CLINICOPATHOLOGICAL SPECTRUM OF RESECTED EXTRADUCTAL MASS-FORMING INTRAHEPATIC CHOLANGIOCARCINOMA

Background. The mode of tumor growth of intrahepatic cholangiocarcinom a (CC) varies considerably from patient to patient. This study describ es the clinicopathologic variety of the extraductal mass-forming type of CC. Methods. Patients with CC characterized by an extraductal mass (n = 26) who underwent hepatectomy from 1976 through 1992 were clinico pathologically classified into three types: Type I(n = 7), no biliary stricture; Type II (n = 13), biliary stricture without jaundice; and T ype III(n = 6), biliary stricture with jaundice. Results. Type I inclu ded three patients with microductular-trabecular arrangement and behav ior reminiscent of hepatocellular carcinoma (high association with chr onic liver disease, mild positivity for alpha-fetoprotein [AFP], no ly mph node metastasis, but frequent intrahepatic metastasis), in contras t to the other typical cholangiocarcinoma. Hepatolithiasis was associa ted only with Type II CC. The serum positivity for AFP and carcinoembr yonic antigen was much higher in Type I CC, whereas positivity of CA 1 9-9 was highest in Type III. Involvement of the portal vein, hepatic a rtery, or hepatic duct was most frequent in Type III CC, which necessi tated resection of the extrahepatic bile duct and hepatectomy. Conclus ion. The clinicopathologic behavior of intrahepatic CC differs conside rably according to the presence or absence of stricture of the biliary tree. Thus, CC without biliary stricture behaves more like hepatocell ular carcinoma, whereas CC with biliary stricture is more like hilar o r extrahepatic bile duct carcinoma.