Features Of Intraductal Papillary Neoplasm Research Articles

Reappraisal of pathological features of intraductal papillary neoplasm of bile duct with respect to the type 1 and 2 subclassifications

The pathological spectrum of intraductal papillary neoplasm of bile duct (IPNB) remains to be clarified. A total of 186 IPNBs were pathologically examined using the type 1 and 2 subclassifications proposed by Japanese and Korean biliary pathologists incorporating a two-tiered grading system (low-grade and high-grade dysplasia), with reference to four subtypes (intestinal [i], gastric [g], pancreatobiliary [pb], and concocytic [o] subtype). IPNBs were classifiable into type 1 composed of low-grade dysplasia and 'high-grade dysplasia with regular structures' (69 IPNBs), and type 2 of 'high grade dysplasia with irregular structures and complicated lesions' (117 IPNBs). Type 1 was more common in the intrahepatic bile duct (78%), whereas type 2 was frequently located in the extrahepatic bile duct (58%). Mucin hypersecretion was more common in type 1 (61%) than in type 2 (37%). IPNBs were classifiable into the four subtypes: 86 iPNBs, 40 gIPNBs, 31 pbIPNBs, and 29 oIPNBs. The four subtypes were histologically evaluable with reference to the type 1 and 2 subclassifications. iIPNB and pbIPNBs were frequently classified as type 2, whereas types 1 and 2 were observed at similar rates in gIPNB and oIPNB. Stromal invasion was almost absent in type 1, irrespective of subtype, but was found in 66 of 117 type 2 IPNBs (P<.01), and postoperative outcome was favorable in IPNBs without invasion compared with IPNBs with invasion (P<.05). The type 1 and 2 subclassifications with reference to the four subtypes may provide useful information for understanding IPNB.

Clinicopathological findings and imaging features of intraductal papillary neoplasms in bile ducts.

BackgroundIntraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is considered an uncommon tumor, and there is limited understanding of IPMN-B. This study aimed to investigate the prognosis and influential factors of the IPMN-B from 58 cases.MethodsThe clinical data of 58 patients with pathologically confirmed IPMN-B admitted to our hospital from January 1, 2012 to August 2017 were collected and analyzed. The patients were followed up by outpatient or telephone until January 1, 2019. SPSS 19.0 software was applied for data analysis. Survival analysis was performed using Kaplan-Meier method and parallel Log-rank test. Prognostic factors were analyzed by univariate analysis and multiple Cox regression model.ResultsAmong of all the patients, 26 cases were benign tumors and 32 cases were malignant tumors. The preoperative tumor markers CA242 and CEA of malignant IPNM-B patients were significantly higher than those in benign tumors (P < 0.05). Survival analysis showed that patients with malignant tumors had a worse prognosis. The median survival time of malignant IPMN-B patients was 40.6 ± 3.0 months, yet median survival time of benign IPMN-B patients was not reached (P = 0.19). The one-year survival rate and three-year survival rate of benign IPMN-B were 84% and 74% respectively. The one-year survival rate and three-year survival rate of malignant IPMN-B were 88% and 64% respectively. Univariate analysis showed that combined lymph node metastasis, surgical method, and differentiation degree could affect patients’ prognosis (P < 0.05). Multivariate analysis showed differentiation degree was an independent risk factor affecting prognosis (OR = 0.06, 95% confidence interval: 0.007∼0.486, P < 0.05).ConclusionThe levels of CEA and CA242 were helpful to identify benign and malignant of IPNM-B. Moreover, radical surgical resection could prolong patients’ survival. Finally, differentiation degree was an independent risk factor affecting malignant IPNM-B prognosis.

Clinicopathologic analysis of intraductal papillary neoplasm of bile duct: Korean multicenter cohort study

BackgroundIPNB is very rare disease and most previous studies on IPNB were case series with a small number due to low incidence. The aim of this study is to validate previously known clinicopathologic features of intraductal papillary neoplasm of bile duct (IPNB) based on the first largest multicenter cohort. MethodsAmong 587 patients previously diagnosed with IPNB and similar diseases from each center in Korea, 387 were included in this study after central pathologic review. We also reviewed all preoperative image data. ResultsOf 387 patients, 176 (45.5%) had invasive carcinoma and 21 (6.0%) lymph node metastasis. The 5-year overall survival was 80.9% for all patients, 88.8% for IPNB with mucosal dysplasia, and 70.5% for IPNB with invasive carcinoma. According to the “Jang & Kim's modified anatomical classification,” 265 (68.5%) were intrahepatic, 103 (26.6%) extrahepatic, and 16 (4.1%) diffuse type. Multivariate analysis revealed that tumor invasiveness was a unique predictor for survival analysis. (p = 0.047 [hazard ratio = 2.116, 95% confidence interval 1.010–4.433]). ConclusionsThis is the first Korean multicenter study on IPNB through central pathologic and radiologic review process. Although IPNB showed good long-term prognosis, relatively aggressive features were also found in invasive carcinoma and extrahepatic/diffuse type.

Clinicopathological Study of Resections of Intraductal Papillary Neoplasm of the Bile Duct.

The aim of this study was to examine the clinicopathological features of intraductal papillary neoplasm of the bile duct (IPNB) and investigate their relationships with intraductal papillary mucinous neoplasm (IPMN). Our study included 104 patients who underwent resection of tumors that showed papillary growth within the bile duct and pancreas. Comparisons were performed based on subtypes and histological grades. The presence of various histological grades was confirmed in both the IPNB group and the IPMN group, and statistical significance was found in the between-group comparisons of subtypes and histological grades. It was shown that while all patients who underwent IPNB resection did not match the classifications proposed by Nakanuma et al., they did reflect classification characteristics. IPNB and IPMN have common clinical histological features. Common features between IPNB subtype classifications were also identified, which may provide novel diagnostics.

Clinical features, diagnosis and treatment of intraductal papillary neoplasm of the bile duct

Objective: To study the clinicopathologic features of intraductal papillary neoplasm of the bile duct(IPNB) and to analyze the diagnostic and therapeutic patterns. Methods: The data of 46 patients with IPNB undergoing surgery in Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to November 2017 were retrospectively analyzed.There were 23 males and 23 females with age of (64±8)years.Patients were followed up by clinics and telephone inquiry.Categorical data were compared with χ(2) test or Fisher's exact test. Results: Abdominal pain(in 31 patients), fever (in 15 patients) and jaundice (in 11 patients) were the most common symptoms.Twenty-five patients were accompanied with cholangiolithiasis and 25 were accompanied with liver atrophy.Preoperative laboratory examination was mainly manifested as the abnormal liver function caused by biliary obstruction.Typical imaging findings included bile duct dilation (in 45 patients) and mass within bile duct (in 22 patients). All the patients were diagnosed as IPNB histopathologically.Among them, high-grade intraepithelial neoplasia and related adenocarcinoma were more common in mucus-hypersecretion IPNB ((13/15 vs. 51.6%(16/31))(χ(2)=5.331, P=0.021). Hepatectomy was performed in 25 patients, hepatectomy combined with biliary resection and reconstruction in 12 cases, biliary resection and reconstruction in 3 cases, pancreatoduodenectomy in 3 cases, hepatopancreaticoduodenectomy in 1 case, liver transplantation in 1 case and radiofrequency ablation in 1 case.Forty-one patients were followed up with a median of 30 (12, 41) months.Seven patients suffered recurrence and 6 died. Conclusion: IPNB is a rare disease with limited knowledge currently.Images are the main diagnositc means and surgery is the first choice.

Clinicopathological features of intraductal papillary neoplasms of the bile duct: a comparison with intraductal papillary mucinous neoplasm of the pancreas with reference to subtypes.

Intraductal papillary epithelial neoplasms of the pancreatobiliary system (intraductal papillary neoplasm of the bile duct (IPNB) and intraductal papillary mucinous neoplasm (IPMN)) seem to share many clinicopathological features; however, IPNB has not been fully characterized. In order to understand the clinicopathological/immunohistochemical features of IPNB better, we compared 52 cases of IPNB with 42 cases of IPMNs with mural nodules. The IPNB cases were divided into two groups according to their histological similarity and according to five key histological findings. All IPNB and IPMN cases mainly affected middle-aged to elderly people, predominantly men. Mucin hypersecretion was less frequent in IPNB compared to IPMN. Group 2 IPNB more frequently had a higher histopathological grade and more extensive stromal invasion than IPMN. Group 1 IPNB and IPMN were further classified into four subtypes (gastric, intestinal, pancreatobiliary, and oncocytic). Although each subtype of IPNB and IPMN showed similar histology, the immunohistochemical results were different. The gastric type of IPNB was less frequently positive for CDX2, and intestinal IPNB was more frequently positive for MUC1 and less frequently positive for MUC2, MUC5AC, and CDX2 compared to each subtype of IPMN, respectively. In conclusion, IPNB and IPMN have some clinicopathological features in common, but mucin hypersecretion was less frequent both in IPNBs than in IPMN. Group 2 IPNB differed from IPMN in several parameters of tumor aggressiveness. Additional clinicopathological and molecular studies should be performed with respect to the subtypes of IPNB and IPMN.

Intraductal papillary neoplasms of intrahepatic bile duct: a clinicopathologic study of 25 cases

To study the clinicopathologic and immunohistochemical features of intraductal papillary neoplasms of the bile duct (IPNB) of the intrahepatic bile duct. The clinical findings, morphologic features and immunophenotype of 25 cases of IPNB were investigated. Of the 25 cases of IPNB, 18 were in the left lobe, 6 were in the hilar bile duct, and 1 was in the right lobe. The average age was 60.6 (26-73) years. The presenting symptom was abdominal pain in 15 cases. Imaging results were variable, including multilobular cysts, mass lesions within the dilated ducts, cholangiolithiasis with dilated bile duct, and solid mass. Gross examinations were concordant with imaging findings. Microscopically, all the IPNB could be divided into four papillary patterns, including 12 gastric type, 8 intestinal type, 4 pancreatobiliary type and 1 oncocytic type. Five IPNB showed mild to moderate atypia, 10 showed high-grade atypia and 10 IPNB were associated with carcinomas.The invasive IPNB were mainly bile duct adenocarcinomas(9 cases), and rarely colloid carcinoma (1 case). Immunohistochemically, IPNB expressed MUC5AC (96.0%, 24/25), MUC2 (32.0%, 8/25), MUC6 (40.0%, 10/25) and MUC1 (12.0%, 3/25). The different MUC expression was commonly associated with specific histological subtype. IPNBs are rare cystic and premalignant neoplasms of the liver. The imaging features vary, but show a common feature of dilated bile duct. The pathologic types and classifications are similar to intraductal papillary mucinous neoplasm of the pancreas. The MUC stains are helpful in diagnosis and histological subtyping.

Systematic Review and Meta-analysis of Current Experience in Treating IPNB: Clinical and Pathological Correlates.

To systematically review studies reporting clinicopathological features of intraductal papillary neoplasm of the bile duct (IPNB) to provide evidence-based guidance for management. IPNB is a rare tumor type. Management decisions are currently based upon anecdotal evidence and small case series. To data, there has been no systematic review of IPNB literature. MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched and data were extracted from relevant studies. Meta-analysis was used to pool study estimates. Evidence of association was determined by comparing pooled crude odds ratios (OR) derived from abstracted data. Fifty-seven retrospective case series were included. At least 43% of 476 specimens contained invasive disease. Invasive tumors were found at significantly higher frequency in pancreaticobiliary than intestinal, gastric or oncocytic-type IPNB [pooled OR 2.5, 95% confidence interval (CI) 1.5-4.2, P < 0.001]. A significantly higher proportion of pancreaticobiliary tumors compared with intestinal tumors expressed MUC-1 [86.4% (95% CI 75.1%-94.7%) vs 13.2% (95% CI 4.6%-25.2%), respectively P < 0.001]. IPNB identified in centers from Asia were more likely to be intrahepatic and were less frequently invasive compared with those from Western centers. Pooled estimates of absolute survival after IPNB resection were 96% (95% CI 93%-99%) at 1 year, 79% (95% CI 69%-88%) at 3 years, and 65% (95% CI 46%-76%) at 5 years. Early surgery is advisable for radiologically suspected IPNB as it is frequently invasive. The pathobiology of IPNB demonstrates geographic variation. Pancreaticobiliary IPNB expresses MUC1 and is more frequently associated with invasive disease than other IPNB subtypes.

Clinical and pathological features of intraductal papillary neoplasm of the biliary tract and gallbladder

BackgroundIntraductal papillary neoplasms of the biliary tract (IPNB) and intracholecystic papillary neoplasms (ICPN) are rare tumours characterized by intraluminal papillary growth that can be associated with invasive carcinoma. Their natural history remains poorly understood. This study examines clinicopathological features and outcomes. MethodsPatients who underwent surgery for IPNB/ICPN (2008–2014) were identified. Descriptive statistics and survival data were generated. ResultsOf 23 patients with IPNB/ICPN, 10 were male, and the mean age was 68 years. The most common presentations were abdominal pain (n = 10) and jaundice (n = 9). Tumour locations were: intrahepatic (n = 5), hilar (n = 3), the extrahepatic bile duct (n = 8) and the gallbladder (n = 7). Invasive cancer was found in 20/23 patients. Epithelial subtypes included pancreatobiliary (n = 15), intestinal (n = 7) and gastric (n = 1). The median follow‐up was 30 months. The 5‐year overall (OS) and disease‐free survivals (DFS) were 51% and 57%, respectively. Decreased OS (P = 0.09) and DFS (P = 0.05) were seen in patients with tumours expressing MUC1 on immunohistochemistry (IHC). ConclusionIPNB/ICPN are rare precursor lesions that can affect the entire biliary epithelium. At pathology, the majority of patients have invasive carcinoma, thus warranting a radical resection. Patients with tumours expressing MUC1 appear to have worse OS and DFSs.

Ultrasound Findings of Intraductal Papillary Neoplasm in Bile Duct and the Added Value of Contrast-Enhanced Ultrasound.

To investigate the imaging features of intraductal papillary neoplasm in bile duct (IPNB) on baseline ultrasound and contrast-enhanced ultrasound (CEUS). The imaging features on baseline ultrasound and CEUS in 16 pathologically proven IPNB lesions in 15 patients were retrospectively analyzed. Real-time contrast specific modes and contrast agent of SonoVue were used for CEUS. Bile duct dilation was present in all patients. The mean lengths for the intraductal papillary adenomas and adenocarcinomas were 2.5 ± 1.1 (range, 1.2 - 4.2 cm) and 5.6 ± 2.0 cm (range, 3.3 - 9.8 cm) (P = 0.004). Three imaging types of IPNB on ultrasound were depicted: bile duct dilation with intraductal mass (n = 8), bile duct dilation without intraductal mass (n = 3), and cystic-solid mixed type (n = 5). On CEUS, solid components of 13 lesions appeared hyper- (n = 12) or iso-enhancement (n = 1) in the arterial phase whereas all showed hypo-enhancement in the portal and late phases. For 3 lesions of bile duct dilation without intraductal mass, CEUS showed non-enhancement during all phases. Pre-surgical CEUS and conventional ultrasound made correct diagnoses in 12 (75.0 %) and 5(31.3 %) of 16 IPNBs respectively (P = 0.04). For CECT, correct diagnosis was also achieved in 12 (75.0 %) of 16 lesions (P = 1.00, in comparison with CEUS). IPNB should be taken into consideration when intraductal mass or cystic-solid mass with bile duct dilation, or remarkable bile duct dilation without intraductal mass, are found on US. Intraductal mass length > 3.0 cm is more commonly found in malignant IPNB. CEUS might facilitate the diagnosis of IPNB by easily excluding the possibility of commonly found sludge, nonshadowing stones, or blood clots.

Intraductal papillary neoplasm of the bile ducts: description of MRI and added value of diffusion-weighted MRI

To evaluate MRI features of intraductal papillary neoplasm of the bile duct (IPNB) and to determine added value of diffusion-weighted MRI (DWI). Twenty-three patients with surgically confirmed invasive (n = 12) and non-invasive (n = 11) IPNB, who underwent preoperative liver MRI were included. Two observers performed consensus review of gadoxetic acid-enhanced MRI and combined gadoxetic acid-enhanced MRI including DWI separately, with regard to conspicuity of intraductal tumor using five point scales, extent of tumors, and the presence of invasiveness. On MRI, there was no significant difference in the conspicuity of intraductal tumors between gadoxetic acid MRI (mean, 4.35) and combined MRI (mean, 4.65) (P = 0.09). However, addition of DWI led seven cases revealed excellent conspicuity as compared with good or moderate conspicuity on gadoxetic acid MRI. With regard to invasiveness, 11 cases (48 %) and 17 (74 %) were correctly diagnosed with gadoxetic acid MRI and combined MRI, respectively (P = 0.06). In invasive tumors, both of the two image sets did not help assess accurate extent of the tumor. The addition of DWI to gadoxetic acid-enhanced MRI has a potency to improve conspicuity for intraductal tumors of IPNB and is helpful in determining tumor invasiveness, but not tumor extent.

Imaging features of intraductal papillary neoplasm of bile duct (IPN-B) on baseline ultrasound and contrast-enhanced ultrasound

Objective To investigate the features of intraductal papillary neoplasm of the bile duct (IPN-B) on baseline ultrasound and contrast-enhanced ultrasound (CEUS).Methods A retrospective analysis of the baseline ultrasound and CEUS in nine pathologically proven IPN-B lesions in eight patients.CEUS was performed with low mechanical index and continuous real-time imaging technique and the contrast agent of SonoVue.Results On conventional ultrasound,5 lesions were appeared as expansion of bile duct type,whose main features were cauliflower shape tumor (n =1) or papillary nodes (n =3) in expanded bile duct with rare blood supply;the other 3 lesions were appeared as complex cystic type,which contained cystic and solid components in the lesions.Many tiny anechoic areas were observed inside the solid lesions.Two lesions were rich in blood supply and another one was rare.All were communicated with adjacent slightly dilated bile duct.On CEUS,solid components of eight lesions appeared homogeneous (n =5) or heterogeneous (n =3) hyper-enhancement in the arterial phase and declined into hypo-enhancement in the portal and late phases.One lesion,on the contrary,was invisible on both conventional ultrasound and CEUS.Conclusions Understanding the ultrasound features of IPN-B is mandatory because of its low preoperative diagnosis rate on CEUS.IPN-B should be taken into consideration when cauliflower shape tumors or papillary nodules in expanded bile duct,as well as hyper-enhancement in the arterial phase and hypo-enhancement in the portal and late phases on CEUS,were demonstrated. Key words: Ultrasonography; Microbubbles ; Bile duct neoplasms

Immunohistochemical characteristics and malignant progression of hepatic cystic neoplasms in comparison with pancreatic counterparts

The recent World Health Organization classification for tumors of the digestive system defined grossly and histologically hepatic mucinous cystic neoplasms and intraductal papillary neoplasms of the bile duct separately. In this study, the immunohistochemical features of intraductal papillary neoplasm of the bile duct (19 cases) and hepatic mucinous cystic neoplasm (5 cases) were characterized and compared with those of similar pancreatic lesions, intraductal papillary mucinous neoplasm of the pancreas (12 cases), and pancreatic mucinous cystic neoplasm (6 cases) and with those of other biliary cystic lesions, peribiliary cysts (10 cases). Intraductal papillary neoplasm of the bile duct and intraductal papillary mucinous neoplasm of the pancreas frequently expressed cytokeratin 7; mucin core proteins 1, 2, 5AC, and 6; trypsin; and amylase. Hepatic and pancreatic mucinous cystic neoplasms frequently expressed cytokeratin 7, mucin core proteins 1 and 5AC, estrogen receptor, progesterone receptor, trypsin, and amylase. Estrogen and progesterone receptors were expressed in the subepithelial stromal cells. The groups with intraductal papillary neoplasm of the bile duct and intraductal papillary mucinous neoplasm of the pancreas were different from the groups with hepatic and pancreatic mucinous cystic neoplasm with respect to several phenotypes reflecting gastric and intestinal metaplasia and also the lack of expression of estrogen and progesterone receptors. The Ki-67 and p53 labeling indexes increased significantly with the malignant progression of intraductal papillary neoplasm of the bile duct and intraductal papillary mucinous neoplasm of the pancreas. The p16 labeling index decreased and EZH2 labeling index increased significantly with the malignant progression of intraductal papillary neoplasm of the bile duct and intraductal papillary mucinous neoplasm of the pancreas. In conclusion, intraductal papillary neoplasm of the bile duct and hepatic mucinous cystic neoplasm might be regarded as biliary counterparts of intraductal papillary mucinous neoplasm of the pancreas and pancreatic mucinous cystic neoplasm, respectively, and the mucinous cystic neoplasm and intraductal papillary neoplasm groups differed from each other. Labeling indexes of Ki-67, p53, p16, and EZH2 were comparable in intraductal papillary neoplasm of the bile duct and intraductal papillary mucinous neoplasm of the pancreas along with their malignant progression, suggesting a common carcinogenic process of the tumors.

Clinicopathologic Features of Intraductal Papillary Neoplasm of the Bile Duct According to Histologic Subtype

Despite an increase in the reports of intraductal papillary neoplasm of the bile duct (IPN-B), the clinical characteristics and long-term prognosis of this disease are not well known compared with those of intraductal papillary mucinous neoplasms of the pancreas. The objective of our study was to compare the clinical features, radiologic findings, and clinical outcomes of IPN-B according to histologic subtype. A retrospective analysis was performed on the medical records of 97 patients diagnosed with IPN-B by pathologic analysis of their surgical specimens between May 1995 and May 2010. We compared the clinical manifestations, radiological findings, pathologic grade, curative resection rate, recurrence, and overall survival according to four histologic subtypes: gastric (n=15), intestinal (n=46), pancreaticobiliary (n=33), and oncocytic (n=3), which were classified on the basis of hematoxylin and eosin staining and the immunohistochemical profile of mucin core proteins. Mucin hypersecretion was significantly more frequent in patients with gastric and intestinal types than it was in those with oncocytic and pancreaticobiliary types (P=0.014). There were no significant differences between groups regarding the presence of bile duct stones or tumor location. The frequency of invasive carcinoma in the pancreaticobiliary type was significantly higher than those in the gastric and intestinal types (72.7 vs. 26.7 and 32.6%, P<0.001 and P<0.001). When comparing the survival curves according to histologic subtype, patients with pancreaticobiliary type demonstrated significantly worse survival compared to those with gastric and intestinal types (P=0.035). Gastric and intestinal types of IPN-B have similar clinical characteristics compared with the pancreaticobiliary type, which has a worse prognosis.

The clinicopathological features of intraductal papillary neoplasms of the bile duct in a Chinese population

BackgroundIntraductal papillary neoplasms of the bile duct have been applied to certain types of papillary tumours occurring in the biliary tract. Although many cases have been sporadically reported, there remain controversies. AimsTo analyze the clinicopathologic characteristics and long-term survival of intraductal papillary neoplasms of the bile duct. MethodsThe clinicopathologic data of 52 patients who underwent surgery for intraductal papillary neoplasms of the bile duct were retrospectively evaluated. ResultsIn our series, tumours located in intrahepatic and hilar bile duct, rather than in extrahepatic bile duct, were more commonly diagnosed as adenomas or borderline tumours (12/19 and 7/13 vs 6/20; P=0.046). And the gastric type was more commonly associated with adenomas or borderline tumour (85.7%), whilst the pancreaticobiliary type mainly comprised of noninvasive carcinoma or invasive carcinoma (93.8%). However, only the types of treatment (median survival: curative resection: 72 months and palliative groups: 12 months; P<0.001) and histologic grades (adenoma or borderline malignancy vs noninvasive carcinoma: P=0.018) were significantly associated with survival. ConclusionIntraductal papillary neoplasms of the bile duct are rare type of biliary neoplasms, long-term survival may be achieved with complete resection. However, further studies are needed to clarify the relationship between these variables like location, cellular types and histologic grades.

Clinical Features of Intraductal Papillary Neoplasm of the Bile Duct According to Histopathologic Classification

Background. The incidence of cholangiocarcinoma has increased worldwide with the mortality remaining high. The aetiology is largely unknown but aspirin, non steroidal anti-inflammatory drugs (NSAIDs) and statins may be protective. The growth of cholangiocarcinoma cells is inhibited in both in-vitro and animal models by NSAIDs, which block the Cox-2 enzyme. Additionally, statins inhibit the production of intracellular mediators stimulating the cell cycle. The epidemiological data in this area is minimal with no studies having specifically investigated aspirin or statins in Western populations. The aim of this study was to investigate if there was a negative association between these medications and the development of cholangiocarcinoma in two centres in the United Kingdom. Methods. Cases of cholangiocarcinoma were identified in Norwich (years 2004-2010) and Leicester (year 2007) from the multi-disciplinary team meeting cancer clinical databases used at the local hospitals. Inclusion required diagnostic evidence from CT scans and/or histology. Controls were patients with basal cell carcinomas treated in the dermatology departments. The case notes of all subjects were reviewed to obtain information on the use of NSAIDS and aspirin. Data were analysed using unconditional logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age and gender. Results. A total of 77 cases of cholangiocarcinoma (median age at diagnosis of 76 yrs, range 41-96 years, 51% men) and 251 controls were identified. All patients had radiological evidence of cancer and 29% had histological confirmation, with 85% involving the extrahepatic biliary system. The median survival of all patients was 3.6 months (IQ range 0.9-8.0 months). There was a borderline statistically significant negative association between aspirin use and the occurrence of cholangiocarcinoma (OR=0.55, 95% CI=0.28-1.07, p=0.08) but no association with NSAID use (OR=0.49, 95% CI=0.16-1.48 p=0.21) or statins (OR=0.71, 95% CI=0.37-1.38, p=0.31). Conclusions. This epidemiological data may support biological evidence for aspirin protecting against the development of cholangiocarcinoma. The work is progressing to identify further subjects to more precisely define the effect size. Aetiological work in other populations is required to determine if the association with aspirin is consistent although its use should currently be measured in aetiological studies of cholangiocarcinoma.