Intrapancreatic distal common bile duct carcinoma: analysis, staging considerations, and comparison with pancreatic ductal and ampullary adenocarcinomas.
Thirty-seven percent (n = 15 of 41) of bile duct carcinomas and 41% (n = 36 of 87) of PDACs were called "negative for malignant cells" or "atypical, favor reactive"; 17 of 41 bile duct carcinomas (41%) and 30 of 87 PDACs (35%) were called "suspicious" or "malignant" on cytology (Table 3).
The case presented here emphasizes that clinically and cholangiographically, IgG4-SC resembles bile duct carcinoma and PSC in many aspects.
No complete obstruction of a bile duct is seen, a finding that would have been more characteristic of bile duct carcinoma. 2: occlusive balloon, 3: endoscope, 4: guide wire.
Bile duct carcinomas have been reported in young psittacine birds of the genus Amazona.
(7,16) Bile duct carcinomas are often associated with increased gamma-glutamyl transferase and bile acid levels; however, these tests are not specific for bile duct carcinomas.
Distinction of PDAC from distal bile duct carcinoma
involving the pancreas may be even more problematic than distinguishing ampullary tumors because of their intrapancreatic location and identical pancreatobiliary-type morphology and immunophenotype.
On imaging 3 patterns (30) of disease emerge: (1) multiple strictures, as well as dilation of the intrahepatic and extrahepatic biliary system, and an appearance that typically mimics primary sclerosing cholangitis; (2) an intrahepatic or hilar mass-forming lesion that may or may not be accompanied by biliary strictures, and an appearance that mimics cholangiocarcinoma or bile duct carcinoma
; and (3) isolated stricture of the bile duct, and, in this scenario, the leading diagnosis is bile duct carcinoma
Because 5% of patients with bile duct carcinoma
have synchronous carcinomas of the gallbladder, examination of the entire surgical specimen, including the gallbladder, is advised.
Complete surgical resection with microscopically negative surgical margins is an important predictor of outcome in multivariate analysis for both perihilar and distal bile duct carcinomas
, with overall 5-year survival for distal tumor improved from roughly 10% for patients with positive margins to 27% for those with negative resection margins.
(5) In the literature, MUC4 expression appears to be associated with more aggressiveness and increased metastases in breast cancer, extrahepatic bile duct carcinoma
, pancreatic cancer, and cholangiocarcinoma.
This pattern of strong expression of CK7 and negative expression of CK20 was most frequent in carcinomas of the ampulla or pancreas, but the majority of gallbladder and bile duct carcinomas
also had this profile.