Pathological classification of cholangiocarcinoma

Although the incidence of bile duct cancer is not very high, its prognosis is relatively poor. Therefore, after the disease is diagnosed, it is necessary to seek professional treatment in time to improve the survival rate. Therefore, it is necessary for everyone to understand some common knowledge about bile duct cancer. Today I will introduce to you the pathological classification of bile duct cancer. Let’s take a look.

According to the location of bile duct cancer, it can be divided into three types: upper, middle and lower. The upper segment includes the left and right hepatic ducts and the common hepatic duct. Cancers occurring here are more common, accounting for about 40%-75% of bile duct cancer. The middle segment refers to the section of the common bile duct located above the lower edge of the duodenum from the cystic duct. The lower segment refers to cancer occurring in the bile duct between the lower edge of the duodenum and the ampulla of Vater.

According to pathological histological classification, most bile duct cancers are adenocarcinomas, and a few are squamous cell carcinomas. Adenocarcinomas are further divided according to the degree of cell differentiation:

①Poorly differentiated adenocarcinoma. This type of cancer is highly malignant and can easily infiltrate and grow into surrounding tissues and metastasize through the blood circulation and lymphatic vessels, resulting in poor surgical results.

② Well-differentiated adenocarcinoma. Most bile duct cancers, especially high-positioned bile duct cancer (Crateskin tumor), are well-differentiated adenocarcinomas, which grow slowly, are less likely to invade other organs, have good surgical results, and patients have a long survival period after surgical treatment.

In the histological classification of bile duct cancer, adenocarcinoma accounts for the vast majority, and squamous cell carcinoma, adenosquamous carcinoma, undifferentiated carcinoma, carcinoid, sarcoma, etc. are occasionally seen. Adenocarcinoma is the most common type of bile duct cancer, while squamous cell carcinoma and sarcoma are very rare. Adenocarcinoma can be divided into papillary adenocarcinoma, mucinous adenocarcinoma, and sclerosing adenocarcinoma.

The size of cholangiocarcinoma is generally small, but it often infiltrates the entire bile duct wall or protrudes into the lumen early, forming annular stenosis, leading to bile duct obstruction and symptoms of jaundice, bleeding and infection. Cholangiocarcinoma often infiltrates the liver and local lymph nodes early, followed by the gallbladder, peritoneal surface, gastrointestinal serosa and lymph nodes around the abdominal aorta. The next is the pancreas, bladder, rectal recess, etc. No one died due to extensive metastasis of the tumor, and the main cause of death was bile duct obstruction combined with infection. Common bile duct and common bile duct cancers are mostly limited to the primary site, and hilar cancer often spreads to the contralateral side or the common hepatic duct.

The sclerosing bile duct is a highly differentiated adenocarcinoma with a large number of fibrous tissues, which only proliferate and make the duct wall hardened, thickened, deformed, and thinned. In addition, the disease progresses slowly, and the course of the disease can take months to years. Due to repeated attacks of cholangitis, biliary cirrhosis may occur in the late stage, which may cause liver damage and affect coagulation function.

The above is an introduction to the pathological classification of cholangiocarcinoma. I hope it will be helpful to you.