Gonzalez Raul S, Bagci Pelin, Basturk Olca, Reid Michelle D, Balci Serdar, Knight Jessica H, Kong So Yeon, Memis Bahar, Jang Kee-Taek, Ohike Nobuyuki, Tajiri Takuma, Bandyopadhyay Sudeshna, Krasinskas Alyssa M, Kim Grace E, Cheng Jeanette D, Adsay N Volkan
Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA.
Department of Pathology, Marmara University, Istanbul, Turkey.
Mod Pathol. 2016 Nov;29(11):1358-1369. doi: 10.1038/modpathol.2016.125. Epub 2016 Jul 29.
Distal common bile duct carcinoma is a poorly characterized entity for reasons such as variable terminology and difficulty in determining site of origin of intrapancreatic lesions. We compared clinicopathologic features of pancreatobiliary-type adenocarcinomas within the pancreas, but arising from the distal common bile duct, with those of pancreatic and ampullary origin. Upon careful review of 1017 pancreatoduodenectomy specimens with primary adenocarcinoma, 52 (5%) qualified as intrapancreatic distal common bile duct carcinoma. Five associated with an intraductal papillary neoplasm were excluded; the remaining 47 were compared to 109 pancreatic ductal adenocarcinomas and 133 ampullary carcinomas. Distal common bile duct carcinoma patients had a younger median age (58 years) than pancreatic ductal adenocarcinoma patients (65 years) and ampullary carcinoma patients (68 years). Distal common bile duct carcinoma was intermediate between pancreatic ductal adenocarcinoma and ampullary carcinoma with regard to tumor size and rates of node metastases and margin positivity. Median survival was better than for pancreatic ductal adenocarcinoma (P=0.0010) but worse than for ampullary carcinoma (P=0.0006). Distal common bile duct carcinoma often formed an even band around the common bile duct and commonly showed intraglandular neutrophil-rich debris and a small tubular pattern. Poor prognostic indicators included node metastasis (P=0.0010), lymphovascular invasion (P=0.0299), and margin positivity (P=0.0069). Categorizing the tumors based on size also had prognostic relevance (P=0.0096), unlike categorization based on anatomic structures invaded. Primary distal common bile duct carcinoma is seen in younger patients than pancreatic ductal adenocarcinoma or ampullary carcinoma. Its prognosis is significantly better than pancreatic ductal adenocarcinoma and worse than ampullary carcinoma, at least partly because of differences in clinical presentation. Use of size-based criteria for staging appears to improve its prognostic relevance. Invasive pancreatobiliary-type distal common bile duct carcinomas are uncommon in the West and have substantial clinicopathologic differences from carcinomas arising from the pancreas and ampulla.
由于术语不统一以及难以确定胰腺内病变的起源部位等原因，肝外胆管远端癌是一种特征描述不清的实体。我们比较了起源于肝外胆管远端但位于胰腺内的胰胆管型腺癌与胰腺及壶腹起源的腺癌的临床病理特征。在仔细检查1017例原发性腺癌的胰十二指肠切除标本后，52例（5%）符合胰腺内肝外胆管远端癌的诊断标准。排除5例合并导管内乳头状肿瘤的病例；其余47例与109例胰腺导管腺癌和133例壶腹癌进行比较。肝外胆管远端癌患者的中位年龄（58岁）比胰腺导管腺癌患者（65岁）和壶腹癌患者（68岁）年轻。在肿瘤大小、淋巴结转移率和切缘阳性率方面，肝外胆管远端癌介于胰腺导管腺癌和壶腹癌之间。中位生存期优于胰腺导管腺癌（P=0.0010），但差于壶腹癌（P=0.0006）。肝外胆管远端癌常围绕肝外胆管形成均匀的带状，常见腺体内富含中性粒细胞的碎屑和小的管状结构。不良预后指标包括淋巴结转移（P=0.0010）、淋巴管浸润（P=0.0299）和切缘阳性（P=0.0069）。与基于侵犯的解剖结构分类不同，基于肿瘤大小对肿瘤进行分类也具有预后相关性（P=0.0096）。原发性肝外胆管远端癌患者比胰腺导管腺癌或壶腹癌患者年轻。其预后明显优于胰腺导管腺癌，劣于壶腹癌，至少部分原因是临床表现不同。使用基于大小的标准进行分期似乎可以提高其预后相关性。侵袭性胰胆管型肝外胆管远端癌在西方并不常见，与起源于胰腺和壶腹的癌在临床病理上有很大差异。
