Precancerous Bile Duct Pathology in Sporadic Hilar Cholangiocarcinoma
SC Abraham, S Leung, CB Rosen, TT Wu. MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester
Background: Most cholangiocarcinomas (CCAs) arise in the hilum, an anatomic region that often renders them surgically unresectable. This has hindered the study of presumed precursor lesions (metaplasia and dysplasia) in noncancerous bile ducts of the hilum and intrahepatic parenchyma.
Design: We studied 29 patients with sporadic hilar CCA who underwent neoadjuvant chemoradiation followed by liver transplantation from 1994-2007. After reevaluating the preserved gross liver explants, we took multiple (11) casettes of large hilar and intrahepatic bile ducts. Ducts were scored for the following histologic features: metaplasia (intestinal, pyloric, and mucinous/foveolar), dysplasia (low or high grade, number of dysplastic ducts, and hilar or intrahepatic location), and cancerization (malignant biliary epithelium near invasive CCA). These results were compared with two previously published control groups: 1) 28 patients with PSC-associated hilar CCA who received chemoradiation and liver transplant, and 2) 65 noncirrhotic liver transplants without CCA in patients >21 yr.
Results: Twenty-eight (97%) patients were Caucasian and 1 (3%) Asian; none had known predisposing conditions for CCA (choledochal cysts, hepatolithiasis, etc). Residual CCA was detected in 22 (76%) and ductal cancerization in 3 (10%). They had low rates of intestinal metaplasia (10%) but high rates of pyloric metaplasia (90%), mucinous metaplasia (93%) and bile duct dysplasia (55%). Of 16 cases with dysplasia, 10 involved both hilar and intrahepatic ducts and 6 involved intrahepatic ducts only. Comparison with PSC-associated CCA and non-CCA liver explants is shown below.
Bile Duct Pathology in Hilar CCA*P values are in comparison to the sporadic CCA group
|Age||Gender||Biliary Metaplasia||Biliary Dysplasia|
|Sporadic hilar CCA (n=29)||52 yr (22-64)||62% M||10%||90%||93%||55%||17%|
|PSC with hilar CCA (n=28)||47 yr (p=0.09)||71% M (p=1)||39% (p=0.015)||75% (p=0.2)||89% (p=0.7)||82% (p=0.045)||57% (p=0.003)|
|Noncirrhotic without CCA (n=65)||47 yr (p=0.08)||63% M (p=1)||8% (p=0.7)||9% (p<0.001)||72% (p=0.03)||15% (p<0.001)||0% (p=0.002)|
Conclusions: The presence of intestinal metaplasia and the presence and extent of bile duct dysplasia are significantly lower in sporadic vs. PSC-associated hilar CCA, suggesting a field effect in PSC. Pyloric metaplasia and dysplasia of noncancerous bile ducts best distinguish CCA from non-CCA cases.
Category: Liver & Pancreas
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 249, Wednesday Morning