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Minute nodular intrahepatic cholangiocarcinoma
M Yamamoto1, K Takasaki, M Nakano
1Institute of Gastroenterology, Tokyo Women's Medical College, Japan.
Insights
Minute nodular intrahepatic cholangiocarcinoma (ICC) shows a strong link to hepatitis viral infections. Early detection of these small tumors is possible through monitoring patients with chronic liver conditions.
Area of Science:
- Hepatobiliary Surgery
- Gastroenterology
- Oncology
Background:
- Intrahepatic cholangiocarcinoma (ICC) is a primary liver cancer.
- Minute ICC (<3 cm) presents unique clinicopathologic features.
- The association between minute nodular ICC and hepatitis viral infection requires clarification.
Purpose of the Study:
- To describe clinicopathologic features of minute ICC.
- To investigate the relationship between minute nodular ICC and hepatitis viral infection.
- To assess the potential for early detection of minute nodular ICC.
Main Methods:
- Serum analysis for hepatitis C virus antibody (anti-HCV) and hepatitis B surface antigen (HBsAg) in 50 ICC patients.
- Classification of minute ICC into nodular and nonnodular types.
- Correlation of viral markers with tumor type and patient history.
Main Results:
- Hepatitis viral infection prevalence was 83% in minute nodular ICC versus 0% in minute nonnodular ICC (P < 0.05).
- Hepatitis C virus infection was prevalent in minute nodular ICC cases.
- Minute nodular tumors were identified during surveillance of patients with chronic hepatitis or cirrhosis.
Conclusions:
- Minute nodular ICC is associated with hepatitis viral infection.
- Early detection of minute nodular ICC is feasible through monitoring high-risk liver disease patients.
- This parallels early detection strategies for hepatocellular carcinoma.
Background:
This study describes the clinicopathologic features of minute intrahepatic cholangiocarcinoma (ICC) and clarifies the relation between minute nodular ICC and hepatitis viral infection.
Methods:
The presence of hepatitis C virus antibody (anti-HCV) and hepatitis B surface antigen (HBsAg) was examined in the serum of 50 patients with ICC who underwent hepatectomy from 1990-1996. The ICCs included 12 minute tumors (<3 cm in greatest dimension), 6 of which were nodular type and 6 others were nonnodular type (5 of periductal spreading or infiltrating type and 1 of intraductal type).
Results:
Of these 50 patients with ICC, 16 (32%) were positive for anti-HCV, 5 (10%) were positive for HBsAg, and 1 (2%) was positive for both. The prevalence of hepatitis viral infection in cases of minute nodular-type tumor (83%; 5 patients positive for anti-HCV) was significantly higher than that in cases of minute nonnodular-type tumor (0%; P < 0.05). These minute nodular-type tumors were detected during follow-up of patients with chronic hepatitis or cirrhosis. All patients were treated with hepatectomy alone. At last follow-up, 3 patients had been free of disease for >5 years after surgery. However, 1 patient died 2 years after surgery because of remnant liver and lymph node recurrence.
Conclusions:
Minute nodular ICC appears to be related to hepatitis viral infection and could be detected at an early stage, similar to hepatocellular carcinoma, by following up cases of chronic hepatitis or cirrhosis.