Bile duct dysplasia and associated invasive carcinoma: clinicopathological features, diagnosis, and practical challenges

Hum Pathol. 2023 Feb:132:158-168. doi: 10.1016/j.humpath.2022.06.012. Epub 2022 Jun 14.


Cholangiocarcinoma represents the second most frequent type of primary liver cancer that develops through a multistep histopathologic sequence. Dysplasia in the biliary tract epithelium is a precursor lesion of cholangiocarcinoma. This review provides a practical overview of bile duct dysplasia in relation to invasive carcinoma, covering clinicopathological features, diagnostic criteria, differential diagnosis, useful testing modalities, and challenges in daily practice. The key features of biliary intraepithelial neoplasia, intraductal papillary neoplasm, intraductal tubulopapillary neoplasm, and mucinous cystic neoplasm are described. Important differential diagnoses are included. Common pitfalls in histopathologic interpretation of bile duct biopsies and frozen sections are discussed.

Keywords: Bile duct dysplasia; Cholangiocarcinoma; Histomorphology; Immunohistochemistry; Molecular genetics.

Publication types

  • Review

MeSH terms

  • Bile Duct Neoplasms* / diagnosis
  • Bile Duct Neoplasms* / pathology
  • Bile Ducts, Intrahepatic / pathology
  • Biopsy
  • Carcinoma in Situ* / diagnosis
  • Carcinoma in Situ* / pathology
  • Cholangiocarcinoma* / diagnosis
  • Cholangiocarcinoma* / pathology
  • Humans
  • Neoplasms, Cystic, Mucinous, and Serous* / pathology