Distal Common Bile Duct Adenocarcinoma: Analysis of 47 Cases and Comparison with Pancreatic and Ampullary Ductal Carcinomas
Raul S Gonzalez, Pelin Bagci, So Yeon Kong, Kee-Taek Jang, Nobuyuki Ohike, Takuma Tajiri, Olca Basturk, Sudeshna Bandyopadhyay, Leslie Ducato, Alyssa Krasinskas, Grace Kim, Jeanette Cheng, Volkan Adsay. Emory U, Atlanta; Showa U, Tokyo, Japan; MSKCC, New York; WSU, Detroit; UPMC, Pittsburgh; UCSF, San Francisco; Piedmont Hospital, Atlanta
Background: Distal common bile duct carcinoma (CBDC; aka “intrapancreatic cholangiocarcinoma”) is a well-known but poorly characterized entity.
Design: Of 1017 whipples with primary adenocarcinoma, 52 qualified as non-ampullary CBDC based on gross (Fig1) and microscopic findings. 5 associated with an intraductal papillary neoplasm (9%) were excluded; the remaining 47 were compared to 112 pancreatic ductal adenocarcinomas (PDAC) and 40 pancreatobiliary-type adenocarcinomas of ampullary ductal origin (AMP-D; >75% of tumor in the intra-ampullary/distal tip of the CBD or PD).
Results: Clinicopathologic characteristics of CBDC (Table, p-values <0.001) included younger age and prognosis significantly better than PDAC but worse than AMP-D (Fig2). Parallel with the average size, LN mets and margin positivity rates. Grossly, CBDCs were subtle, scirrhous, constrictive lesions forming circumferential plaque-like thickening of the CBD wall. 4 showed cystic duct–CBD union within the pancreas (what we propose to call low union), with the tumor immediately distal to this abnormal junction. Microscopically, many cases formed an even band around the CBD, with careful analysis revealing more infiltrative foci. Compared to PDACs, CBDCs more commonly showed intraglandular neutrophil-rich debris and a smaller tubular pattern.
|Average Tumor Size (cm)||1.9||2.9||3.6|
|Lymph Node Metastases||42%||60%||73%|
|Median Survival (months)||24||16||11|