[Histological appearance of carcinoma of the upper bile duct and the mode of its spread].

The histopathology of 34 resected cases of carcinoma of the upper bile duct was reviewed in relation to its mode of spread and prognosis of the patients. The patients with papillary adenocarcinoma showed 3-year survival rate of 75 percent which was better than those with carcinoma of other histologic types. There were no 2-year survivals in patients with poorly differentiated adenocarcinoma. Infiltration to the serosa of the bile duct and to the liver, lymph node metastasis, and venous, lymphatic or perineural invasion of carcinoma were thought to be important prognostic factors, since the chance for survival was definitely better for patients without those factors than with those factors. In four patients with papillary adenocarcinoma, no involvement of hepatic parenchyma and lymph node metastasis was found. Three of these patients had no cancer infiltration to the serosa of the bile duct. Most cases of poorly differentiated adenocarcinoma, in contrast, had positive and extensive association of those prognostic factors. Seventy-five percent of patients with papillary adenocarcinoma and only 22 percent of those with poorly differentiated adenocarcinoma were microscopically considered curable by resection. It is noteworthy that histological appearance of carcinoma may be valid as a fundamental factor to determine mode of spread of carcinoma of the upper bile duct and prognosis of the patients.