Integrative Analysis of Intrahepatic Cholangiocarcinoma Subtypes for Improved Patient Stratification: Clinical, Pathological, and Radiological Considerations

Intrahepatic cholangiocarcinomas (iCCAs) may be subdivided into large and small duct types that differ in etiology, molecular alterations, therapy, and prognosis. Therefore, the optimal iCCA subtyping is crucial for the best possible patient outcome. In our study, we analyzed 148 small and 84 large...

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Published inCancers Vol. 14; no. 13; p. 3156
Main Authors Gerber, Tiemo S., Müller, Lukas, Bartsch, Fabian, Gröger, Lisa-Katharina, Schindeldecker, Mario, Ridder, Dirk A., Goeppert, Benjamin, Möhler, Markus, Dueber, Christoph, Lang, Hauke, Roth, Wilfried, Kloeckner, Roman, Straub, Beate K.
Format Journal Article
LanguageEnglish
Published Basel MDPI AG 28.06.2022
MDPI
Subjects
adenocarcinoma
Bile ducts
Cadherins
CD56 antigen
Cholangiocarcinoma
Decision making
Diagnosis
diagnostic imaging
Etiology
Growth patterns
Histology
Jaundice
large duct type
Liver cancer
Magnetic resonance imaging
Medical prognosis
Mucin
N-Cadherin
Neoplasia
Patients
Prognosis
Regression analysis
small duct type
subtyping
Survival analysis
Tumors
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Summary:Intrahepatic cholangiocarcinomas (iCCAs) may be subdivided into large and small duct types that differ in etiology, molecular alterations, therapy, and prognosis. Therefore, the optimal iCCA subtyping is crucial for the best possible patient outcome. In our study, we analyzed 148 small and 84 large duct iCCAs regarding their clinical, radiological, histological, and immunohistochemical features. Only 8% of small duct iCCAs, but 27% of large duct iCCAs, presented with initial jaundice. Ductal tumor growth pattern and biliary obstruction were significant radiological findings in 33% and 48% of large duct iCCAs, respectively. Biliary epithelial neoplasia and intraductal papillary neoplasms of the bile duct were detected exclusively in large duct type iCCAs. Other distinctive histological features were mucin formation and periductal-infiltrating growth pattern. Immunohistochemical staining against CK20, CA19-9, EMA, CD56, N-cadherin, and CRP could help distinguish between the subtypes. To summarize, correct subtyping of iCCA requires an interplay of several factors. While the diagnosis of a precursor lesion, evidence of mucin, or a periductal-infiltrating growth pattern indicates the diagnosis of a large duct type, in their absence, several other criteria of diagnosis need to be combined.
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ISSN:2072-6694
2072-6694
DOI:10.3390/cancers14133156