Biliary carcinomas: pathology and the role of DNA mismatch repair deficiency.
The pathology of biliary carcinomas is diverse with different gross and histological features in tumors arising in the different segments of the biliary system. Various epidemiological risk factors, varied genetic makeup, and tissue microenvironment are contributory factors. As biliary tumors have been shown to be a part of the Lynch syndrome tumor spectrum, it is plausible to speculate that DNA mismatch repair (MMR) deficiency plays a role in biliary tumors. Literature data suggest that DNA MMR deficiency indeed occurs in these tumors, albeit infrequently with the reported frequencies (weighted for sample size) of high level microsatellite instability (MSI) being 5% each for gallbladder carcinoma and carcinoma of extra-hepatic bile ducts, and 10% each for intrahepatic cholangiocarcinoma and ampullary carcinoma. Importantly, the presence of MMR deficiency in these tumors has been shown to have different implications with regard to its association with Lynch syndrome, tumor histological features, and other clinical characteristics, when compared with non-biliary tumors or among the biliary tumors from the different segments of the biliary system. Ongoing and future efforts that utilize large scale sequencing techniques and aim at detecting actionable molecular targets should emphasize a multidisciplinary approach that integrates genomic discoveries with not only functional studies but also studies of tumor pathology and the tumor's clinical and biological behavior.
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Vitor Werneck Krauss
VW
Silva
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gokce
G
Askan
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Tanisha D
TD
Daniel
Weill Cornell Medical College, New York, NY, USA.
Maeve
M
Lowery
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
David S
DS
Klimstra
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
Ghassan K
GK
Abou-Alfa
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA. Shiaj@mskcc.org.
Jinru
J
Shia
D001650:Bile Duct Neoplasms / Q000235:genetics* / Q000473:pathology; D053843:DNA Mismatch Repair; D006801:Humans; D053842:Microsatellite Instability
Microsatellite instability (MSI); ampulla; bile duct; biliary neoplasm; cholangiocarcinoma; gallbladder