Abstract
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. KEYWORDS VD, CD34, Grade, Cholangiocarcinoma
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