Noninvasive and minimally invasive papillary carcinomas of the extrahepatic bile ducts

BACKGROUND. Adenocarcinomas of the extrahepatic bile ducts (EBD) are uncomm on neoplasms that are morphologically heterogenous and associated with a po or prognosis. Papillary carcinomas of the EBD, however, appear to follow a much less aggressive clinical course. METHODS, The authors reviewed the clinical records of nine patients with pa pillary carcinoma of the EBD, analyzed the microscopic features, and select ed immunohistochemical reactivity (p53 and MIB-1) that might correlate with patient survival. RESULTS. Six patients were male and three were female, with a mean age of 6 5 years (range, 48-83 years). The clinical presentation of disease in these patients was similar to that reported for conventional adenocarcinoma of E BD. According to their cell phenotypes, these papillary carcinomas were cla ssified as biliary type (7 cases) and intestinal type (2 cases). Most were located in the common bile duct and were well differentiated (7 cases). Fiv e showed minimal expansile invasion into the ductal wail and four were noni nvasive. Five patients were treated with a Whipple operation, three underwe nt segmental resections, and one underwent a left hepatic lobectomy. One pa tient died of unrelated causes 16 years after a Whipple operation, and anot her died of postoperative complications. The remaining 7 patients are alive and disease free 1-13 years after surgery. CONCLUSIONS. Noninvasive and minimally invasive papillary carcinomas of the EBD are associated with excellent long term prognosis regardless of their cytologic features or their immunohistochemical reactivity to p53 and MIB-1 . These tumors should be distinguished from biliary papillomatosis, intradu ctal papillary mucinous carcinomas of the pancreas extending into the bile ducts, papillary adenomas, and papillary hyperplasia. (C) 2000 American Can cer Society.