Neenu Jojan1, Geetha Sukumaran2
BACKGROUND
Cholangiocarcinoma is a highly malignant but rare tumour arising from the bile
duct, with a dismal prognosis owing to the advanced stage at presentation. A
complete surgical resection is the only curative treatment available till date.
There is an increase in the incidence of this tumour, especially intrahepatic
cholangiocarcinoma. The objective of the present study was to assess the
microvascular density in cholangiocarcinoma and its relationship to grade, which
itself is a separate and important prognostic factor.
METHODS
All the specimens of cholangiocarcinomas received in the Department of
Pathology, Government Medical College, Trivandrum, during a two-year period is
included in the study (n = 26). Grading of tumours was done from H & E
sections. Microvascular density was assessed using immunostaining with CD34
and counted using the method published by Weidner et al.
RESULTS
A total of 26 cases were studied. There was a male preponderance (57.7 %)
with a mean age incidence of 55.77 years. Most of the tumours were located
extra hepatically. 53.8 % were moderately differentiated tumours. Only 15 % of
tumours showed lymph node metastases. Median microvascular density score
was 15 vessels per high power field. High microvascular density was found in
higher grade tumours. Although 75 % of the cases with lymph node metastases
had high microvascular density, there was no significant correlation between
microvascular density and nodal metastases, probably due to few cases of nodal
metastases in the present study.
CONCLUSIONS
This study concludes that microvascular density in cholangiocarcinoma has a
positive correlation with the grade of the tumour which itself is a significant
prognostic factor. Hence, microvascular density can be used as a prognostic
indicator especially in cases of incomplete resection and inadequate lymph node
harvest. It may also be helpful in studying the possibility of newer therapeutic
measures like anti-angiogenic treatment modalities.
