Radiation Oncology/Bile duct/Pathology

• 90% adenocarcinoma (papillary, nodular, sclerosing)
  • CA19-9 and CA-50 are positive in 80-90% of cholangiocarcinomas and rarely in hepatomas
  • AFP is rarely positive in cholangiocarcinoma but in 35-75% of hepatomas
  • Presence of MIB-1 and AgNOR, and lack of CD44 (esp. CD44v6) appears correlated with LN mets and tumor progression
• 10% all other histologies (squamous cell, mucoepidermoid, etc.)

They are locally invasive, and rarely metastatic PMID 4354116

• Asahikawa Japan PMID 15150102 -- Serine/threonine kinase AKT is frequently activated in human bile duct cancer and is associated with increased radioresistance. (2004 Tanno S, Cancer Res. 2004 May 15;64(10):3486-90.)
  • Conclusion: "These results indicate that activated AKT in BDC cells is associated with radioresistance and suggest that pharmacological or genetic modulation of AKT activity may have important therapeutic implications in BDC patients treated with radiation."

• Hiroshima Japan PMID 12883663 -- Prognostic value of p53 and Ki-67 expression in resected or biopsy specimens of bile duct carcinoma. (2003 Murakami M, Oncol Rep. 2003 Sep-Oct;10(5):1091-6.)
  • Conclusion: "Assessment of mean Ki-67 antigen expression, as measured by MIB-1 staining, in samples of hilar bile duct carcinoma appeared to be an important indicator of clinical behavior. However, there were no significant correlations between clinicopathological factors or stent patency and p53 immunoreactivity."

• Iwate Japan PMID 12168833 -- Allelotype analysis of the PTEN, Smad4 and DCC genes in biliary tract cancer. (2002 Suto T, Anticancer Res. 2002 May-Jun;22(3):1529-36.)
  • Conclusion: "Our results suggest that (a) alteration of the Smad4 gene is a major factor in the development of ampullary cancer and (b) PTEN, Smad4 and DCC genes are altered infrequently in EHBD cancers."

• Iwate Japan PMID 11223838 -- Infrequent microsatellite instability in biliary tract cancer. (2001 Suto T, J Surg Oncol. 2001 Feb;76(2):121-6)
  • Conclusion: "Our results suggest that genetic defects in the DNA mismatch repair system and MSI do not play an important role in the majority of biliary tract cancers."

• Iwate Japan PMID 10738270 -- Aberrations of the K-ras, p53, and APC genes in extrahepatic bile duct cancer. (2000 Suto T, J Surg Oncol. 2000 Mar;73(3):158-63.)
  • K-ras, p53, and APC genes were mutated in 9.6%, 32.7%, and 0% of EHBD cancers, respectively
  • Conclusion: "Our results suggest that an unknown suppressor gene on 5q other than the APC gene may be responsible for EHBD cancer."

• UT Southwestern PMID 10196386 -- Well-differentiated adenocarcinoma, gastric foveolar type, of the extrahepatic bile ducts: A previously unrecognized and distinctive morphologic variant of bile duct carcinoma. (1999 Albores-Saavedra J, Ann Diagn Pathol. 1999 Apr;3(2):75-80.)
  • Case report. 2 tumors composed predominantly (>95%) of gastric foveolar-type epithelium

• Hiroshima Japan PMID 10547541 -- Lack of CD44 variant 6 expression in advanced extrahepatic bile duct/ampullary carcinoma. (1999 Yokoyama, Cancer. 1999 Nov 1;86(9):1691-9.)
  • Conclusion: "The results of the current study suggest that a lack of expression of CD44, especially CD44v6, is correlated with lymph node metastases and poor prognosis, and may be a prognostic factor for patients with EHBD/ampullary carcinoma."

• Iwate Japan PMID 9428483 -- Assessment of the expression of p53, MIB-1 (Ki-67 antigen), and argyrophilic nucleolar organizer regions in carcinoma of the extrahepatic bile duct. (1998 SutoT, Cancer. 1998 Jan 1;82(1):86-95.)
  • Conclusion: "The results of this study indicated that MIB-1 and AgNOR might be markers of the progression of EHBD carcinoma."

• Iwate Japan PMID 9260603 -- Immunohistochemical detection of proliferating cell nuclear antigen and p53 expression in carcinoma of the extrahepatic bile duct. (1997 Suto T, Oncology. 1997 Sep-Oct;54(5):407-13.)
  • Conclusion: "The results suggest that PCNA immunoreactivity may be a useful predictor of malignancy in patients with EHBD carcinomas." "We detected p53 in 37% of the EHBD cancers."

• UT Southwestern PMID 7802141 -- Clear cell carcinomas of the gallbladder and extrahepatic bile ducts. (1995 Vardaman C, Am J Surg Pathol. 1995 Jan;19(1):91-9.)
  • Case report of 10 clear cell carcinoma of GB/bile duct

• SEER Data PMID 1516001 -- Carcinoma of the extrahepatic bile ducts. Histologic types, stage of disease, grade, and survival rates. (1992 Henson DE, Cancer. 1992 Sep 15;70(6):1498-501.)