Nakajima T, Kondo Y, Miyazaki M, Okui K
Department of Pathology, School of Medicine, Chiba University, Japan.
Hum Pathol. 1988 Oct;19(10):1228-34. doi: 10.1016/s0046-8177(88)80156-4.
In our survey of 102 cases of intrahepatic cholangiocarcinoma, 71 peripheral type cases and 31 hilar type cases were observed, the former being prone to metastasize to remote organs and lymph nodes when compared with the latter. These cases were histologically classified into nine histologic types according to the predominant features and rearranged into three groups (well-differentiated, less-differentiated, and uncommon). Although most of these cases were mucin-producing adenocarcinomas with variable grades of differentiation (92 of 102; 90%), several uncommon types were also encountered (ten of 102; 10%), such as adenosquamous, squamous, mucinous, or anaplastic carcinoma. Remote organ metastases were observed more frequently in the less-differentiated group than in the well-differentiated group. In regard to intrahepatic tumor spreading, expansion via sinusoidal spaces (93%), vascular (52%) or lymphatic (18%) involvement, perineural invasion (16%), replacing growth in the bile duct (12%), and permeation in the portal connective tissue (19%) were observed. The cholangiocarcinomas with the vascular involvement presented a higher tendency of intrahepatic as well as extrahepatic metastasis. For correct diagnosis and treatment of cholangiocarcinoma, it seems to be important to possess some knowledge of these histologic types, including their variations and patterns of intrahepatic spread.
在我们对102例肝内胆管癌的调查中，观察到71例周围型病例和31例肝门型病例，与后者相比，前者更容易转移至远处器官和淋巴结。根据主要特征，这些病例在组织学上分为九种组织学类型，并重新分为三组（高分化、低分化和罕见型）。虽然这些病例大多数为不同分化程度的黏液腺癌（102例中的92例；90%），但也遇到了几种罕见类型（102例中的10例；10%），如腺鳞癌、鳞癌、黏液癌或未分化癌。低分化组比高分化组更常观察到远处器官转移。关于肝内肿瘤扩散，观察到通过窦状隙扩展（93%）、血管受累（52%）或淋巴管受累（18%）、神经周围侵犯（16%）、胆管内替代生长（12%）以及门静脉结缔组织内浸润（19%）。血管受累的胆管癌肝内和肝外转移倾向更高。对于胆管癌的正确诊断和治疗，了解这些组织学类型，包括其变异和肝内扩散模式似乎很重要。
