Ogino M, et al. - Authors studied 310 candidates to demonstrate the prognostic influence of tumor budding grade and its association with clinicopathological and epithelial-mesenchymal transition (EMT)-related characteristics in perihilar cholangiocarcinoma (PHCC) and distal cholangiocarcinoma (DCC). They categorized tumor buds in PHCC as follows: low (0–4 buds), intermediate (5–11 buds), and high (≥12 buds) whereas DCC cases into 2 grades ie, low (0–4 buds) and high (≥5 buds). They noticed a relationship of high tumor budding grade with poor histological differentiation, higher pT factor, the presence of lymphatic, venous, perineural invasion, and regional lymph node metastasis, in both PHCC and DCC candidates. An increment in the number of tumor buds was observed in subjects with tumors exhibiting a mesenchymal profile (negative for E-cadherin and positive for vimentin) during an immunohistochemical analysis. They concluded an association of higher tumor budding grade with invasive clinicopathological traits, unfavorable postoperative prognosis, and EMT status in extrahepatic cholangiocarcinoma.