Cholangiocarcinoma - Revision history

Michael: +more SO

2024-12-17T18:06:01Z

+more SO

← Older revision		Revision as of 18:06, 17 December 2024
Line 170:		Line 170:
	Note:		Note:
	*On biopsy, it isn't possible to cleanly separate from [[pancreatic adenocarcinoma]]. Thus, it is better to stay vague.		*On biopsy, it isn't possible to cleanly separate from [[pancreatic adenocarcinoma]]. Thus, it is better to stay vague.

			===Alternate===
			<pre>
			Liver, Core Biopsy:
			- ADENOCARCINOMA, see comment.

			Comment:
			The tumour stains as follows:
			POSITIVE: CK7 (strong, diffuse), CK19 (moderate, diffuse), HNF1b (moderate, diffuse).
			NEGATIVE: CK20, GATA3, HepPar-1, PAX-8, WT-1, CDX2, mammaglobin, TTF-1.

			The findings would be compatible with a foregut primary lesion; a non-exhaustive list of possibilities includes: cholangiocarcinoma, pancreatic adenocarcinoma and gastric adenocarcinoma. Clinical and radiologic correlation is required.
			</pre>

	===Micro===		===Micro===
	The sections show an atypical gland-forming lesion (adenocarcinoma) in a fibrous		The sections show an atypical gland-forming lesion (adenocarcinoma) in a fibrous

Michael: /* Gross */

2017-08-14T13:41:37Z

Gross

← Older revision		Revision as of 13:41, 14 August 2017
Line 51:		Line 51:
	==Gross==		==Gross==
	*Classically one large mass - outline described as ''cauliflower-like''.<ref name=pmid18425077>{{Cite journal \| last1 = Nakanishi \| first1 = Y. \| last2 = Zen \| first2 = Y. \| last3 = Kawakami \| first3 = H. \| last4 = Kubota \| first4 = K. \| last5 = Itoh \| first5 = T. \| last6 = Hirano \| first6 = S. \| last7 = Tanaka \| first7 = E. \| last8 = Nakanuma \| first8 = Y. \| last9 = Kondo \| first9 = S. \| title = Extrahepatic bile duct carcinoma with extensive intraepithelial spread: a clinicopathological study of 21 cases. \| journal = Mod Pathol \| volume = 21 \| issue = 7 \| pages = 807-16 \| month = Jul \| year = 2008 \| doi = 10.1038/modpathol.2008.65 \| PMID = 18425077 \| URL = http://www.nature.com/modpathol/journal/v21/n7/full/modpathol200865a.html }}</ref>		*Classically one large mass - outline described as ''cauliflower-like''.<ref name=pmid18425077>{{Cite journal \| last1 = Nakanishi \| first1 = Y. \| last2 = Zen \| first2 = Y. \| last3 = Kawakami \| first3 = H. \| last4 = Kubota \| first4 = K. \| last5 = Itoh \| first5 = T. \| last6 = Hirano \| first6 = S. \| last7 = Tanaka \| first7 = E. \| last8 = Nakanuma \| first8 = Y. \| last9 = Kondo \| first9 = S. \| title = Extrahepatic bile duct carcinoma with extensive intraepithelial spread: a clinicopathological study of 21 cases. \| journal = Mod Pathol \| volume = 21 \| issue = 7 \| pages = 807-16 \| month = Jul \| year = 2008 \| doi = 10.1038/modpathol.2008.65 \| PMID = 18425077 \| URL = http://www.nature.com/modpathol/journal/v21/n7/full/modpathol200865a.html }}</ref>
	**May have satellite nodules.		**May have [[satellite nodules]].

	===Image===		===Image===
Line 57:		Line 57:
	Image:Cholangiocarcinoma.png \| Cholangiocarcinoma. (WC)		Image:Cholangiocarcinoma.png \| Cholangiocarcinoma. (WC)
	</gallery>		</gallery>

	==Microscopic==		==Microscopic==
	Features:<ref name=Ref_GLP609>{{Ref GLP\|609}}</ref>		Features:<ref name=Ref_GLP609>{{Ref GLP\|609}}</ref>

Michael at 17:15, 20 December 2016

2016-12-20T17:15:16Z

← Older revision		Revision as of 17:15, 20 December 2016
Line 129:		Line 129:
	E [[File: 6_16572554904132_sl 5.png\|Cholangiocarcinoma, poorly differentiated]]		E [[File: 6_16572554904132_sl 5.png\|Cholangiocarcinoma, poorly differentiated]]

	Cholangiocarcinnoma, intrahepatic, in a 72 year old man, poorly differentiated. A. Multiple cancerous foci strew otherwise unremarkable liver. B. Low cuboidal glands fuse and spread, with desmoplasia (green arrows points to slightly blue sttroma) and indian files (blue arrows). C. Aberrant single cells and cell clusters are present, with very little apparent cytoplasm, with extremely variable nuclei, with black and sometimes bubbly chromatin. Note close approximation raising possibility of molding (arrows). D. A mucicarmine stain, even when negative, can highlight the epithelial grouping of the nuclei by virtue of the slightly pink stroma. E. CK7 immunostain shows mostly groups, but also demarcates isolated cancer cells amid scar. Tumor was negative for ~~P40~~, CK20 CDX2, TTF1, PAX8.		Cholangiocarcinnoma, intrahepatic, in a 72 year old man, poorly differentiated. A. Multiple cancerous foci strew otherwise unremarkable liver. B. Low cuboidal glands fuse and spread, with desmoplasia (green arrows points to slightly blue sttroma) and indian files (blue arrows). C. Aberrant single cells and cell clusters are present, with very little apparent cytoplasm, with extremely variable nuclei, with black and sometimes bubbly chromatin. Note close approximation raising possibility of molding (arrows). D. A mucicarmine stain, even when negative, can highlight the epithelial grouping of the nuclei by virtue of the slightly pink stroma. E. CK7 immunostain shows mostly groups, but also demarcates isolated cancer cells amid scar. Tumor was negative for p40, CK20 CDX2, TTF1, PAX8.

Mitchell: /* Images */ Added a case. Changed to better format for others. Depending on one's cell phone or computer, the images may not appear as rows. Hence, the need to letter them.

2016-12-16T22:33:38Z

Images: Added a case. Changed to better format for others. Depending on one's cell phone or computer, the images may not appear as rows. Hence, the need to letter them.

← Older revision		Revision as of 22:33, 16 December 2016
Line 84:		Line 84:
	Image:Cholangiocarcinoma - very high mag.jpg \| Cholangiocarcinoma - very high mag. (WC/Nephron)		Image:Cholangiocarcinoma - very high mag.jpg \| Cholangiocarcinoma - very high mag. (WC/Nephron)
	</gallery>		</gallery>
	{\|		A [[File:1 CCA 1MRI.png\| Cholangiocarcinoma, intrahepatic, large duct type.]]
	[[File:1 CCA 1MRI.png\| Cholangiocarcinoma, intrahepatic, large duct type.]]		B [[File:2 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
	<br>		<br>
	[[File:2 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]		C [[File:3 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
	[[File:3 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]		D [[File:4 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
	<br>		<br>
	[[File:4 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]		E [[File:5 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
	[[File:5 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]		F [[File:6 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
	<br>		<br>
	~~[[File:6 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]~~		G [[File:7 CCA 1 1360x1024px.tif\| Cholangiocarcinoma, intrahepatic, large duct type.]]
	[[File:7 CCA 1 1360x1024px.tif\| Cholangiocarcinoma, intrahepatic, large duct type.]]
	\|}		Cholangiocarcinoma, intrahepatic, large duct type. Extremely unfortunate case arising in a pre-teenage girl. A. MRI showing multiple hepatic masses. B. A mass comprising often large ducts abuts uninvolved liver. C. CK7 immunostain emphasizes large, often adjoining ducts. D. Trichrome stain shows spread of tumor into scar with collagen deposition. E. Reticulin stain emphasizes disorderly vertical and horizontal spread of bizarrely shaped acini. F. PAS-D stain shows luminal mucin; note absence of red lining of outside of ducts seen in normal bile ducts/proliferating bile ductules. G. Loss of polarity (varied orientation with respect to base of epithelium) and variable size and shape of nuclei are obvious (Row 3 Right 400X, high pixel image).
	Cholangiocarcinoma, intrahepatic, large duct type. Extremely unfortunate case arising in a pre-teenage girl. MRI showing multiple hepatic masses. ~~Histologic images~~. A mass comprising often large ducts abuts uninvolved liver ~~(Row 1 Left 40X)~~. CK7 immunostain emphasizes large, often adjoining ducts ~~(Row 1 Right 40X)~~. Trichrome stain shows spread of tumor into scar with collagen deposition ~~(Row 2 Left 100X)~~. Reticulin stain emphasizes disorderly vertical and horizontal spread of bizarrely shaped acini ~~(Row 2 Right 100X)~~. PAS-D stain shows luminal mucin; note absence of red lining of outside of ducts seen in normal bile ducts/proliferating bile ductules ~~(Row 3 Left 200X)~~. Loss of polarity (varied orientation with respect to base of epithelium) and variable size and shape of nuclei are obvious (Row 3 Right 400X, high pixel image).

	{\|
	[[File:1 cholangio 2 680x512px.tif\| Cholangiocarcinoma, intrahepatic, small duct type.]]		A [[File:1 cholangio 2 680x512px.tif\| Cholangiocarcinoma, intrahepatic, small duct type.]]
	[[File:2 cholangio 2 680x512px.tif\| Cholangiocarcinoma, intrahepatic, small duct type.]]		B [[File:2 cholangio 2 680x512px.tif\| Cholangiocarcinoma, intrahepatic, small duct type.]]
	<br>		<br>
	[[File:3 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]		C [[File:3 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
	[[File:4 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]		D [[File:4 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
	<br>		<br>
	[[File:5 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]		E [[File:5 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
	[[File:6 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]		F [[File:6 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
	\|}
	Cholangiocarcinoma, intrahepatic, small duct type. Middle aged man with jaundice. Small dark tumorous masses [arrows] irrupt scar (Row 1 Left 20X). Cribriforming (net like pattern) of gland in gland [arrow] without intervening stroma, which can be difficult to discern from reactive bile ducts at times (Row 1 Right 100X). A second focus shows, on the left, glands with disorderly spread, further explored, and in the middle, partly formed glands with necrosis, further explored, both diagnostic (Row 2 Left 100X). Note how some glands go up and down [red arrows] & others go right to left [black arrows] showing disorderly spread (Row 2 Right 400X). Note necrotic cell nuclei [red arrows] and incompletely formed glands [black arrows] (Row 4 Left 200X). Nuclear anaplasia is also able to be used for a definite diagnosis, but there is considerable nuclear variability in reactive bile duct proliferations, making it less facile than disorderly spread, incomplete glands, and necrotic nuclei (Row 3 Right 400X).

	~~[[File:1 Cholangio 4 680x512px~~.~~tif\| Cholangiocarcinoma~~ with ~~associated abscess~~]]		Cholangiocarcinoma, intrahepatic, small duct type. Middle aged man with jaundice. A. Small dark tumorous masses [arrows] irrupt scar. B. Cribriforming (net like pattern) of gland in gland [arrow] without intervening stroma, which can be difficult to discern from reactive bile ducts at times. C. A second focus shows, on the left, glands with disorderly spread, further explored, and in the middle, partly formed glands with necrosis, further explored, both diagnostic. D. Note how some glands go up and down [red arrows] & others go right to left [black arrows] showing disorderly spread. E. Note necrotic cell nuclei [red arrows] and incompletely formed glands [black arrows]. F. Nuclear anaplasia is also able to be used for a definite diagnosis, but there is considerable nuclear variability in reactive bile duct proliferations, making it less facile than disorderly spread, incomplete glands, and necrotic nuclei.
	~~[[File:2 Cholangio 4 680x512px~~.~~tif\| Cholangiocarcinoma~~ with ~~associated abscess~~]]
	[[~~File:3 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]~~]
	~~[[File:4 Cholangio 4 680x512px~~.~~tif\| Cholangiocarcinoma with associated abscess]]~~
	~~[[File:5 Cholangio 4 680x512px~~.~~tif\| Cholangiocarcinoma with associated abscess]]~~
	~~[[File:6 Cholangio 4 680x512px~~.~~tif\| Cholangiocarcinoma with associated abscess]]~~

	Cholangiocarcinoma, intrahepatic, with associated abscess. A. Aberrant spaces (arrows) contrast with the scar to the regions left and, at right, hemosiderin laden macrophages amid granulation tissue ~~[40X]~~. B1. Disorderly spreading glands (black arrows) associated with atypical single cells (cyan arrows) have nuclei that contrast with those of the normal bile duct (blue arrow) with its associated artery (green arrow) ~~[200X]~~. C. PAS without diastase shows disorderly spreading, aberrantly shaped glands at left (arrows) and red degenerated hepatocytes to right ~~[200X]~~. D. PAS with diastase shows proliferating bile ducts to left, one with highly aberrant nuclei (black arrow), highly atypical cells at middle (green arrows) with sometimes incomplete (cyan arrows) acini, and normal liver at right (blue arrow) ~~[200X]~~. E. CK7 immunostain shows proliferating glands at left and a disorderly spread of single cells and cell groups at right, amid hepatocytes ~~[200X]~~. F. CK7 immunostain at higher power shows the stained cells have aberrant nuclei [~~400X~~].		A [[File:1 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			B [[File:2 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			<br>
			C [[File:3 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			D [[File:4 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			<br>
			E [[File:5 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			F [[File:6 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]

			Cholangiocarcinoma, intrahepatic, with associated abscess. A. Aberrant spaces (arrows) contrast with the scar to the regions left and, at right, hemosiderin laden macrophages amid granulation tissue . B. Disorderly spreading glands (black arrows) associated with atypical single cells (cyan arrows) have nuclei that contrast with those of the normal bile duct (blue arrow) with its associated artery (green arrow). C. PAS without diastase shows disorderly spreading, aberrantly shaped glands at left (arrows) and red degenerated hepatocytes to right. D. PAS with diastase shows proliferating bile ducts to left, one with highly aberrant nuclei (black arrow), highly atypical cells at middle (green arrows) with sometimes incomplete (cyan arrows) acini, and normal liver at right (blue arrow). E. CK7 immunostain shows proliferating glands at left and a disorderly spread of single cells and cell groups at right, amid hepatocytes. F. CK7 immunostain at higher power shows the stained cells have aberrant nuclei.


			A [[File: 6_16572554904132_sl 1.png\|Cholangiocarcinoma, poorly differentiated]]
			B [[File: 6_16572554904132_sl 2.png\|Cholangiocarcinoma, poorly differentiated]]
			<br>
			C [[File: 6_16572554904132_sl 3.png\|Cholangiocarcinoma, poorly differentiated]]
			D [[File: 6_16572554904132_sl 4.png\|Cholangiocarcinoma, poorly differentiated]]
			<br>
			E [[File: 6_16572554904132_sl 5.png\|Cholangiocarcinoma, poorly differentiated]]

			Cholangiocarcinnoma, intrahepatic, in a 72 year old man, poorly differentiated. A. Multiple cancerous foci strew otherwise unremarkable liver. B. Low cuboidal glands fuse and spread, with desmoplasia (green arrows points to slightly blue sttroma) and indian files (blue arrows). C. Aberrant single cells and cell clusters are present, with very little apparent cytoplasm, with extremely variable nuclei, with black and sometimes bubbly chromatin. Note close approximation raising possibility of molding (arrows). D. A mucicarmine stain, even when negative, can highlight the epithelial grouping of the nuclei by virtue of the slightly pink stroma. E. CK7 immunostain shows mostly groups, but also demarcates isolated cancer cells amid scar. Tumor was negative for P40, CK20 CDX2, TTF1, PAX8.

Mitchell: /* Images */ added a very tough case

2016-11-17T16:52:00Z

Images: added a very tough case

← Older revision		Revision as of 16:52, 17 November 2016
Line 109:		Line 109:
	\|}		\|}
	Cholangiocarcinoma, intrahepatic, small duct type. Middle aged man with jaundice. Small dark tumorous masses [arrows] irrupt scar (Row 1 Left 20X). Cribriforming (net like pattern) of gland in gland [arrow] without intervening stroma, which can be difficult to discern from reactive bile ducts at times (Row 1 Right 100X). A second focus shows, on the left, glands with disorderly spread, further explored, and in the middle, partly formed glands with necrosis, further explored, both diagnostic (Row 2 Left 100X). Note how some glands go up and down [red arrows] & others go right to left [black arrows] showing disorderly spread (Row 2 Right 400X). Note necrotic cell nuclei [red arrows] and incompletely formed glands [black arrows] (Row 4 Left 200X). Nuclear anaplasia is also able to be used for a definite diagnosis, but there is considerable nuclear variability in reactive bile duct proliferations, making it less facile than disorderly spread, incomplete glands, and necrotic nuclei (Row 3 Right 400X).		Cholangiocarcinoma, intrahepatic, small duct type. Middle aged man with jaundice. Small dark tumorous masses [arrows] irrupt scar (Row 1 Left 20X). Cribriforming (net like pattern) of gland in gland [arrow] without intervening stroma, which can be difficult to discern from reactive bile ducts at times (Row 1 Right 100X). A second focus shows, on the left, glands with disorderly spread, further explored, and in the middle, partly formed glands with necrosis, further explored, both diagnostic (Row 2 Left 100X). Note how some glands go up and down [red arrows] & others go right to left [black arrows] showing disorderly spread (Row 2 Right 400X). Note necrotic cell nuclei [red arrows] and incompletely formed glands [black arrows] (Row 4 Left 200X). Nuclear anaplasia is also able to be used for a definite diagnosis, but there is considerable nuclear variability in reactive bile duct proliferations, making it less facile than disorderly spread, incomplete glands, and necrotic nuclei (Row 3 Right 400X).

			[[File:1 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			[[File:2 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			[[File:3 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			[[File:4 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			[[File:5 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			[[File:6 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]

			Cholangiocarcinoma, intrahepatic, with associated abscess. A. Aberrant spaces (arrows) contrast with the scar to the regions left and, at right, hemosiderin laden macrophages amid granulation tissue [40X]. B1. Disorderly spreading glands (black arrows) associated with atypical single cells (cyan arrows) have nuclei that contrast with those of the normal bile duct (blue arrow) with its associated artery (green arrow) [200X]. C. PAS without diastase shows disorderly spreading, aberrantly shaped glands at left (arrows) and red degenerated hepatocytes to right [200X]. D. PAS with diastase shows proliferating bile ducts to left, one with highly aberrant nuclei (black arrow), highly atypical cells at middle (green arrows) with sometimes incomplete (cyan arrows) acini, and normal liver at right (blue arrow) [200X]. E. CK7 immunostain shows proliferating glands at left and a disorderly spread of single cells and cell groups at right, amid hepatocytes [200X]. F. CK7 immunostain at higher power shows the stained cells have aberrant nuclei [400X].



	www:		www:

Mitchell: /* Images */ added a case

2016-09-19T23:17:46Z

Images: added a case

← Older revision		Revision as of 23:17, 19 September 2016
Line 96:		Line 96:
	[[File:7 CCA 1 1360x1024px.tif\| Cholangiocarcinoma, intrahepatic, large duct type.]]		[[File:7 CCA 1 1360x1024px.tif\| Cholangiocarcinoma, intrahepatic, large duct type.]]
	\|}		\|}
	Cholangiocarcinoma, intrahepatic, large duct type. Extremely unfortunate case arising in a pre-teenage girl. MRI showing multiple hepatic masses. Histologic images. A mass comprising often large ducts abuts uninvolved liver (Row 1 Left 40X). CK7 immunostain emphasizes large, often adjoining ducts (Row 1 Right 40X). Trichrome stain shows spread of tumor into scar with collagen deposition (Row 2 Left 100X). Reticulin stain emphasizes disorderly vertical and horizontal spread of bizarrely shaped acini (Row 2 Right 100X). PAS-D stain shows luminal mucin; note absence of red lining of outside of ducts seen in normal bile ducts/proliferating bile ductules (Row 3 Left 200X). Loss of polarity (varied orientation with respect to base of epithelium) and variable size and shape of nuclei are obvious (Row 3 Right 400X, high pixel image).		Cholangiocarcinoma, intrahepatic, large duct type. Extremely unfortunate case arising in a pre-teenage girl. MRI showing multiple hepatic masses. Histologic images. A mass comprising often large ducts abuts uninvolved liver (Row 1 Left 40X). CK7 immunostain emphasizes large, often adjoining ducts (Row 1 Right 40X). Trichrome stain shows spread of tumor into scar with collagen deposition (Row 2 Left 100X). Reticulin stain emphasizes disorderly vertical and horizontal spread of bizarrely shaped acini (Row 2 Right 100X). PAS-D stain shows luminal mucin; note absence of red lining of outside of ducts seen in normal bile ducts/proliferating bile ductules (Row 3 Left 200X). Loss of polarity (varied orientation with respect to base of epithelium) and variable size and shape of nuclei are obvious (Row 3 Right 400X, high pixel image).

			{\|
			[[File:1 cholangio 2 680x512px.tif\| Cholangiocarcinoma, intrahepatic, small duct type.]]
			[[File:2 cholangio 2 680x512px.tif\| Cholangiocarcinoma, intrahepatic, small duct type.]]
			<br>
			[[File:3 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
			[[File:4 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
			<br>
			[[File:5 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
			[[File:6 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
			\|}
			Cholangiocarcinoma, intrahepatic, small duct type. Middle aged man with jaundice. Small dark tumorous masses [arrows] irrupt scar (Row 1 Left 20X). Cribriforming (net like pattern) of gland in gland [arrow] without intervening stroma, which can be difficult to discern from reactive bile ducts at times (Row 1 Right 100X). A second focus shows, on the left, glands with disorderly spread, further explored, and in the middle, partly formed glands with necrosis, further explored, both diagnostic (Row 2 Left 100X). Note how some glands go up and down [red arrows] & others go right to left [black arrows] showing disorderly spread (Row 2 Right 400X). Note necrotic cell nuclei [red arrows] and incompletely formed glands [black arrows] (Row 4 Left 200X). Nuclear anaplasia is also able to be used for a definite diagnosis, but there is considerable nuclear variability in reactive bile duct proliferations, making it less facile than disorderly spread, incomplete glands, and necrotic nuclei (Row 3 Right 400X).

	www:		www:

Mitchell: /* Images */ added a case

2016-09-06T18:20:05Z

Images: added a case

← Older revision		Revision as of 18:20, 6 September 2016
Line 84:		Line 84:
	Image:Cholangiocarcinoma - very high mag.jpg \| Cholangiocarcinoma - very high mag. (WC/Nephron)		Image:Cholangiocarcinoma - very high mag.jpg \| Cholangiocarcinoma - very high mag. (WC/Nephron)
	</gallery>		</gallery>
			{\|
			[[File:1 CCA 1MRI.png\| Cholangiocarcinoma, intrahepatic, large duct type.]]
			<br>
			[[File:2 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
			[[File:3 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
			<br>
			[[File:4 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
			[[File:5 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
			<br>
			[[File:6 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
			[[File:7 CCA 1 1360x1024px.tif\| Cholangiocarcinoma, intrahepatic, large duct type.]]
			\|}
			Cholangiocarcinoma, intrahepatic, large duct type. Extremely unfortunate case arising in a pre-teenage girl. MRI showing multiple hepatic masses. Histologic images. A mass comprising often large ducts abuts uninvolved liver (Row 1 Left 40X). CK7 immunostain emphasizes large, often adjoining ducts (Row 1 Right 40X). Trichrome stain shows spread of tumor into scar with collagen deposition (Row 2 Left 100X). Reticulin stain emphasizes disorderly vertical and horizontal spread of bizarrely shaped acini (Row 2 Right 100X). PAS-D stain shows luminal mucin; note absence of red lining of outside of ducts seen in normal bile ducts/proliferating bile ductules (Row 3 Left 200X). Loss of polarity (varied orientation with respect to base of epithelium) and variable size and shape of nuclei are obvious (Row 3 Right 400X, high pixel image).

	www:		www:
	*[http://path.upmc.edu/cases/case296.html Cholangiocarcinoma & liver flukes - several images (upmc.edu)].		*[http://path.upmc.edu/cases/case296.html Cholangiocarcinoma & liver flukes - several images (upmc.edu)].

Michael: /* IHC */

2016-08-05T21:31:23Z

IHC

← Older revision		Revision as of 21:31, 5 August 2016
Line 96:		Line 96:

	Others:		Others:
	*CA125 +ve/-ve (30 +ve of 63 cases<ref name=pmid22286058>{{Cite journal \| last1 = Higashi \| first1 = M. \| last2 = Yamada \| first2 = N. \| last3 = Yokoyama \| first3 = S. \| last4 = Kitamoto \| first4 = S. \| last5 = Tabata \| first5 = K. \| last6 = Koriyama \| first6 = C. \| last7 = Batra \| first7 = SK. \| last8 = Yonezawa \| first8 = S. \| title = Pathobiological implications of MUC16/CA125 expression in intrahepatic cholangiocarcinoma-mass forming type. \| journal = Pathobiology \| volume = 79 \| issue = 2 \| pages = 101-6 \| month = \| year = 2012 \| doi = 10.1159/000335164 \| PMID = 22286058 }}</ref>).		*[[CA125]] +ve/-ve (30 +ve of 63 cases<ref name=pmid22286058>{{Cite journal \| last1 = Higashi \| first1 = M. \| last2 = Yamada \| first2 = N. \| last3 = Yokoyama \| first3 = S. \| last4 = Kitamoto \| first4 = S. \| last5 = Tabata \| first5 = K. \| last6 = Koriyama \| first6 = C. \| last7 = Batra \| first7 = SK. \| last8 = Yonezawa \| first8 = S. \| title = Pathobiological implications of MUC16/CA125 expression in intrahepatic cholangiocarcinoma-mass forming type. \| journal = Pathobiology \| volume = 79 \| issue = 2 \| pages = 101-6 \| month = \| year = 2012 \| doi = 10.1159/000335164 \| PMID = 22286058 }}</ref>).

	Note:		Note:

Michael: /* IHC */

2016-08-05T21:31:01Z

IHC

← Older revision		Revision as of 21:31, 5 August 2016
Line 95:		Line 95:
	*[[AFP]] -ve.<ref name=stc6dec2010>STC. 6 December 2010.</ref>		*[[AFP]] -ve.<ref name=stc6dec2010>STC. 6 December 2010.</ref>

			Others:
			*CA125 +ve/-ve (30 +ve of 63 cases<ref name=pmid22286058>{{Cite journal \| last1 = Higashi \| first1 = M. \| last2 = Yamada \| first2 = N. \| last3 = Yokoyama \| first3 = S. \| last4 = Kitamoto \| first4 = S. \| last5 = Tabata \| first5 = K. \| last6 = Koriyama \| first6 = C. \| last7 = Batra \| first7 = SK. \| last8 = Yonezawa \| first8 = S. \| title = Pathobiological implications of MUC16/CA125 expression in intrahepatic cholangiocarcinoma-mass forming type. \| journal = Pathobiology \| volume = 79 \| issue = 2 \| pages = 101-6 \| month = \| year = 2012 \| doi = 10.1159/000335164 \| PMID = 22286058 }}</ref>).

			Note:
			*''MUC-1'' is also known as ''[[EMA]]''.

			===Hepatocellular carcinoma versus cholangiocarcinoma===
	ICC vs. HCC:<ref name=pmid19173916>[Evaluation of immunohistochemical markers for differential diagnosis of hepatocellular carcinoma from intrahepatic cholangiocarcinoma] Dong H, Cong WL, Zhu ZZ, Wang B, Xian ZH, Yu H. Zhonghua Zhong Liu Za Zhi. 2008 Sep;30(9):702-5. Chinese. PMID 19173916.</ref>		ICC vs. HCC:<ref name=pmid19173916>[Evaluation of immunohistochemical markers for differential diagnosis of hepatocellular carcinoma from intrahepatic cholangiocarcinoma] Dong H, Cong WL, Zhu ZZ, Wang B, Xian ZH, Yu H. Zhonghua Zhong Liu Za Zhi. 2008 Sep;30(9):702-5. Chinese. PMID 19173916.</ref>
	*ICC: [[CK19]] (92.5%), [[MUC-1]] (73.8%) +ve.		*ICC: [[CK19]] (92.5%), [[MUC-1]] (73.8%) +ve.
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	HCC vs. ICC:<ref name=pmid16627262>{{cite journal \|author=Lei JY, Bourne PA, diSant'Agnese PA, Huang J \|title=Cytoplasmic staining of TTF-1 in the differential diagnosis of hepatocellular carcinoma vs cholangiocarcinoma and metastatic carcinoma of the liver \|journal=Am. J. Clin. Pathol. \|volume=125 \|issue=4 \|pages=519–25 \|year=2006 \|month=April \|pmid=16627262 \|doi=10.1309/59TN-EFAL-UL5W-J94M \|url=}}</ref>		HCC vs. ICC:<ref name=pmid16627262>{{cite journal \|author=Lei JY, Bourne PA, diSant'Agnese PA, Huang J \|title=Cytoplasmic staining of TTF-1 in the differential diagnosis of hepatocellular carcinoma vs cholangiocarcinoma and metastatic carcinoma of the liver \|journal=Am. J. Clin. Pathol. \|volume=125 \|issue=4 \|pages=519–25 \|year=2006 \|month=April \|pmid=16627262 \|doi=10.1309/59TN-EFAL-UL5W-J94M \|url=}}</ref>
	*TTF-1: ~90-100% +ve (cytoplasmic) in HCC vs. ~10% in cholangiocarcinoma.		*TTF-1: ~90-100% +ve (cytoplasmic) in HCC vs. ~10% in cholangiocarcinoma.

	~~Note:~~
	*''MUC-1'' is also known as ''[[EMA]]''.

	==Molecular==		==Molecular==

Jensflorian: /* molecular*/

2016-07-20T07:48:50Z

molecular

← Older revision		Revision as of 07:48, 20 July 2016
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	Note:		Note:
	*''MUC-1'' is also known as ''[[EMA]]''.		*''MUC-1'' is also known as ''[[EMA]]''.

			==Molecular==
			*Approx. 10% of the tumors carry a [[IDH-1]] or IDH-2 hotspot mutation.<ref>{{Cite journal \| last1 = Wang \| first1 = P. \| last2 = Dong \| first2 = Q. \| last3 = Zhang \| first3 = C. \| last4 = Kuan \| first4 = PF. \| last5 = Liu \| first5 = Y. \| last6 = Jeck \| first6 = WR. \| last7 = Andersen \| first7 = JB. \| last8 = Jiang \| first8 = W. \| last9 = Savich \| first9 = GL. \| title = Mutations in isocitrate dehydrogenase 1 and 2 occur frequently in intrahepatic cholangiocarcinomas and share hypermethylation targets with glioblastomas. \| journal = Oncogene \| volume = 32 \| issue = 25 \| pages = 3091-100 \| month = Jun \| year = 2013 \| doi = 10.1038/onc.2012.315 \| PMID = 22824796 }}</ref>
			*FGFR2 gene fusions have been reported.<ref>{{Cite journal \| last1 = Wu \| first1 = YM. \| last2 = Su \| first2 = F. \| last3 = Kalyana-Sundaram \| first3 = S. \| last4 = Khazanov \| first4 = N. \| last5 = Ateeq \| first5 = B. \| last6 = Cao \| first6 = X. \| last7 = Lonigro \| first7 = RJ. \| last8 = Vats \| first8 = P. \| last9 = Wang \| first9 = R. \| title = Identification of targetable FGFR gene fusions in diverse cancers. \| journal = Cancer Discov \| volume = 3 \| issue = 6 \| pages = 636-47 \| month = Jun \| year = 2013 \| doi = 10.1158/2159-8290.CD-13-0050 \| PMID = 23558953 }}</ref>

	==Sign out==		==Sign out==

← Older revision		Revision as of 22:33, 16 December 2016
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	Image:Cholangiocarcinoma - very high mag.jpg \| Cholangiocarcinoma - very high mag. (WC/Nephron)		Image:Cholangiocarcinoma - very high mag.jpg \| Cholangiocarcinoma - very high mag. (WC/Nephron)
	</gallery>		</gallery>
	{\|		A [[File:1 CCA 1MRI.png\| Cholangiocarcinoma, intrahepatic, large duct type.]]
	[[File:1 CCA 1MRI.png\| Cholangiocarcinoma, intrahepatic, large duct type.]]		B [[File:2 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
	<br>		<br>
	[[File:2 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]		C [[File:3 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
	[[File:3 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]		D [[File:4 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
	<br>		<br>
	[[File:4 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]		E [[File:5 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
	[[File:5 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]		F [[File:6 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]
	<br>		<br>
	~~[[File:6 CCA 1 680x512px.tif\|Cholangiocarcinoma, intrahepatic, large duct type.]]~~		G [[File:7 CCA 1 1360x1024px.tif\| Cholangiocarcinoma, intrahepatic, large duct type.]]
	[[File:7 CCA 1 1360x1024px.tif\| Cholangiocarcinoma, intrahepatic, large duct type.]]
	\|}		Cholangiocarcinoma, intrahepatic, large duct type. Extremely unfortunate case arising in a pre-teenage girl. A. MRI showing multiple hepatic masses. B. A mass comprising often large ducts abuts uninvolved liver. C. CK7 immunostain emphasizes large, often adjoining ducts. D. Trichrome stain shows spread of tumor into scar with collagen deposition. E. Reticulin stain emphasizes disorderly vertical and horizontal spread of bizarrely shaped acini. F. PAS-D stain shows luminal mucin; note absence of red lining of outside of ducts seen in normal bile ducts/proliferating bile ductules. G. Loss of polarity (varied orientation with respect to base of epithelium) and variable size and shape of nuclei are obvious (Row 3 Right 400X, high pixel image).
	Cholangiocarcinoma, intrahepatic, large duct type. Extremely unfortunate case arising in a pre-teenage girl. MRI showing multiple hepatic masses. ~~Histologic images~~. A mass comprising often large ducts abuts uninvolved liver ~~(Row 1 Left 40X)~~. CK7 immunostain emphasizes large, often adjoining ducts ~~(Row 1 Right 40X)~~. Trichrome stain shows spread of tumor into scar with collagen deposition ~~(Row 2 Left 100X)~~. Reticulin stain emphasizes disorderly vertical and horizontal spread of bizarrely shaped acini ~~(Row 2 Right 100X)~~. PAS-D stain shows luminal mucin; note absence of red lining of outside of ducts seen in normal bile ducts/proliferating bile ductules ~~(Row 3 Left 200X)~~. Loss of polarity (varied orientation with respect to base of epithelium) and variable size and shape of nuclei are obvious (Row 3 Right 400X, high pixel image).

	{\|
	[[File:1 cholangio 2 680x512px.tif\| Cholangiocarcinoma, intrahepatic, small duct type.]]		A [[File:1 cholangio 2 680x512px.tif\| Cholangiocarcinoma, intrahepatic, small duct type.]]
	[[File:2 cholangio 2 680x512px.tif\| Cholangiocarcinoma, intrahepatic, small duct type.]]		B [[File:2 cholangio 2 680x512px.tif\| Cholangiocarcinoma, intrahepatic, small duct type.]]
	<br>		<br>
	[[File:3 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]		C [[File:3 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
	[[File:4 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]		D [[File:4 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
	<br>		<br>
	[[File:5 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]		E [[File:5 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
	[[File:6 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]		F [[File:6 cholangio 2 680x512px.tif\|Cholangiocarcinoma, intrahepatic, small duct type.]]
	\|}
	Cholangiocarcinoma, intrahepatic, small duct type. Middle aged man with jaundice. Small dark tumorous masses [arrows] irrupt scar (Row 1 Left 20X). Cribriforming (net like pattern) of gland in gland [arrow] without intervening stroma, which can be difficult to discern from reactive bile ducts at times (Row 1 Right 100X). A second focus shows, on the left, glands with disorderly spread, further explored, and in the middle, partly formed glands with necrosis, further explored, both diagnostic (Row 2 Left 100X). Note how some glands go up and down [red arrows] & others go right to left [black arrows] showing disorderly spread (Row 2 Right 400X). Note necrotic cell nuclei [red arrows] and incompletely formed glands [black arrows] (Row 4 Left 200X). Nuclear anaplasia is also able to be used for a definite diagnosis, but there is considerable nuclear variability in reactive bile duct proliferations, making it less facile than disorderly spread, incomplete glands, and necrotic nuclei (Row 3 Right 400X).

	~~[[File:1 Cholangio 4 680x512px~~.~~tif\| Cholangiocarcinoma~~ with ~~associated abscess~~]]		Cholangiocarcinoma, intrahepatic, small duct type. Middle aged man with jaundice. A. Small dark tumorous masses [arrows] irrupt scar. B. Cribriforming (net like pattern) of gland in gland [arrow] without intervening stroma, which can be difficult to discern from reactive bile ducts at times. C. A second focus shows, on the left, glands with disorderly spread, further explored, and in the middle, partly formed glands with necrosis, further explored, both diagnostic. D. Note how some glands go up and down [red arrows] & others go right to left [black arrows] showing disorderly spread. E. Note necrotic cell nuclei [red arrows] and incompletely formed glands [black arrows]. F. Nuclear anaplasia is also able to be used for a definite diagnosis, but there is considerable nuclear variability in reactive bile duct proliferations, making it less facile than disorderly spread, incomplete glands, and necrotic nuclei.
	~~[[File:2 Cholangio 4 680x512px~~.~~tif\| Cholangiocarcinoma~~ with ~~associated abscess~~]]
	[[~~File:3 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]~~]
	~~[[File:4 Cholangio 4 680x512px~~.~~tif\| Cholangiocarcinoma with associated abscess]]~~
	~~[[File:5 Cholangio 4 680x512px~~.~~tif\| Cholangiocarcinoma with associated abscess]]~~
	~~[[File:6 Cholangio 4 680x512px~~.~~tif\| Cholangiocarcinoma with associated abscess]]~~

	Cholangiocarcinoma, intrahepatic, with associated abscess. A. Aberrant spaces (arrows) contrast with the scar to the regions left and, at right, hemosiderin laden macrophages amid granulation tissue ~~[40X]~~. B1. Disorderly spreading glands (black arrows) associated with atypical single cells (cyan arrows) have nuclei that contrast with those of the normal bile duct (blue arrow) with its associated artery (green arrow) ~~[200X]~~. C. PAS without diastase shows disorderly spreading, aberrantly shaped glands at left (arrows) and red degenerated hepatocytes to right ~~[200X]~~. D. PAS with diastase shows proliferating bile ducts to left, one with highly aberrant nuclei (black arrow), highly atypical cells at middle (green arrows) with sometimes incomplete (cyan arrows) acini, and normal liver at right (blue arrow) ~~[200X]~~. E. CK7 immunostain shows proliferating glands at left and a disorderly spread of single cells and cell groups at right, amid hepatocytes ~~[200X]~~. F. CK7 immunostain at higher power shows the stained cells have aberrant nuclei [~~400X~~].		A [[File:1 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			B [[File:2 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			<br>
			C [[File:3 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			D [[File:4 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			<br>
			E [[File:5 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]
			F [[File:6 Cholangio 4 680x512px.tif\| Cholangiocarcinoma with associated abscess]]

			Cholangiocarcinoma, intrahepatic, with associated abscess. A. Aberrant spaces (arrows) contrast with the scar to the regions left and, at right, hemosiderin laden macrophages amid granulation tissue . B. Disorderly spreading glands (black arrows) associated with atypical single cells (cyan arrows) have nuclei that contrast with those of the normal bile duct (blue arrow) with its associated artery (green arrow). C. PAS without diastase shows disorderly spreading, aberrantly shaped glands at left (arrows) and red degenerated hepatocytes to right. D. PAS with diastase shows proliferating bile ducts to left, one with highly aberrant nuclei (black arrow), highly atypical cells at middle (green arrows) with sometimes incomplete (cyan arrows) acini, and normal liver at right (blue arrow). E. CK7 immunostain shows proliferating glands at left and a disorderly spread of single cells and cell groups at right, amid hepatocytes. F. CK7 immunostain at higher power shows the stained cells have aberrant nuclei.


			A [[File: 6_16572554904132_sl 1.png\|Cholangiocarcinoma, poorly differentiated]]
			B [[File: 6_16572554904132_sl 2.png\|Cholangiocarcinoma, poorly differentiated]]
			<br>
			C [[File: 6_16572554904132_sl 3.png\|Cholangiocarcinoma, poorly differentiated]]
			D [[File: 6_16572554904132_sl 4.png\|Cholangiocarcinoma, poorly differentiated]]
			<br>
			E [[File: 6_16572554904132_sl 5.png\|Cholangiocarcinoma, poorly differentiated]]

			Cholangiocarcinnoma, intrahepatic, in a 72 year old man, poorly differentiated. A. Multiple cancerous foci strew otherwise unremarkable liver. B. Low cuboidal glands fuse and spread, with desmoplasia (green arrows points to slightly blue sttroma) and indian files (blue arrows). C. Aberrant single cells and cell clusters are present, with very little apparent cytoplasm, with extremely variable nuclei, with black and sometimes bubbly chromatin. Note close approximation raising possibility of molding (arrows). D. A mucicarmine stain, even when negative, can highlight the epithelial grouping of the nuclei by virtue of the slightly pink stroma. E. CK7 immunostain shows mostly groups, but also demarcates isolated cancer cells amid scar. Tumor was negative for P40, CK20 CDX2, TTF1, PAX8.