The significance of galectin-3 immunohistochemistry, clinical characteristics and liver imaging in differentiating intrahepatic cholangiocarcinoma from adenocarcinoma liver metastasis

OBJECTIVE

To identify differences of Galectin-3 (Gal-3) immunostaining, clinical profiles, and images in patients with intrahepatic cholangiocarcinoma (IHC) and adenocarcinoma liver metastasis, and be able to recognize these parameters as diagnostic tools for differentiating these two diseases.

MATERIAL AND METHOD

Histological slides from patients with IHC and adenocarcinoma liver metastasis were reviewed Immunohistochemical staining for Gal-3, Cytokeratin-7 (CK-7), and Cytokeratin-20 (CK-20) was performed and the results categorized. Moreover clinical characteristics and liver images of the patients were reviewed.

RESULTS

Eighty-two patients were evaluated, 31 IHC and 51 adenocarcinoma liver metastasis. Patients who strongly expressed Gal-3 were positive for CK-7 and negative for CK-20. Finding showed that 86% of them were IHC whereas only 14% were in adenocarcinoma liver metastasis. All patients with liver images showing a single lesion, located at central site, and having intrahepatic duct dilatation were IHC. On the other hand, 77% of patients with liver imaging showing multiple liver masses, located at peripheral site and having no intrahepatic duct dilatation were adenocarcinoma liver metastasis while only 23% were in IHC.

CONCLUSION

Adding Gal-3 to CK-7 and CK-20 immunohistochemistry has benefits to differentiate IHC from adenocarcinoma liver metastasis. Furthermore, liver imaging profiles also give benefits for differentiating between these two diseases.

Significance of galectin-3 immunohistochemistry , clinical characteristics, and liver imaging in differentiating intrahepatic cholangiocarcinoma from adenocarcinoma liver metastasis

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Background: Difficulties remain in distinguishing intrahepatic cholangiocarcinoma from adenocarcinoma liver metastasis , therefore specific immunohistochemistry markers are still needed. Galectin-3 is a beta-galactoside-binding protein and has been reported as a tissue marker in many neoplasms, including cholangiocarcinoma. Adding Galectin-3 to Cytokeratin immunohistochemistry may provide more definitive diagnosis to these conditions. Methods: Histological slides of intrahepatic cholangiocarcinoma and adenocarcinoma liver metastasis were reviewed independently by 2 pathologists to confirm diagnosis. Immunohistochemical staining was done with primary antibodies for Galectin-3 (NCL-GAL3), Cytokeratin-7 (CK-7) and Cytokeratin-20 (CK-20) in paraffin embedded tissues. The extent of Galectin-3 staining was categorized as 0% (none), 1–25% (weak), 26–65% (moderate), and > 65% (strong) positive of tumor cells. Clinical characteristics and liver imaging of all patients were also reviewed. Results: Thirty-three patients were evaluated , 17 cholangiocarcinoma and 16 adenocarcinoma liver metastasis. Seventy-five percent of cholangiocarcinoma strongly expressed Galectin-3 whereas 56% of adenocarcinoma liver metastasis did. CK-7 expression was found in 47% of cholangiocarcinoma and CK-20 41%. In colorectal liver metastasis, 6 of 7 patients (85%) were negative for CK-7 and positive for CK-20. When correlated with patient characteristics, cholangiocarcinoma tended to occur in patients who were older than 55 years. Regarding liver imaging, multiple liver masses without intrahepatic bile duct dilatation correlated with adenocarcinoma liver metastasis. Conclusion: Adding Galectin-3 immunohistochemistry may benefit for differentiating intrahepatic cholangiocarcinoma from adenocarcinoma liver metastasis. Further study in a larger series is encouraged to better define role of this protein in cholangiocarcinoma diagnosis.

No significant financial relationships to disclose.

Liver involvement in murine typhus

Liver involvement was retrospectively evaluated in 137 patients with murine typhus. Fifteen (10.9%) were jaundiced. One patient had been subjected to cholecystectomy after misdiagnosis of acute cholecystitis. Serum aminotransferase levels were abnormal in 48/52 measurements, and there were elevations of > 5-fold in 14 patients. Liver biopsies and/or necropsies from four jaundiced patients showed portal tract and sinusoidal infiltrates, cloudy swelling/and necrosis of the hepatocytes and occasional pseudogranuloma formation. There were striking mitoses even in the early stage, suggesting rapid hepatocellular regeneration. Haemolytic diseases (G6PD deficiency or haemoglobinopathies), alcoholism, and a second infection probably also contributed to the pathogenesis of jaundice in murine typhus. This rickettsiosis should be included among differential diagnoses of acute hepatitis in patients exposed to areas endemic for Rickettsia typhi.