Surgical pathology of hepatobiliary malignancies.

In this paper we review an Italian series of resected primary malignant tumors of the liver, with special reference to hepatocellular carcinoma, according to the classification criteria proposed by Japanese authors. The study emphasizes the presence of a thick peritumoral capsule as the main pathological feature that would indicate survival rate after surgery.

A report of 5 cases of cystic bile duct carcinoma of the liver and proposal of a new classification.

Primary biliary cystadenocarcinoma of the liver is rare. Among 239 patients with primary liver cancer admitted to our service during the last 13 years, there were 5 cases of cystic bile duct carcinoma of the liver. Three of these were cystadenocarcinoma, one was adenocarcinoma arising from a liver cyst, and one was carcinoma of the intrahepatic bile ducts with cystic dilatation. A better classification of these entities seems necessary, and it is suggested that malignant cystic tumors of the liver should be divided into 3 groups: Group A is cystic adenocarcinoma, group B is bile duct carcinoma with primary or secondary intrahepatic bile duct, and group C is degenerative cyst formation by other types of malignant tumors. Cystic adenocarcinoma (Group A) can then be further subdivided into cystadenocarcinoma, cystadenocarcinoma with cystadenoma, and carcinoma in a simple cyst of the liver.

A histopathologic study of 102 cases of intrahepatic cholangiocarcinoma: histologic classification and modes of spreading.

In our survey of 102 cases of intrahepatic cholangiocarcinoma, 71 peripheral type cases and 31 hilar type cases were observed, the former being prone to metastasize to remote organs and lymph nodes when compared with the latter. These cases were histologically classified into nine histologic types according to the predominant features and rearranged into three groups (well-differentiated, less-differentiated, and uncommon). Although most of these cases were mucin-producing adenocarcinomas with variable grades of differentiation (92 of 102; 90%), several uncommon types were also encountered (ten of 102; 10%), such as adenosquamous, squamous, mucinous, or anaplastic carcinoma. Remote organ metastases were observed more frequently in the less-differentiated group than in the well-differentiated group. In regard to intrahepatic tumor spreading, expansion via sinusoidal spaces (93%), vascular (52%) or lymphatic (18%) involvement, perineural invasion (16%), replacing growth in the bile duct (12%), and permeation in the portal connective tissue (19%) were observed. The cholangiocarcinomas with the vascular involvement presented a higher tendency of intrahepatic as well as extrahepatic metastasis. For correct diagnosis and treatment of cholangiocarcinoma, it seems to be important to possess some knowledge of these histologic types, including their variations and patterns of intrahepatic spread.

Colangiohepatitis oriental / Oriental cholangiohepatitis

Presentamos en este trabajo un caso clínico de una paciente de 52 años procedente de china, quien ingresó al Servicio de Cirugía I del Hospital General del Oeste con cuadro compatible con una colangiohepatitis oriental y en quien en estudios sucesivos se demostró litiasis biliar primaria. Aprovechamos la oportunidad para discutir la etiología de esta enfermedad

[Macroscopic study of cholangiocarcinoma].

Fourty three autopsy cases of cholangiocarcinoma and 18 cases of Thorotrast-related cholangiocarcinoma were macroscopically studied. They were classified into two types, according to the intrahepatic location of the tumors; middle-peripheral type and hilar type. Most Thorotrast-related cases (83%) were middle-peripheral type, while the non-Thorotrast-related cases were hilar type (68%). According to the gross characteristics of the tumor. They were classified into four gross types: infiltrative type (54%), nodular type (21%), periductal type (18%), and diffuse type (7%). Non-specific liver cirrhosis (mixed macro and micronodular type) was associated in 4 of non-Thorotrast related cases, and the association of biliary cirrhosis was found in 3 of the non-Thorotrast cases of the hilar type.