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. 1998 Jan;227(1):63–69. doi: 10.1097/00000658-199801000-00010

Clinical studies of mucin-producing cholangiocellular carcinoma: a study of 22 histopathology-proven cases.

M F Chen 1, Y Y Jan 1, T C Chen 1
PMCID: PMC1191174  PMID: 9445112

Abstract

OBJECTIVE: We present the clinical features and outcomes of 22 surgically treated and histopathology-proven cases of mucin-producing cholangiocellular carcinoma (MPCCC). BACKGROUND: Cholangiocellular carcinoma (CCC) is an uncommon malignancy. Unlike hepatocellular carcinoma, it is difficult to set up a high-risk group, and a specific tumor marker has yet to be found. Chronic liver disease is usually not found to be associated with CCC. Information about patients with MPCCC is limited, and the frequency of MPCCC in all patients with CCC has not been reported. METHODS: The clinical features of 22 surgically treated and histopathology-proven cases of MPCCC were reviewed, including morbidity, mortality, and follow-up results. Factors that may influence the outcomes were also analyzed. Clinical features and outcomes of 148 patients with non-mucin-producing cholangiocellular carcinoma (non-MPCCC) were also summarized for comparison. RESULTS: Of 170 cases of CCC, 22 (12.9%) were MPCCC. Imaging studies were important in the differential diagnosis of CCC. Operative findings (e.g., gross appearance of the liver, mucobilia found by common bile duct exploration, choledochoscopic findings, and frozen section) were useful in the diagnosis of MPCCC. Surgical procedures included common bile duct exploration, or hepaticostomy, and intraoperative choledochoscopy in all 22 patients. Hepatic resection was done in 14 of the 22 cases (63.6%). No early surgical mortality was noted. Wound infections (two patients), bile leak (one patient), and intraabdominal abscess (one patient) were the postoperative complications. The 1-, 2-, 3-, 4-, and 5-year survival rates were 86.5%, 68.5%, 59.0%, 38.5%, and 31.0%, respectively. A significant difference in survival pattern was found between the MPCCC and non-MPCCC patient groups. Patients with hepatic resection had a significantly better prognosis than those without resection. Although patients with hepatolithiasis had a better survival pattern than those without hepatolithiasis, the difference was not statistically significant. CONCLUSIONS: We present the clinical features and outcomes of 22 surgically treated and histopathology-proven cases of MPCCC. Patients with hepatic resection were found to have better survival rates.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balasegaram M. Hepatic calculi. Ann Surg. 1972 Feb;175(2):149–154. doi: 10.1097/00000658-197202000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. CATTELL R. B., BRAASCH J. W., KAHN F. Polypoid epithelial tumors of the bile ducts. N Engl J Med. 1962 Jan 11;266:57–61. doi: 10.1056/NEJM196201112660201. [DOI] [PubMed] [Google Scholar]
  3. CHANG H. P. PATHOLOGICAL CHANGES IN THE INTRAHEPATIC BILE DUCTS OF CATS (FELIS CATUS) INFESTED WITH CLONORCHIS SINENSIS. J Pathol Bacteriol. 1965 Jan;89:357–364. doi: 10.1002/path.1700890138. [DOI] [PubMed] [Google Scholar]
  4. Chen M. F., Jan Y. Y., Wang C. S., Hwang T. L., Jeng L. B., Chen S. C., Chen T. J. A reappraisal of cholangiocarcinoma in patient with hepatolithiasis. Cancer. 1993 Apr 15;71(8):2461–2465. doi: 10.1002/1097-0142(19930415)71:8<2461::aid-cncr2820710806>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  5. Chen M. F., Jan Y. Y., Wang C. S., Jeng L. B., Hwang T. L., Chen S. C. Intrahepatic stones associated with cholangiocarcinoma. Am J Gastroenterol. 1989 Apr;84(4):391–395. [PubMed] [Google Scholar]
  6. Chen M. F., Jan Y. Y., Wang C. S., Jeng L. B., Hwang T. L. Clinical experience in 20 hepatic resections for peripheral cholangiocarcinoma. Cancer. 1989 Dec 1;64(11):2226–2232. doi: 10.1002/1097-0142(19891201)64:11<2226::aid-cncr2820641107>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  7. Chen M. F., Jan Y. Y., Wang C. S., Jeng L. B., Hwang T. L. Intraoperative fiberoptic choledochoscopy for malignant biliary tract obstruction. Gastrointest Endosc. 1989 Nov-Dec;35(6):545–547. doi: 10.1016/s0016-5107(89)72908-4. [DOI] [PubMed] [Google Scholar]
  8. Chen P. H., Lo H. W., Wang C. S., Tsai K. R., Chen Y. C., Lin K. Y., Siauw C. P., Hwang R. R., Liu M. H., Ko H. C. Cholangiocarcinoma in hepatolithiasis. J Clin Gastroenterol. 1984 Dec;6(6):539–547. doi: 10.1097/00004836-198412000-00010. [DOI] [PubMed] [Google Scholar]
  9. Choi T. K., Wong J., Ong G. B. The surgical management of primary intrahepatic stones. Br J Surg. 1982 Feb;69(2):86–90. doi: 10.1002/bjs.1800690210. [DOI] [PubMed] [Google Scholar]
  10. Falchuk K. R., Lesser P. B., Galdabini J. J., Isselbacher K. J. Cholangiocarcinoma as related to chronic intrahepatic cholangitis and hepatolithiasis. Case report and review of the literature. Am J Gastroenterol. 1976 Jul;66(1):57–61. [PubMed] [Google Scholar]
  11. Gallagher P. J., Millis R. R., Mitchinson M. J. Congenital dilatation of the intrahepatic bile ducts with cholangiocarcinoma. J Clin Pathol. 1972 Sep;25(9):804–808. doi: 10.1136/jcp.25.9.804. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hadjis N. S., Slater R. N., Blumgart L. H. Mucobilia: an unusual cause of jaundice. Br J Surg. 1987 Jan;74(1):48–49. doi: 10.1002/bjs.1800740115. [DOI] [PubMed] [Google Scholar]
  13. Jan Y. Y., Chen M. F., Chen T. J. [Cholangiocarcinoma with mucobilia]. J Formos Med Assoc. 1994 Dec;93 (Suppl 3):S149–S155. [PubMed] [Google Scholar]
  14. Koga A., Ichimiya H., Yamaguchi K., Miyazaki K., Nakayama F. Hepatolithiasis associated with cholangiocarcinoma. Possible etiologic significance. Cancer. 1985 Jun 15;55(12):2826–2829. doi: 10.1002/1097-0142(19850615)55:12<2826::aid-cncr2820551219>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  15. Kokubo T., Itai Y., Ohtomo K., Itoh K., Kawauchi N., Minami M. Mucin-hypersecreting intrahepatic biliary neoplasms. Radiology. 1988 Sep;168(3):609–614. doi: 10.1148/radiology.168.3.2841715. [DOI] [PubMed] [Google Scholar]
  16. Maki T., Sato T., Matsushiro T. A reappraisal of surgical treatment for intrahepatic gallstones. Ann Surg. 1972 Feb;175(2):155–165. doi: 10.1097/00000658-197202000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Okuda K., Kubo Y., Okazaki N., Arishima T., Hashimoto M. Clinical aspects of intrahepatic bile duct carcinoma including hilar carcinoma: a study of 57 autopsy-proven cases. Cancer. 1977 Jan;39(1):232–246. doi: 10.1002/1097-0142(197701)39:1<232::aid-cncr2820390137>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
  18. Sanguily J., Calderin V. O. Partial resection of the liver for primary cholangiocarcinoma. Presentation of a successful case. Am J Surg. 1974 Nov;128(5):603–607. doi: 10.1016/s0002-9610(74)80009-7. [DOI] [PubMed] [Google Scholar]
  19. Styne P., Warren G. H., Kumpe D. A., Halgrimson C., Kern F., Jr Obstructive cholangitis secondary to mucus secreted by a solitary papillary bile duct tumor. Gastroenterology. 1986 Mar;90(3):748–753. doi: 10.1016/0016-5085(86)91133-9. [DOI] [PubMed] [Google Scholar]
  20. Todoroki T., Okamura T., Fukao K., Nishimura A., Otsu H., Sato H., Iwasaki Y. Gross appearance of carcinoma of the main hepatic duct and its prognosis. Surg Gynecol Obstet. 1980 Jan;150(1):33–40. [PubMed] [Google Scholar]
  21. Venu R. P., Geenen J. E., Hogan W. J., Johnson G. K., Klein K., Stone J. Intraluminal radiation therapy for biliary tract malignancy--an endoscopic approach. Gastrointest Endosc. 1987 Jun;33(3):236–238. doi: 10.1016/s0016-5107(87)71567-3. [DOI] [PubMed] [Google Scholar]
  22. Wen C. C., Lee H. C. Intrahepatic stones: a clinical study. Ann Surg. 1972 Feb;175(2):166–177. doi: 10.1097/00000658-197202000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]

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