Clin Mol Hepatol.  2022 Jul;28(3):396-407. 10.3350/cmh.2021.0287.

Intrahepatic cholangiocarcinoma: Tumour heterogeneity and its clinical relevance

Affiliations
  • 1Department of Pathology, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
  • 2Department of Pathology, School of Medicine, Keio University, Tokyo, Japan
  • 3Department of Pathology, School of Medicine, Kurume University, Fukuoka, Japan

Abstract

Treatment of intrahepatic cholangiocarcinoma (iCCA) is currently at a significant turning point due to the identification of isocitrate dehydrogenase (IDH) mutations and fibroblast growth factor receptor (FGFR) fusions that can be targeted with currently available therapies. Clinical trials of these targeted therapies have been promising, and the iCCA patients who may benefit from these targeted treatments can be identified by pathological examination prior to molecular investigations. This is because IDH mutations and FGFR fusions are mainly seen in the small duct type iCCA, a subtype of iCCA defined by the 5th World Health Organization classification, which can be recognized by the pathological diagnostic process. Therefore, pathology plays an important role in precision medicine for iCCA, not only in confirming the diagnosis, but also in identifying the iCCA patients who may benefit from targeted treatments. However, caution is advised with the pathological diagnosis, as iCCA shows tumour heterogeneity, making it difficult to distinguish small duct type iCCA from hepatocellular carcinoma (HCC), and combined HCC-CCA. This review focuses on the pathological/molecular features of both subtypes of iCCA (large and small duct types), as well as their diagnostic pitfalls, clinical relevance, and future perspectives.

Keyword

Cholangiocarcinomas; Adult liver cancers; Histological types of neoplasms; Pathology; Hepatocellular carcinoma
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