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Background. Postoperative recurrence of hepatic hilar ductal carcinoma usually occurs in a localized region around the surgical margin, such as the bile duct. This study was aimed at assessing the invasive patterns of the hepatic hilar ductal carcinoma by histologically examining surgical specimens obtained by extended liver resection, especially the involvement of intrahepatic duct. Methods. Eighteen resected specimens of hepatic hilar ductal carcinoma were histologically investigated. Multiple sections vertical to the extrahepatic and intrahepatic 4bile duct were made at a 5-mm interval. The extension of carcinoma was evaluated on each of three layers (mucosal, extramucosal-intramural, and extramural), and routes of the invasion were examined. Results. Extramucosal extent toward the hepatic side was observed in 14 patients (77.8%) and that toward the duodenal side in 8 patients (44.4%) (P < 0.05). The distance of extramucosal tumor extent was also significantly longer (P < 0.05) in the hepatic side than in the duodenal side. Histologic tumor margin was usually identified in the extramural layer. Two patients bad discontinuous extramucosal invasion. The lymphatic invasions were observed most frequently, followed by perineural invasion, and venous invasion was rare. In the extramucosal invasion of the liver, the left dominant carcinomas had extended toward the left, whereas those right dominant had extended toward the right (P < 0.05). Well differentiated tubular adenocarcinomas extended to the liver more extensively than moderately and poorly differentiated ones, but not significantly. Conclusions. The authors examined the extramucosal invasion of hepatic hilar ductal carcinoma. This invasion extended more frequently and further to the hepatic side than to the duodenal side, usually by the route of the extramural layer. Cancer 1994; 73:2922-9. Key words: bile duct carcinoma, hepatic hilar ductal carcinoma, pathology, hepatic resection, extramucosal invasion.

Background. Although there have been a few reports dealing with the sarcomatous changes of intrahepatic cholangiocarcinoma, its clinicopathologic features as well as immunohistochemical nature remain obscure. Methods. Among 155 cases of intrahepatic cholangiocarcinoma, 7 cases of sarcomatous cholangiocarcinoma were chosen. Immunohistochemical studies using the avidin-biotin-peroxidase complex method were performed on these cases. Results. The tumor showed both mucin-producing adenocarcinoma areas and sarcomatous areas, the latter being predominant in three cases and focal in the other four. All the sarcomatous areas consisted of atypical spindle cells arranged in sheets or bundles. Pleomorphic giant cells were observed in some sarcomatous components in five cases. Immunohistochemical staining for keratin and epithelial membrane antigen revealed apparent positivity in the sarcomatous components of five cases. The patients with these tumors showed aggressive intrahepatic spreading and widespread metastasis of the sarcomatous cells, and demonstrated poorer prognosis than those with ordinary cholangiocarcinoma, with one exception, a patient who remained disease-free for 3 years after surgery. Conclusions. These findings favor the possible epithelial origin of sarcomatous cells. Radical operation would be necessary for patients with this special type of cholangiocarcinoma. Cancer 1993; 72:1872-7.

Nine cases of biliary cystadenocarcinoma of the liver were studied, with emphasis on its clinicopathologic features, mucin profiles, and immunohistochemical characteristics. In general, the cystic tumors had protrusions that consisted of well-differentiated papillary adenocarcinoma cells with or without benign-appearing epithelial elements. In invading or metastatic foci, the carcinoma cells tended to show distinctive anaplastic changes. Tumor growth was confined to the cystic lesions in five cases (noninvasive type), whereas in four cases it extended to the hepatic parenchyma or neighboring organs (invasive type). There was a considerable difference between the two groups in terms of prognosis. In fact, the patients included in the group with the noninvasive type had no sign of tumor recurrence after an appropriate surgical procedure. With mucin histochemical and immunohistochemical approaches, positive reactions with carcinoembryonic antigen, tissue polypeptide antigen, carbohydrate 19-9, and Dupan-2 and the predominance of sialomucin were observed in most cases of biliary cystadenocarcinoma, indicating a similar cellular nature of cholangiocarcinoma. Cancer 1992; 69:2426-2432.

Magnetic resonance (MR) imaging is a technique used to produce images of soft tissues of the body. MR is very useful in diagnosing the various types of liver tumors, such as hepatocellular carcinoma (HCC). On one type of MR image known as T1-weighted, HCC appears as an area of high intensity compared with normal tissue. One theory as to why HCC shows a high-intensity signal pattern on T-1 images is that this tumor contains a higher concentration of metals with magnetic properties, such as copper, than the surrounding tissue. MR images were obtained from 112 patients with HCCs smaller than 5 centimeter (cm). Tumor samples were obtained to determine copper content and other characteristics. HCC tumor signal intensities on T1 images were low in 43 patients (38.4 percent), the same as surrounding tissue in 16 patients (14.3 percent), high in 45 patients (40.2 percent), and mixed in 8 patients (7.1 percent). Examination of tumor tissue showed that steatosis (fat tissue degeneration) and clear cell formation were significantly greater in tumors with high-intensity patterns. Copper and iron concentrations were significantly higher in tumors that had high-intensity patterns than in tumors with other intensity patterns. These results indicate that the difference in signal intensities seen on T1 MR images of HCC may be due to varying concentrations of copper in the tumor. The significance of the variations in copper content of tumors requires more elucidation. (Consumer Summary produced by Reliance Medical Information, Inc.)