We studied clinicopathologic aspects of cholangiocellular carcinoma in nine patients, among then hepatic resection was performed in eight cases, and two cases were associated with hepatolithiasis. In all cases, the first diagnostic modality was ultrasonography.
The results were as follows;
1. CA19-9 (carbohydrate antigen 19-9) had a high positive incidence (83.3%) and a high score.
2. Ultrasonography and plain CT showed a hypoechoic and low density mass in all cases. The macroscopic massive type showed a hypoechoic heterogenous with an irregular margin and heterogenous enhancement on contrast CT. The macroscopic nodular type showed a homogeneous echoic mass with halo and marginal enhancement. In hepatic angiography, encasement and abruption were common in the massive type, and portal and hepatic vein involvement was prevalent. However, in the nodular type, tumor neovascularization was common. Cholangiography (ERCP, PTC) showed stenosis, dilatation, irregularity and obstruction at the first branch of the bile duct in the massive type, and peripherally from the second branch in the nodular type.
3. The massive type showed infiltrative growth, and was bigger than the nodular type which showed expansive growth. Histologically, all cases showed tubular adenocarcinoma. Vascular and lymphatic vessel invasion was noted and intra-and perineural invasion was common, especially in the massive type infiltrating to the hepatic hilum.
The prognosis was not so good in cases of such macroscopic and histological evidence. Therefore, early diagnosis is crucial and multimodality therapy may be important.
