clinicopathologic spectrum of resected extraductal mass-forming intrahepatic cholangiocarcinoma

Abstract

Background. The mode of tumor growth of intrahepatic cholangiocarcinoma (CC) varies considerably from patient to patient. This study describes the clinicopathologic variety of the extraductal mass‐forming type of CC. Methods. Patients with CC characterized by an extraductal mass (n = 26) who underwent hepatectomy from 1976 through 1992 were clinicopathologically classified into three types: Type I (n = 7), no biliary stricture; Type II (n = 13), biliary stricture without jaundice; and Type III (n = 6), biliary stricture with jaundice. Results. Type I included three patients with microductular‐trabecular arrangement and behavior reminiscent of hepatocellular carcinoma (high association with chronic liver disease, mild positivity for alpha‐fetoprotein [AFP], no lymph node metastasis, but frequent intrahepatic metastasis), in contrast to the other typical cholangiocarcinoma. Hepatolithiasis was associated only with Type II CC. The serum positivity for AFP and carcinoembryonic antigen was much higher in Type I CC, whereas positivity of CA 19‐9 was highest in Type III. Involvement of the portal vein, hepatic artery, or hepatic duct was most frequent in Type III CC, which necessitated resection of the extrahepatic bile duct and hepatectomy. Conclusion. The clinicopathologic behavior of intrahepatic CC differs considerably according to the presence or absence of stricture of the biliary tree. Thus, CC without biliary stricture behaves more like hepatocellular carcinoma, whereas CC with biliary stricture is more like hilar or extrahepatic bile duct carcinoma.

Cytokeratin-19 fragments in serum (CYFRA 21-1) as a marker in primary liver cancer

“…Follow-up of patients with HCV infection therefore can detect many cases of ICC as well as HCC. Although serum concentrations of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are commonly measured to detect and monitor of ICC, insufficient sensitivity and specificity has been a problem with using these established markers in this form of cancer Mizumoto, 1984, 1990;Wang et al, 1994;Yamanaka et al, 1995;Nakamura et al, 1996;Chu et al, 1997;Kim et al, 1999). A more accurate marker for ICC is needed.…”

“…Kubo et al (1995) reported that a high-serum CEA concentration strongly suggests ICC in patients with hepatolithiasis, even when no hepatic tumour is detected. Generally, however, serum CEA concentrations are elevated in only 20 -45% of patients with ICC (Yamanaka et al, 1995;Chu et al, 1997;Harrison et al, 1998;Kashihara et al, 1998;Kim et al, 1999;Uenishi et al, 2001). In the present study, serum CEA also showed a low sensitivity for ICC (34.8%).…”

CT Differentiation of Cholangiocarcinoma from Periductal Fibrosis in Patients with Hepatolithiasis

“…In patients with hepatolithiasis, fibrotic masses in the bile duct walls and periductal hepatic parenchyma are often seen as a form of periductal tumorlike lesions and may appear similar to cholangiocarcinoma on CT [19]. Furthermore, in patients with hepatolithiasis, the stricture or stenosis caused by cholangiocarcinoma may not be easy to differentiate from that caused by stones [6,10,20].…”

“…Because surgery remains the only intervention offering the possibility of a cure [25], early detection of cholangiocarcinoma is essential in hepatolithiasis patients; early detection raises the chance that a patient can be included as a surgical candidate and may consequently improve their prognosis. However, the diagnosis may be easily delayed because the symptoms related to cholangiocarcinoma are vague and are also similar to those of hepatolithiasis [10,23].…”

“…Alternatively, the percentage of patients with cholangiocarcinoma with concomitant hepatolithiasis has been reported to be in the range H of 17-27% [10][11][12]. Chronic irritation by intrahepatic calculi, bile stasis, and bacterial infection have been proposed as possible factors responsible for its development [6].…”