Inflammatory Pseudotumor of the Liver in Patients with Recurrent Pyogenic Cholangitis: CT-Histopathologic Correlation

Yoon, Kwon‐Ha; Ha, Hyun Kwon; Lee, Jin Seong; Suh, Jae Hee; Kim, Myung Hwan; Kim, Pyo Nyun; Lee, Moon-Gyu; Yun, Ki Jung; Choi, Suck-Chei; Nah, Yong-Ho; Kim, Chang Guhn; Won, Jong Jin; Auh, Yong Ho

doi:10.1148/radiology.211.2.r99ma36373

Cited by 99 publications

(74 citation statements)

References 27 publications

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“…However, only a few reports describe the radiologic findings of cholangiocarcinoma occurring in patients with hepatolithiasis [17][18][19]. In patients with hepatolithiasis, fibrotic masses in the bile duct walls and periductal hepatic parenchyma are often seen as a form of periductal tumorlike lesions and may appear similar to cholangiocarcinoma on CT [19]. Furthermore, in patients with hepatolithiasis, the stricture or stenosis caused by cholangiocarcinoma may not be easy to differentiate from that caused by stones [6,10,20].…”

mentioning

confidence: 99%

CT Differentiation of Cholangiocarcinoma from Periductal Fibrosis in Patients with Hepatolithiasis

Park

Lee

Kim

et al. 2006

American Journal of Roentgenology

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OBJECTIVE. The objective of our study was to determine useful CT findings for differentiating cholangiocarcinoma from periductal fibrosis in patients with hepatolithiasis.MATERIALS AND METHODS. CT images of 30 patients with hepatolithiasis and pathologically proven cholangiocarcinoma (n = 14) or periductal fibrosis (n = 16) were retrospectively reviewed. Helical CT scans were obtained before, 30 seconds after, and 65 seconds after the start of contrast material injection. Analysis of CT findings included evaluation for the presence of periductal soft-tissue density, bile duct wall thickening at the stricture site, ascites, portal vein obliteration, lymph node enlargement, and a duct stone; assessment of the degree of ductal dilatation; and evaluation of the enhancement pattern of periductal lesions, thickened ductal wall, and hepatic parenchyma. The CT attenuation coefficients of the thickened ductal wall and adjacent normal-looking bile duct were measured on images obtained during each phase. Among these findings, statistically significant variables were determined using the Fisher's exact test and Student's t test. Sensitivity and specificity values of the CT criteria were also calculated.RESULTS. The presence of periductal soft-tissue density (p = 0.002), higher enhancement of the duct than adjacent bile duct on portal venous phase images (p = 0.008), ductal wall thickening (p = 0.026), portal vein obliteration (p = 0.031), and lymph node enlargement (p = 0.031) were found to be the significant findings for differentiating cholangiocarcinoma from fibrosis in patients with hepatolithiasis. When any two or more of these five criteria were used in combination, we could identify 100% of the patients with cholangiocarcinoma but only 12.5% of the patients with fibrosis.

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confidence: 99%

CT Differentiation of Cholangiocarcinoma from Periductal Fibrosis in Patients with Hepatolithiasis

Park

Lee

Kim

et al. 2006

American Journal of Roentgenology

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“…Many mechanisms and hypothesized etiologic factors like infections, trauma, autoimmunity reactions, radiotherapy, and local reaction to changes in the walls of bile ducts are suggested [1][2][3][4][5][6][7]10,13,[18][19][20][21][22][23][24][25][26]. Some microorganisms that access the portal vein including Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Gram-positive cocci and Actinomyces were regarded as causative agents.…”

Section: Discussionmentioning

confidence: 99%

“…Viral infections (Epstein-Barr virus [20], hepatitis B and C virus) [10,27] and parasitic infestations (Schistosoma mansoni) may play role in the pathogenesis [18]. Some authors suggested that disturbance of biliary drainage, e.g., due to biliary stones [1,7], recurrent pyogenic cholangitis [4,26] or sclerosing cholangitis is also important [25]. The tumor was also noted in HIV infected persons [24].…”

Section: Discussionmentioning

confidence: 99%

Inflammatory Pseudotumor of the Liver in Patient with Type 2 Diabetes

Zdunek¹,

Ostrowska²,

Wilczynski³

et al. 2016

Int J Gastroenterol Disord Ther

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“…Spots of more hypodense areas could not be found in the lesion. Simultaneously, the surrounding hepatic parenchyma may present small wedge shape or patchy of enhancing zone during the hepatic arterial phase [12] , which is caused by the inflammatory hyperemia involving the tissue near the inflammtory lesion. In contrast, SHCC lacks this feature.…”

Section: Hepatic Inflammatory Pseudotumormentioning

confidence: 99%

Small hepatocellular carcinoma keeping hypodense during dual phase helical CT scan and correlative pathology

Shen¹,

Gao²,

Zhao³

et al. 2013

JBGC

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Rationale and Objectives: To evaluate the dual-phase helical computed tomography (CT) appearance of small hepatocellular carcinoma (SHCC) with hypodense and to evaluate its correlation with pathology. Materials and Methods:The helical CT dual-phase appearance of 33 lesions with keeping hypodense was retrospectively analyzed, all lesions were confirmed as SHCC by histopathology. CT appearance included border, inner density. Results:In 33 lesions, which were confirmed as SHCC by pathology, keeping hypodense during hepatic arterial phase and portal venous phase, 19 lesions are ill-defined borders and 14 lesions are well-defined borders, 22 lesions show homogenous hypodense and 11 lesions show heterogeneous hypodense in non-enhancing CT scan; however, only 9 lesions are ill-defined borders and the other 24 lesions are well-defined borders with slightly irregular contours, only 9 lesions show homogenous hypodense and the other 24 lesions show heterogenous hypodense with flecks of more hypodense in enhancing CT scan.Conclusion: SHCC with hypodense prefers to have a well-defined border with slightly irregular contour, and flecks of more hypodense in the lesion in dual-phase enhancing helical CT scan.

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Inflammatory Pseudotumor of the Liver in Patients with Recurrent Pyogenic Cholangitis: CT-Histopathologic Correlation

Abstract: Although CT features are not specific, inflammatory pseudotumor should be included in the differential diagnosis in patients with recurrent pyogenic cholangitis and a hepatic mass detected at CT.

Cited by 99 publications

References 27 publications

CT Differentiation of Cholangiocarcinoma from Periductal Fibrosis in Patients with Hepatolithiasis

CT Differentiation of Cholangiocarcinoma from Periductal Fibrosis in Patients with Hepatolithiasis

Inflammatory Pseudotumor of the Liver in Patient with Type 2 Diabetes

Small hepatocellular carcinoma keeping hypodense during dual phase helical CT scan and correlative pathology

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