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Extrahepatic bile duct carcinoma with extensive intraepithelial spread: a clinicopathological study of 21 cases

Authors :
Nakanishi, Yoshitsugu
Zen, Yoh
Kawakami, Hiroshi
Kubota, Kanako
Itoh, Tomoo
Hirano, Satoshi
Tanaka, Eiichi
Nakanuma, Yasuni
Kondo, Satoshi
Source :
Modern Pathology; July 2008, Vol. 21 Issue: 7 p807-816, 10p
Publication Year :
2008

Abstract

Extrahepatic bile duct carcinoma occasionally presents with intraepithelial spread for a considerable area around the main tumor. In this study, we compared clinicopathological features of extrahepatic bile duct carcinoma with and without extensive intraepithelial spread (≥20 mm from the main tumor). Out of 117 cases of extrahepatic bile duct carcinoma, 21 (18%) were found to have extensive intraepithelial spread. Those cases were pathologically characterized by a papillary or nodular main tumor, a more differentiated histological grade, less deep invasion, and infrequent portal vein or hepatic invasion in comparison with cases without intraepithelial spread. Areas of intraepithelial spread histologically consisted of low-papillary growth (17 cases, 81%) and completely flat growth (4 cases, 19%) of carcinoma cells. The former histology corresponded to a macroscopic granular mucosa, whereas the latter growth was hardly detected by gross examination. Immunohistochemically, in 16 of 21 cases (76%), at least one of p53, CEA, and MUC1 was expressed in both the main tumor and the spreading area. Interestingly, patients with intraepithelial spread had a better postoperative prognosis than those without intraepithelial spread (P=0.009). However, three patients had anastomotic recurrence 54–130 months after surgery. In conclusion, intraepithelial-spreading bile duct carcinoma is characterized by papillary or nodular main lesions, a more differentiated histological grade, and less invasiveness. The presence of intraepithelial spread was not an indicator of a poor prognosis, but carcinoma in situ at the bile duct stump could cause late anastomotic recurrence after surgery.Modern Pathology (2008) 21, 807–816; doi:10.1038/modpathol.2008.65; published online 18 April 2008

Details

Language :
English
ISSN :
08933952 and 15300285
Volume :
21
Issue :
7
Database :
Supplemental Index
Journal :
Modern Pathology
Publication Type :
Periodical
Accession number :
ejs14545176
Full Text :
https://doi.org/10.1038/modpathol.2008.65