Cholangiocarcinoma classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]

Classification

• Cholangiocarcinoma may be classified according to location of the tumor into three groups:
  • Intrahepatic bile duct cancer
  • Perihilar bile duct cancer
  • Extrahepatic bile duct cancer
• Cholangiocarcinoma may be classified according to gross and histological features into [number] subtypes:

Conventional type (bile duct type type) Small bile duct type (peripheral type) Well differentiated Moderately differentiated Poorly differentiated Large bile duct type (perihilar type) Well differentiated Moderately differentiated Poorly differentiated Bile ductular type Intraductal type Papillary type Tubular type Superficial spreading type Rare variants Squamous/adenosquamous cell type Mucinous/signet ring cell Clear cell type Undifferentiated type Lymphoepithelial type Others

Extrahepatic Bile Duct Cancer

• Carcinoma in situ
• Adenocarcinoma, not otherwise specified (NOS)
• Adenocarcinoma

• Intestinal type
• Mucinous type
• Clear cell type

• Signet-ring cell carcinoma
• Adenosquamous carcinoma
• Squamous cell carcinoma
• Small cell (oat cell) carcinoma
• Undifferentiated carcinoma

• Spindle cell type
• Giant cell type
• Small cell type

• Papillomatosis
• Papillary carcinoma

• Noninvasive

• Papillary carcinoma

  Invasive

• Carcinoma, NOS

Perihilar Bile Duct Cancer

• Carcinoma in situ
• Adenocarcinoma, not otherwise specified (NOS)
• Adenocarcinoma

• Intestinal type
• Mucinous type
• Clear cell type

• Signet-ring cell carcinoma
• Adenosquamous carcinoma
• Squamous cell carcinoma
• Small cell (oat cell) carcinoma
• Undifferentiated carcinoma

• Spindle cell type
• Giant cell type
• Small cell type

• Papillomatosis
• Papillary carcinoma

• Noninvasive
• Invasive

• Carcinoma, NOS

Intrahepatic Bile Duct Cancer

• Mass-forming tumor growth pattern
• Periductal-infiltrating tumor growth pattern
• Mixed mass-forming and periductal-infiltrating growth pattern

Bismuth-Corlette classification

Perihilar cholangiocarcinoma may be classified according to Bismuth-Corlette classification into five subtypes based on the extent of ductal infiltration:

Type I: Limited to the common hepatic duct, below the level of the confluence of the right and left hepatic ducts

Type II: Involves the confluence of the right and left hepatic ducts

Type IIIa: Type II and extends to the bifurcation of the right hepatic duct

Type IIIb: Type II and extends to the bifurcation of the left hepatic duct

Type IV: Extending to the bifurcations of both right and left hepatic duct or multifocal involvement

Type V: Stricture at the junction of common bile duct and cystic duct