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Fulltext Survival analysis of cholangiocarcinoma: a 10-year experience in Malaysia

Yusoff AR, Razak MM, Yoong BK, Vijeyasingam R, Siti ZM

World J Gastroenterol, 2012 Feb 7;18(5):458-65.
PMID: 22346252 DOI: 10.3748/wjg.v18.i5.458

To investigate the clinical features and survival of patients treated for cholangiocarcinoma in our institution and to analyze the factors affecting their survival.

Matched MeSH terms: Cholangiocarcinoma/mortality*; Cholangiocarcinoma/pathology; Cholangiocarcinoma/physiopathology; Cholangiocarcinoma/surgery
Fulltext Recommendations for the use of next-generation sequencing in patients with metastatic cancer in the Asia-Pacific region: a report from the APODDC working group

Loong HH, Shimizu T, Prawira A, Tan AC, Tran B, Day D, et al.

ESMO Open, 2023 Aug;8(4):101586.
PMID: 37356359 DOI: 10.1016/j.esmoop.2023.101586

INTRODUCTION: Next-generation sequencing (NGS) diagnostics have shown clinical utility in predicting survival benefits in patients with certain cancer types who are undergoing targeted drug therapies. Currently, there are no guidelines or recommendations for the use of NGS in patients with metastatic cancer from an Asian perspective. In this article, we present the Asia-Pacific Oncology Drug Development Consortium (APODDC) recommendations for the clinical use of NGS in metastatic cancers.
METHODS: The APODDC set up a group of experts in the field of clinical cancer genomics to (i) understand the current NGS landscape for metastatic cancers in the Asia-Pacific (APAC) region; (ii) discuss key challenges in the adoption of NGS testing in clinical practice; and (iii) adapt/modify the European Society for Medical Oncology guidelines for local use. Nine cancer types [breast cancer (BC), gastric cancer (GC), nasopharyngeal cancer (NPC), ovarian cancer (OC), prostate cancer, lung cancer, and colorectal cancer (CRC) as well as cholangiocarcinoma and hepatocellular carcinoma (HCC)] were identified, and the applicability of NGS was evaluated in daily practice and/or clinical research. Asian ethnicity, accessibility of NGS testing, reimbursement, and socioeconomic and local practice characteristics were taken into consideration.
RESULTS: The APODDC recommends NGS testing in metastatic non-small-cell lung cancer (NSCLC). Routine NGS testing is not recommended in metastatic BC, GC, and NPC as well as cholangiocarcinoma and HCC. The group suggested that patients with epithelial OC may be offered germline and/or somatic genetic testing for BReast CAncer gene 1 (BRCA1), BRCA2, and other OC susceptibility genes. Access to poly (ADP-ribose) polymerase inhibitors is required for NGS to be of clinical utility in prostate cancer. Allele-specific PCR or a small-panel multiplex-gene NGS was suggested to identify key alterations in CRC.
CONCLUSION: This document offers practical guidance on the clinical utility of NGS in specific cancer indications from an Asian perspective.

Matched MeSH terms: Cholangiocarcinoma*
Fulltext Cholangiocarcinoma: a 10-year experience of a single tertiary centre in the multi ethnicity-Malaysia

Yusoff AR, Siti ZM, Muzammil ARM, Yoong BK, Vijeyasingam R

Med J Malaysia, 2012 Feb;67(1):45-51.
PMID: 22582548 MyJurnal

Cholangiocarcinoma (CCA) is a rare biliary tract epithelial malignancy. We described the clinical features of CCA patients in our institution. A 10-year retrospective study of patients with cholangiocarcinoma in University Malaya Medical Centre was conducted. Clinical data and outcomes in relation to the three anatomical groups of CCA were collected and analysed. Of the 69 patients that were included 55% were male. Mean age was 61 years. Twelve (17%) had intrahepatic, 38 (55%) perihilar and 19 (28%) distal tumour. Mean age (p=0.043), median duration of symptoms (p=0.011), jaundice (p<0.001), total bilirubin level (p=0.003), INR (p=0.005) and mean tumour size (p=0.048) were significantly related to the site of tumour. Only 12 patients had curative resection with seven R0 resections. Cholangiocarcinoma is increasingly diagnosed in our population. Despite that, the diagnosis is still often late. Age, jaundice and tumour size may predict anatomical location of CCA.

Matched MeSH terms: Cholangiocarcinoma/pathology; Cholangiocarcinoma/surgery*
Intrahepatic cholangiocarcinoma and portal hypertension developing in a patient with multicystic biliary microhamartomas

Sugawara T, Shindoh J, Hoshi D, Hashimoto M

Malays J Pathol, 2018 Dec;40(3):331-335.
PMID: 30580365

INTRODUCTION: We report a case of intrahepatic cholangiocarcinoma and portal hypertension developing in a liver with biliary microhamartomas (von Meyenburg's complex).
CASE REPORT: The patient was a 55-year-old man who had a past medical history of diffuse multiple liver abscesses. During follow-up examination, a hypovascular nodule measuring 2.1 cm in diameter was incidentally found in segment 8 of the liver. Surgical resection was performed based on a suspected diagnosis of hepatocellular carcinoma. A gastrofiberscopy examination detected characteristic findings of portal hypertensive gastropathy. During the laparotomy, multiple tiny cystic lesions were observed in a diffuse pattern across the liver surface. The liver parenchyma was slightly fibrotic and haemorrhagic. A histopathological examination revealed intrahepatic cholangiocarcinoma with vascular invasions in von Meyenburg's complex. Multiple biliary adenomas were also observed among the biliary microhamartomas adjacent to the main tumour, suggesting that the malignant transformation of the biliary adenomas might have been responsible for the development of the intrahepatic cholangiocarcinoma. The histopathologic examination also revealed sinusoidal dilation and abnormal spacing of the portal tracts and central veins as evidence of portal hypertension.

Matched MeSH terms: Cholangiocarcinoma/etiology; Cholangiocarcinoma/pathology*
Intrahepatic biloma: an unusual complication of cholangiocarcinoma treated endoscopically

Ranjeev P, Goh KL, Rosmawati M, Tan YM

Gastrointest Endosc, 1999 Nov;50(5):711-3.
PMID: 10536338
Matched MeSH terms: Cholangiocarcinoma/complications*; Cholangiocarcinoma/therapy
Primary biliary cirrhosis and auto immune hepatitis overlap syndrome mimicking cholangiocarcinoma

Adel A, Zamri Z, Azlanuddin A, Bong JJ

Clin Ter, 2013;164(6):e493-5.
PMID: 24424229 DOI: 10.7417/CT.2013.1643

Primary Biliary Cirrhosis (PBC) and Auto Immune Hepatitis (AIH) are autoimmune diseases of the liver which highlighted with slow destructive process of intra hepatic small bile ducts. As a result of these damages cholestasis and over the time tissue damage will happen, which leads to scarring, fibrosis and finally cirrhosis. Some patients may present with clinical and biochemical features of both conditions, which is called "Overlap syndrome". Here we are reporting a case of PBC-AIH overlap syndrome that primarily diagnosed as gallbladder carcinoma and went under operation and finally histological examination revealed to be PBC.

Matched MeSH terms: Cholangiocarcinoma/diagnosis*
Fulltext Biliary ascariasis and extrahepatic cholangiocarcinoma: a report of two cases

Lim KG, Sellaiah SP

Singapore Med J, 1994 Aug;35(4):400-2.
PMID: 7899902

We report two cases of rural Malay women in Perak, Malaysia, with extrahepatic cholangiocarcinoma and coexistent biliary ascariasis. In both cases, the narrowed bile duct may have resulted in inability of the migratory nematode to return to the gastrointestinal tract. It may be reasonable, also, to postulate that chronic biliary tract infestation by Ascaris lumbricoides may have contributed to the development of cholangiocarcinoma; a situation similar to that observed in liver fluke infestation.

Matched MeSH terms: Cholangiocarcinoma/complications*
Fulltext The utility of hepatocyte paraffin 1 antibody in the immunohistological distinction of hepatocellular carcinoma from cholangiocarcinoma and metastatic carcinoma

Shiran MS, Isa MR, Mohd Sidik S, Rampal L, Hairuszah I, Sabariah AR

Malays J Pathol, 2006 Dec;28(2):87-92.
PMID: 18376797 MyJurnal

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and its diagnosis on routine stains is usually straightforward, except in some cases where there may be difficulty in distinguishing HCCs from metastatic carcinomas (MC) and cholangiocarcinomas (CC). Hepatocyte Paraffin 1 antibody (Hep Par 1) is a new monoclonal antibody which reacts with normal and neoplastic hepatocytes, and this study aims to determine its specificity and sensitivity in distinguishing hepatocellular carcinoma (HCC) from cholangiocarcinoma (CC) and metastatic carcinomas (MC). Hep Par 1 antibody was applied to 28 cases of HCC, 22 cases of MC from varying sites and 8 CCs, and produced a strong, diffuse, granular, cytoplasmic staining of all benign hepatocytes. 23 out of 28 cases of HCC showed heterogeneously positive staining for Hep Par 1 irrespective of their degree of differentiation, while 2 out of 8 cases of cholangiocarcinoma were positive for Hep Par 1, and all 22 cases of metastatic carcinoma were negative. The sensitivity and specificity of Hep Par 1 for HCC was 82.1% and 93.3% respectively; whereby the antibody was noted to show occasional false positivity in cases of cholangiocarcinoma and non-neoplastic bowel mucosa, while its variable staining in HCC produced false negative results in some small biopsies. Thus, Hep Par 1 should be used in a panel with other antibodies to obtain useful information in distinguishing HCC from CC and MC.

Matched MeSH terms: Cholangiocarcinoma/diagnosis*; Cholangiocarcinoma/chemistry
Determination of chemical composition of gallbladder stones and their association with induction of cholangiocarcinoma

Hussain SM, Al-Jashamy KA

Asian Pac J Cancer Prev, 2013;14(11):6257-60.
PMID: 24377514

Gallstone disease is a major surgical problem in many populations; it is probably related to diet, especially excessive consumption of meat. The objective of this study was to determine the chemical composition of gallstones and their association with neoplastic changes including cholangiocarcinomas in cholecystectomised patients. The chemical composition of gallstones from 40 patients (8 males and 32 females) was analyzed. This is a prospective study performed in Baquba teaching hospital in the period from 1/10/2012 to 1/1/2013 in which we collected the gallstones for the patients who underwent cholecystectomy, whether open or laparoscopic. The stones were classified according to their chemical composition as a mixed stones (MS), and examined using a stone analysis set (chemical qualitative method) for calcium, magnesium, phosphate, uric acid and oxalate which was used reagent for qualitative determination of main individual components of stones. The results of this study showed the highest incidence of gallstones in the age group 40-49 was 13 cases followed by 11, 8 and 4 cases for age groups 30-39, 50-59, 20-29 and 60 and above, respectively. The chemical analysis showed the majority of gallstones were mixed, 38 containing calcium followed by 37 cases with uric acid, 28 with magnesium, and 25 and 22 stones with oxalate and phosphate, respectively. Microscopically, we confirmed neoplastic changes (17.5%) as cholangiocarcinomas (CCCs) (7.55%) and dysplastic cells of carcinoma in situ in 4 (10%), 31 (77.5%) cases were chronic cholecystitis and 2 (5%) cases were acute cholecystitis with empyema out of bile duct disorders patients. In conclusion, majority of cases had mixed gallstones that involved five and four of inorganic chemicals of calcium, magnesium and phosphate, the highest incidence of gallstones in age group 40-49 years old was 13 cases, and neoplastic changes were confirmed (17.5%) including CCCs, (7.5%) and dysplastic cells of carcinoma in situ (10%), while 31 (77.5%) cases were chronic cholecystitis.

Matched MeSH terms: Cholangiocarcinoma/pathology*
Fulltext Glypican-3 is useful but not superior to Hep Par 1 in differentiating hepatocellular carcinoma from other liver tumours

Pour AM, Masir N, Rose IM

Malays J Pathol, 2016 Dec;38(3):229-233.
PMID: 28028292 MyJurnal

To assess the diagnostic utility of glypican-3 (GPC-3) in comparison to Hep Par 1 in the diagnosis of liver tumours, a cross-sectional study involving 66 resected liver tumours were tested for the protein expression of these markers by immunohistochemistry using monoclonal antibodies. Of the 66 cases, 26 (39.4%) were hepatocellular carcinoma (HCC), 4 (6.1%) were intrahepatic cholangiocarcinoma and 36 (54.5%) were metastatic tumours. Hep Par 1 and GPC-3 expressions in HCC were 24/26 (92.3%) and 19/26 (73.1%) respectively. In contrast, of non-HCC cases, only 2/40 cases (5.0%) expressed Hep Par 1, including a metastatic colorectal adenocarcinoma and a metastatic gastric adenocarcinoma. GPC-3 was expressed in 3/40 cases (7.5%), i.e. a metastatic adenocarcinoma of unknown origin, a metastatic gastric adenocarcinoma and an intrahepatic cholangiocarcinoma. The sensitivity and specificity for Hep Par 1 were 92.3% and 95% respectively while that of GPC-3 was 73.1% and 92.5% respectively. GPC-3 is a useful marker in the diagnosis of HCC. However it is not superior to Hep Par 1 in its sensitivity and specificity. We recommend that it is utilized together with Hep Par 1 as a panel in the diagnosis of HCC.

Matched MeSH terms: Cholangiocarcinoma/diagnosis
Fulltext Cholangiocarcioma in a cat

Lim, M.L., Watanabe, M.

Jurnal Veterinar Malaysia, 2016;28(1):16-19.
MyJurnal

A 7-year-old, intact female Domestic Shorthair cat was referred to University Veterinary Hospital (UVH), UPM for diagnostic workup of a hepatomegaly observed on abdominal radiographs. Physical examination revealed no significant findings except for a distended abdomen. Hematology and serum biochemistry findings included a regenerative anaemia, left shift neutrophilia and a 10-fold elevation in gamma-glutamyltranspeptidase (GGT). Abdominal ultrasound revealed heterechoic liver lobes with irregular margins and presence of nodular and cyst-like structures predominantly affecting the left lobes. A mild ascites was also noted. A fine needle aspiration of the liver was performed and cytology results confirmed a cholangiocarcinoma. Generally, the outcome for cholagiocarcinoma is poor and there is limited information regarding the prognosis for patients with cholangiocarcinoma following chemotherapy or surgery.

Matched MeSH terms: Cholangiocarcinoma