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Pathogenesis of cholangiocarcinoma
Last reviewed: 16.05.2018
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Cholangiocarcinoma often develops at the junction of the vesical and general hepatic ducts or the left and right hepatic ducts in the portal of the liver and grows into the liver. It causes complete obstruction of the extrahepatic bile ducts, accompanied by an enlargement of the intrahepatic ducts and an increase in the liver. The gallbladder collapses, the pressure in it decreases. If cholangiocarcinoma affects only one hepatic duct, biliary obstruction is incomplete and jaundice does not develop. The proportion of the liver drained by this duct is atrophy; the other part is hypertrophied.
Cholangiocarcinoma of the common bile duct is a dense knot or plaque; it leads to an annular stricture that can ulcerate. The tumor spreads along the bile duct and through its wall.
Local and distant metastases even in autopsy are only detected in about half the cases. They are detected on the peritoneum, in the lymph nodes of the abdominal cavity, in the diaphragm, liver or gall bladder. Invasion of the blood vessels is rare; The spread beyond the abdominal cavity of this tumor is not peculiar.
Histologically, the cholangiocarcinoma is usually a mucin-producing adenocarcinoma consisting of a cubic or cylindrical epithelium. Possible spread of the tumor along the nerve trunks. Tumors in the area of the gates are accompanied by sclerotherapy, they have a well developed fibrous stroma. Dis-located tumors are nodular or papillary.
Changes at the molecular level
With cholangiocarcinoma, point mutations were found in the 12th codon of the K-ras oncogene. In this tumor, especially when it is located in the middle and lower thirds of the biliary tract, p53 protein is expressed . With cholangiocarcinoma of the liver gates, aneuploidy (a violation of the normal number of chromosomes) is detected , combined with invasion of nerve trunks and low survival.
Cholangiocarcinoma cells contain somatostatin receptor RNA , and cell lines have specific receptors. Somatostatin analogues inhibit cell growth. Cholangiocarcinoma can be detected by radionuclide scanning with a labeled analog of somatostatin.
[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]