Clinical aspects of intrahepatic bile duct carcinoma including hilar carcinoma.A study of 57 autopsy-proven cases

Abstract

The clinical features of 57 autopsied cases of intrahepatic bile duct carcinoma including 28 cases of the peripheral type (cholangiocarcinoma in the narrow sense) and 29 cases of the hilar type are described in comparison with those of hepatocellular carcinoma, with a review of the literature on the clinicopathological aspects of intrahepatic bile duct carcinoma. As compared with hepatocellular carcinoma, the average age of the patients was older; the male predominance was not obvious, chronic parenchymal liver disease was infrequent in the past history, association of primary cirrhosis was seldom, cholestatic features were frequently the early signs and more pronounced during the course, the liver was enlarged to a lesser extent, ascites was less common, signs of portal hypertension were absent or minimal, a n d extrahepatic metastases were less frequent. In many respects, the hilar type resembled extrahepatic bile duct carcinoma, and the peripheral type was somewhat between it and hepatocellular carcinoma. Although the overall survival was not much different from that for hepatocellular carcinoma, early diagnosis is emphasized; this would make surgical management possible. Differential diagnosis from hepatocellular carcinoma may be possible in the majority with direct cholangiography , liver scan, celiac angiography, determination of a-fetoprotein and hepatitis B antigen, and blood chemistry such as SCOT, SLDH, serum bilirubin and alkaline phosphatase. Illustrative cases are given including one patient with a hilar carcinoma who survived for more than 2 years after transhepatic biliary drainage.

Liver Resection for Hilar and Peripheral Cholangiocarcinomas: A Study of 62 Cases

“…When the disease originates in the common hepatic duct as well as in the first and second bifurcations, it can be classified as hilar type (HCCA); whereas the peripheral intrahepatic type (PCCA) takes origin in a segmental duct or more peripheral duct (1)(2)(3)(4)(5). Duct cell carcinomas of the common and proper bile duct (6) and gallbladder were excluded from this study.…”

Molecular diagnosis of primary liver cancer by microsatellite DNA analysis in the serum

“…The cholangiocarcinoma (CC), an intrahepatic malignant tumour which arises in the epithelium of the bile ducts, is the second common hepatic tumour. Its occurrence is largely high in areas where liver fluke infestation or intrahepatic stones is endemic, such as Hong Kong, Thailand and Taiwan (Okuda et al, 1977).…”

“…The prognosis of HCC or CC is usually poor, with 3-year survival rates estimated at 44.9% and 34% after hepatic resection, respectively (Okuda et al, 1977). In patients with symptomatic HCC, the tumours are usually either too large and/or with local invasion or distant metastasis.…”

Surgical Palliative Drainage in Un-resectable Malignant Biliary Obstruction

“…There was no significant relation between thecauseof mechanical cholestasis and post-operative cholangitis. In addition, prevalence of cholangitis was not significantly higher in metastatic patients (P=0.612) [16][17][18][19][20]. …”