title: Extrahepatic bile duct carcinoma with extensive intraepithelial spread: a clinicopathological study of 21 cases.
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 (>or=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.
authors.affiliation: Department of Surgical Oncology, Division of Cancer Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Nakanishi
authors.forename: Yoh
authors.initials: Y
authors.lastname: Zen
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.forename: Kanako
authors.initials: K
authors.lastname: Kubota
authors.forename: Tomoo
authors.initials: T
authors.lastname: Itoh
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Yasuni
authors.initials: Y
authors.lastname: Nakanuma
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000737:chemistry / Q000401:mortality / Q000473:pathology*; D017734:Bile Ducts, Extrahepatic / Q000737:chemistry / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000032:analysis; D018281:Cholangiocarcinoma / Q000737:chemistry / Q000401:mortality / Q000473:pathology*; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007124:Immunoenzyme Techniques; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor