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Clinicopathological spectrum of intrahepatic cholangiocarcinoma with morphologic subtyping and immunohistochemical analysis of the prognostic biomarkers

Natasha Thomas

Background-Cholangiocarcinoma is the second most common primary liver malignancy second to hepatocellular carcinoma of which intrahepatic cholangiocarcinoma comprises 10%.The disease has a wide morphological spectrum based on which several classification systems have emerged. Also, ICC is usually seen as an incidental finding or there are only non-specific symptoms, due to which diagnosis is often late and the prognosis is consequentially poor. As there are no specific prognostic biomarkers, the aim of this study is to analyse the prognostic significance of IHC based biomarkers, specifically EGFR, MUC1, Fascin and Villin. Method-Prospective and retrospective data of 60 patients were collected where histopathological blocks were available and with a minimum follow up of 6 months. Each case was subjected to treatment with the IHC based markers Fascin, EGFR, MUC1 and Villin and was graded accordingly. The overall survival of each patient was determined and comparison of the IHC markers with the overall survival was determined to assess the prognostic implications of the markers. Results-Statistical analysis showed that there was significance when tumour differentiation, tumour size CEA levels and EGFR expression was compared with survival. Conclusion-Tumour size and differentiation had a significant association with survival with larger tumours with poor differentiation having poor overall survival. Tumours with EGFR expression were mainly poorly differentiated tumours and the overall survival was poor in such cases. Important limitations were that most of the cases were diagnosed on biopsies in which lymph vascular invasion and peri-neural invasion could not be properly ascertained. The procurement of antibodies was also difficult and the grading of IHC findings was not uniform between different studies in existing literature.