Cholangiocarcinoma that infiltrated a Periampullary Duodenal Diverticula and the head of the pancreas (16 of 20)

Large and small malignant cholangiolar ducts

Anatomical classification “Cholangiocarcinoma” originally
referred only to primary

tumours of the intrahepatic bile ducts and was not used for extrahepatic bile duct tumours but the term is now regarded as inclusive of intrahepatic, perihilar, and distal extrahepatic tumours of the bile ducts. 20–25% are intrahepatic. 50–60% of all cases of cholangiocarcinoma are perihilar tumours (those involving the bifurcation of the ducts are “Klatskin” tumours)
Most Klatskin tumours may have been coded as intrahepatic
tumours for purposes of death certification.
20–25% are distal extrahepatic tumours.
About 5% of tumours may be multifocal.
The extent of duct involvement by perihilar tumoursmay be
classified as suggested by Bismuth:
type I: tumours below the confluence of the left and right hepatic ducts;
type II: tumours reaching the confluence but not involving the left or right hepatic ducts;