Abstract
The most common gross type of cholangiocarcinoma (CCA) of intrahepatic large bile duct and perihilar and distal bile ducts is the nodular-sclerosing type (NS-CCA). Biliary intraepithelial neoplasia (BilIN) is the term to describe flat or micropapillary or papillotubular dysplastic epithelium in the bile duct and is proposed as a preceding lesion of NS-CCA, particularly those associated hepatolithiasis. Its three-grade classification (BilIN-1, -2, and -3) may reflect multistep carcinogenesis of NS-CCA, and BilIN-3 is regarded as carcinoma in situ. Other intraepithelial growth forms of biliary neoplasia are also not infrequently found in the bile ducts around invasive NS-CCA: intraepithelial invasion of periductal invasive carcinoma through the basement membrane of the bile duct (cancerization). Cancerization in the biliary epithelial layer is a variably differentiated adenocarcinoma and presents flat, micropapillary, and papillotubular patterns. Furthermore, in NS-CCA without preceding chronic biliary diseases, intraepithelial neoplasms are also frequently found in the bile ducts; this lesion may be composed of preinvasive neoplasm (corresponding to BilINs) and cancerization from invasive NS-CCA. In conclusion, the intraepithelial neoplasms of the bile ducts in NS-CCAs could be heterogeneous, and the recognition of these subcategories of intraepithelial neoplasms is important for the evaluation of the development of CCAs, and it is also practically important whether surgical margin of bile duct with intraepithelial neoplasm is BilINs or cancerization.
Yasuni Nakanuma and Tsuneyoshi Uchida equally contributed to preparation of this paper, and Yoshifumi Ohnishi contributed cases to this paper.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- BilIN:
-
Biliary intraepithelial neoplasia
- CCA:
-
Cholangiocarcinoma
- CEA:
-
Carcinoembryonic antigen
- IENB:
-
Intraepithelial neoplasm of bile duct
- NS-CCA:
-
Nodular-sclerosing cholangiocarcinoma
- PanIN:
-
Pancreatic intraepithelial neoplasm
- PDAC:
-
Pancreatic duct adenocarcinoma
- PSC:
-
Primary sclerosing cholangitis
References
Nakanuma Y, Kakuda Y. Pathologic classification of cholangiocarcinoma: new concepts. Best Pract Res Clin Gastroenterol. 2015;29(2):277–93.
Sakamoto E, Nimura Y, Hayakawa N, et al. The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg. 1998;227(3):405–11.
Nakanishi Y, Kondo S, Zen Y, et al. Impact of residual in situ carcinoma on postoperative survival in 125 patients with extrahepatic bile duct carcinoma. J Hepatobiliary Pancreat Sci. 2010;17(2):166–73.
Wakai T, Shirai Y, Moroda T, Yokoyama N, Hatakeyama K. Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer. 2005;103(6):1210–6.
Nakanuma Y, Uchida T, Uesaka K. S100P-positive biliary epithelial field is a pre-invasive intraepithelial neoplasm in nodular-sclerosing cholangiocarcinoma. Hum Pathol. 2017; 60(2): 46–57.
Nakanuma Y, Curado MP, Franceschi S, et al. Intrahepatic cholangiocarcinoma. In: Bosman FT, Carnoiro F, Hruba RH, Theise ND, editors. WHO classification of tumors of the digestive system. Lyon: IARC Press; 2010. p. 217–24.
Albores-Saavedra J, Adsay NV, Crawford JM, et al. Carcinoma of the gallbladder and extrahepatic bile ducts. In: Bosman FT, Carnoiro F, Hruban RH, Theise ND, editors. WHO classification of tumors of the digestive system. Lyon: IARC Press; 2010. p. 266–73.
Sato Y, Harada K, Sasaki M, Nakanuma Y. Histological characteristics of biliary intraepithelial neoplasia-3 and intraepithelial spread of cholangiocarcinoma. Virchows Arch. 2013;462(4):421–7.
Sato Y, Harada K, Sasaki M, Nakanuma Y. Pathological diagnosis of flat epithelial lesions of the biliary tract with emphasis on biliary intraepithelial neoplasia. J Gastroenterol. 2014;49(1):64–72.
Sato Y, Harada K, Sasaki M, Nakanuma Y. Histological characterization of biliary intraepithelial neoplasia with respect to pancreatic intraepithelial neoplasia. Int J Hepatol. 2014;2014:678260. doi:10.1155/2014/678260.
Itatsu K, Zen Y, Ohira S, et al. Immunohistochemical analysis of the progression of flat and papillary preneoplastic lesions in intrahepatic cholangiocarcinogenesis in hepatolithiasis. Liver Int. 2007;27(9):1174–84.
Nakanuma Y. A novel approach to biliary tract pathology based on similarities to pancreatic counterparts: is the biliary tract an incomplete pancreas? Pathol Int. 2010;60(6):419–29.
Basturk O, Hong SM, Wood LD, et al. A revised classification system and recommendations from the Baltimore consensus meeting for neoplastic precursor lesions in the pancreas. Am J Surg Pathol. 2015;39(12):1730–41.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Nakanuma, Y., Uchida, T., Ohnishi, Y. (2017). Intraepithelial Neoplasia of Bile Ducts in Nodular Sclerosing Cholangiocarcinoma: Heterogeneous Categories. In: Nakanuma, Y. (eds) Pathology of the Bile Duct. Springer, Singapore. https://doi.org/10.1007/978-981-10-3500-5_15
Download citation
DOI: https://doi.org/10.1007/978-981-10-3500-5_15
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-3499-2
Online ISBN: 978-981-10-3500-5
eBook Packages: MedicineMedicine (R0)