A proposal of imaging classification of intrahepatic mass-forming cholangiocarcinoma into ductal and parenchymal types: clinicopathologic significance (original) (raw)

Abstract

Objectives

To investigate the clinicopathologic significance of a subclassification of mass-forming intrahepatic cholangiocarcinoma (MF-iCCA) into ductal and parenchymal types based on magnetic resonance imaging (MRI)

Methods

We enrolled 72 consecutive patients, in whom MF-iCCA was diagnosed on preoperative MRI and surgical resection from January 2000 to March 2013. Two readers independently evaluated MRI findings of adjacent bile duct dilation, periductal tumor spread, and presence of diffuse dilatation or abnormality of the intrahepatic bile duct. MF-iCCAs with none of the aforementioned findings were defined as parenchymal type, and those with one or more findings were defined as ductal type. The enhancement pattern in the arterial phase was also evaluated. Clinical and histopathological findings, as well as post-surgical outcomes, were collected from medical records.

Results

Parenchymal-type MF-iCCA (21/78, 27%) exhibited significantly lower serum carbohydrate antigen 19-9 (12.8 vs. 173.8 U/mL) and carcinoembryonic antigen (1.7 vs. 4.2 ng/mL), more frequent viral hepatitis (43% vs. 18%), less frequent biliary intraepithelial neoplasia (0% vs. 26%), and less frequent perineural invasion (0% vs. 59%) and lymph node metastasis (7% vs. 46%), compared with the ductal type (57/78, 73%) (p < 0.05 for all). Parenchymal-type MF-iCCA showed more frequent arterial hypervascularity (p = 0.001) and better overall survival (p = 0.030) than the ductal type.

Conclusion

Subclassification of MF-iCCAs into parenchymal and ductal types may be useful to discriminate clinical and histopathological characteristics and post-surgical outcomes.

Key Points

• We propose subclassification of mass-forming intrahepatic cholangiocarcinoma (MF-iCCA) as parenchymal and ductal types, on the basis of magnetic resonance imaging findings of biliary abnormality.

• Two types of MF-iCCAs exhibit different clinical and histopathological characteristics and post-surgical outcomes.

Access this article

Log in via an institution

Subscribe and save

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

Anti-HCV:

Anti-hepatitis C virus

BilIN:

Biliary intraepithelial neoplasia

CA19-9:

Carbohydrate antigen 19-9

CEA:

Carcinoembryonic antigen

HBsAg:

Surface antigen of the hepatitis B virus

iCCA:

Intrahepatic cholangiocarcinoma

IQR:

Interquartile range

MF-iCCA:

Mass-forming intrahepatic cholangiocarcinoma

MRI:

Magnetic resonance imaging

PI-iCCA:

Periductal infiltrating iCCA

References

  1. Banales JM, Cardinale V, Carpino G et al (2016) Expert consensus document: cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). Nat Rev Gastroenterol Hepatol 13:261–280
    Article PubMed Google Scholar
  2. Razumilava N, Gores GJ (2014) Cholangiocarcinoma. Lancet 383:2168–2179
    Article PubMed PubMed Central Google Scholar
  3. Aishima S, Oda Y (2015) Pathogenesis and classification of intrahepatic cholangiocarcinoma: different characters of perihilar large duct type versus peripheral small duct type. J Hepatobiliary Pancreat Sci 22:94–100
    Article PubMed Google Scholar
  4. Ebata T, Ercolani G, Alvaro D, Ribero D, Di Tommaso L, Valle JW (2016) Current status on cholangiocarcinoma and gallbladder cancer. Liver Cancer 6:59–65
    Article PubMed PubMed Central Google Scholar
  5. Aishima S, Kuroda Y, Nishihara Y et al (2007) Proposal of progression model for intrahepatic cholangiocarcinoma: clinicopathologic differences between hilar type and peripheral type. Am J Surg Pathol 31:1059–1067
    Article PubMed Google Scholar
  6. Nakanuma Y, Kakuda Y (2015) Pathologic classification of cholangiocarcinoma: new concepts. Best Pract Res Clin Gastroenterol 29:277–293
    Article Google Scholar
  7. Lim JH, Park CK (2004) Pathology of cholangiocarcinoma. Abdom Imaging 29:540–547
    CAS PubMed Google Scholar
  8. Yamasaki S (2003) Intrahepatic cholangiocarcinoma: macroscopic type and stage classification. J Hepatobiliary Pancreat Surg 10:288–291
    Article Google Scholar
  9. Nakanuma Y, Curado MP, Franceschi S, Gores GJ, Paradis V, Sripa B, Tsui WMS, Wee A (2010) Intrahepatic cholangiocarcinoma. In: Bosman FT, Carneiro F Hruban RH, Theise ND (Eds) WHO classification of tumours of the digestive system, 4th edn. World Health Organization. pp 217–224
  10. Nakanuma Y, Sato Y, Harada K, Sasaki M, Xu J, Ikeda H (2010) Pathological classification of intrahepatic cholangiocarcinoma based on a new concept. World J Hepatol 2:419–427
    Article PubMed PubMed Central Google Scholar
  11. Komuta M, Govaere O, Vandecaveye V et al (2012) Histological diversity in cholangiocellular carcinoma reflects the different cholangiocyte phenotypes. Hepatology 55:1876–1888
    Article CAS PubMed Google Scholar
  12. Hayashi A, Misumi K, Shibahara J et al (2016) Distinct clinicopathologic and genetic features of 2 histologic subtypes of intrahepatic cholangiocarcinoma. Am J Surg Pathol 40:1021–1030
    Article PubMed Google Scholar
  13. Akita M, Fujikura K, Ajiki T et al (2017) Dichotomy in intrahepatic cholangiocarcinomas based on histologic similarities to hilar cholangiocarcinomas. Mod Pathol 30:986–997
    Article CAS PubMed Google Scholar
  14. Rhee H, Ko JE, Chung T et al (2018) Transcriptomic and histopathological analysis of cholangiolocellular differentiation trait in intrahepatic cholangiocarcinoma. Liver Int 38:113–124
    Article CAS PubMed Google Scholar
  15. Andersen JB, Spee B, Blechacz BR et al (2012) Genomic and genetic characterization of cholangiocarcinoma identifies therapeutic targets for tyrosine kinase inhibitors. Gastroenterology 142:1021–1031 e1015
    Article CAS PubMed Google Scholar
  16. Sia D, Hoshida Y, Villanueva A et al (2013) Integrative molecular analysis of intrahepatic cholangiocarcinoma reveals 2 classes that have different outcomes. Gastroenterology 144:829–840
    Article CAS PubMed PubMed Central Google Scholar
  17. Liau JY, Tsai JH, Yuan RH, Chang CN, Lee HJ, Jeng YM (2014) Morphological subclassification of intrahepatic cholangiocarcinoma: etiological, clinicopathological, and molecular features. Mod Pathol 27:1163–1173
    Article CAS PubMed Google Scholar
  18. Wang Y, Li J, Xia Y et al (2013) Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy. J Clin Oncol 31:1188–1195
    Article PubMed Google Scholar
  19. Shirai K, Ebata T, Oda K et al (2008) Perineural invasion is a prognostic factor in intrahepatic cholangiocarcinoma. World J Surg 32:2395–2402
    Article PubMed Google Scholar
  20. Nam JG, Lee JM, Joo I et al (2018) Intrahepatic mass-forming cholangiocarcinoma: relationship between computed tomography characteristics and histological subtypes. J Comput Assist Tomogr 42:340–349
    Article PubMed Google Scholar
  21. Kim SA, Lee JM, Lee KB et al (2011) Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern—correlation with clinicopathologic findings. Radiology 260:148–157
    Article PubMed Google Scholar
  22. Fujita N, Asayama Y, Nishie A et al (2017) Mass-forming intrahepatic cholangiocarcinoma: enhancement patterns in the arterial phase of dynamic hepatic CT—correlation with clinicopathological findings. Eur Radiol 27:498–506
    Article Google Scholar
  23. Yoshida Y, Imai Y, Murakami T et al (1999) Intrahepatic cholangiocarcinoma with marked hypervascularity. Abdom Imaging 24:66–68
    Article CAS PubMed Google Scholar

Download references

Funding

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Korea (Grant No. 1520160).

Author information

Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul, 03722, South Korea
    Hyungjin Rhee, Myeong-Jin Kim & Chansik An
  2. Department of Pathology, Brain Korea 21 PLUS Project for Medical Science, Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, South Korea
    Young Nyun Park
  3. Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
    Young Nyun Park

Authors

  1. Hyungjin Rhee
  2. Myeong-Jin Kim
  3. Young Nyun Park
  4. Chansik An

Corresponding author

Correspondence toMyeong-Jin Kim.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Myeong-Jin Kim.

Conflict of interest

Myeong-Jin Kim is a recipient of a grant from Bayer HealthCare, which is not related to this study.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Rhee et al [14].

Methodology

• Retrospective

• Observational

• Performed at one institution

Rights and permissions

About this article

Cite this article

Rhee, H., Kim, MJ., Park, Y.N. et al. A proposal of imaging classification of intrahepatic mass-forming cholangiocarcinoma into ductal and parenchymal types: clinicopathologic significance.Eur Radiol 29, 3111–3121 (2019). https://doi.org/10.1007/s00330-018-5898-9

Download citation

Keywords