Mucin ball-producing extrahepatic bile duct carcinoma

The clinicopathological features of biliary intraductal papillary neoplasms according to the location of tumors

BACKGROUND AND AIM

In this study, we analyzed the clinical and pathological features of biliary intraductal papillary neoplasms (IPN-B) according to the location of the tumors.

METHODS

A total of 55 patients with IPN-B were analyzed. We divided them into three groups: common bile duct (CBD), hilar, and intrahepatic duct (IHD) groups. The clinical and laboratory findings, cell types, depth of invasion, malignancy, existence of stones, lymph node metastasis, recurrence, and survival rate were analyzed.

RESULTS

There was no difference in the depth of invasion, lymph node metastasis, and coexistence of stones between the three groups. There were four different cell types; the intestinal cell type was the most common type in each group. The gastric cell type was prevalent in the IHD and hilar groups (58.3% and 33.3%, respectively). Invasive colloid carcinoma mainly showed the intestinal cell type, and tubular carcinoma showed the pancreaticobiliary cell type. There was a trend that malignancy was more prevalent in the CBD group (94.1%) than in the hilar group (64.3%) and IHD group (79.2%), but there was no statistically significant difference. There was no difference in the recurrence rate and the 3-year survival rate between the three groups.

CONCLUSION

IPN-B showed no difference in the malignancy and survival rates according to the location of the tumors. Because IPN-B show good prognosis after surgery, aggressive surgical resection for the treatment of IPN-B is recommended.

Mucin-producing cholangiocarcinoma: clinical experience of 24 cases in 16 years

OBJECTIVE

Mucin-producing cholangiocarcinoma (MPCC) is an uncommon biliary tract malignancy. This retrospective study was designed to investigate the clinical presentations, associated diseases, the value of tumor markers, and treatment and prognosis of MPCC.

MATERIAL AND METHODS

The study included 24 MPCC cases (7 M, 17 F) from 132 histopathology-proven cholangiocarcinoma patients seen between 1988 and 2003. MPCC and non-mucin-producing cholangiocarcinoma (non-MPCC) were compared.

RESULTS

Common clinical symptoms and signs included epigastric or right upper quadrant pain, fever and chills, jaundice, and anemia. Seventeen patients had mucobilia in surgical, cholangiographic, or CT findings. Biliary stones were found in 71% of MPCC patients. In detecting MPCC, a serum CA-19-9 level > 120 U/ml had 73% sensitivity, 41% specificity, 25% positive predictive value, 85% negative predictive value, and 48% accuracy in the 132 cholangiocarcinoma patients. The 1-, 2-, 3-, 4-, and 5-year survival rates were 44.3%, 33.8%, 28.1%, 21.1%, and 21.1%, respectively. Univariate analysis showed that tumor type (MPCC) was the only significant factor predicting survival when compared with non-MPCC patients in 5-year cumulative survival rates (21.1% versus 5.4%). MPCC patients receiving surgical resection had a prolonged median survival time (13 months versus 6 months) than those without resection.

CONCLUSIONS

MPCC clinical presentations were similar to non-MPCC in Taiwan except for more jaundice, fever and chills. The major factor predisposing to MPCC was biliary stones. Using serum CA19-9 levels greater than 120 U/ml was a diagnostic aid to detecting MPCC patients. MPCC patients had a better prognosis than non-MPCC patients. The recommended treatment for MPCC is surgical resection.

Pathologic features of mucin-producing bile duct tumors: two histopathologic categories as counterparts of pancreatic intraductal papillary-mucinous neoplasms

Tumors with clinically recognizable mucin production arising from bile duct, "mucin-producing bile duct tumors (MPBTs)," have not been studied yet for their pathologic features and classification in details. The clinical findings of MPBT have a lot of similarities to those of pancreatic intraductal papillary-mucinous neoplasm. In the present study, we examined 30 MPBTs and classified them into two distinct morphologic categories: 22 cases of "columnar type" composed of pseudostratified columnar cells with basophilic cytoplasm and columnar nuclei and 8 cases of "cuboidal type" composed of pancreaticobiliary and/or oncocytic pattern. Pancreaticobiliary pattern showed abundantly branched papillae lined by acidophilic cuboidal cells with round nuclei, whereas oncocytic pattern was characterized by intraepithelial lumina and cribriform pattern composed of abundant oxyphilic cells with round nuclei, and these patterns overlapped frequently. There were significant differences in the clinicopathologic findings including macroscopic findings, morphometric data, mucin expression profiles (MUC2 expression in columnar type and MUC6 expression in cuboidal type), and cell proliferative activities between columnar type and cuboidal type. Patients with columnar type showed significantly poorer survival than those with cuboidal type. We concluded that columnar type and cuboidal type of MBPTs belong to different lineage of neoplasm and that they are counterparts of "intestinal type" and "pancreaticobiliary type" of pancreatic intraductal papillary-mucinous neoplasm, respectively.