Varying Appearances of Cholangiocarcinoma: Radiologic-Pathologic Correlation

Abstract

Intrahepatic cholangiocarcinoma is the second most common primary hepatic tumor. Various risk factors have been reported for intrahepatic cholangiocarcinoma, and the radiologic and pathologic findings of this disease entity may differ depending on the underlying risk factors. Intrahepatic cholangiocarcinoma can be classified into three types on the basis of gross morphologic features: mass-forming (the most common), periductal infiltrating, and intraductal growth. At computed tomography (CT), mass-forming intrahepatic cholangiocarcinoma usually appears as a homogeneous low-attenuation mass with irregular peripheral enhancement and can be accompanied by capsular retraction, satellite nodules, and peripheral intrahepatic duct dilatation. Periductal infiltrating cholangiocarcinoma is characterized by growth along the dilated or narrowed bile duct without mass formation. At CT and magnetic resonance imaging, diffuse periductal thickening and increased enhancement can be seen with a dilated or irregularly narrowed intrahepatic duct. Intraductal cholangiocarcinoma may manifest with various imaging patterns, including diffuse and marked ductectasia either with or without a grossly visible papillary mass, an intraductal polypoid mass within localized ductal dilatation, intraductal castlike lesions within a mildly dilated duct, and a focal stricture-like lesion with mild proximal ductal dilatation. Awareness of the underlying risk factors and morphologic characteristics of intrahepatic cholangiocarcinoma is important for accurate diagnosis and for differentiation from other hepatic tumorous and nontumorous lesions.

Intrahepatic peripheral cholangiocarcinoma in cirrhosis patients may display a vascular pattern similar to hepatocellular carcinoma on contrast-enhanced ultrasound

“…Larger tumors usually develop a central fibrotic area, justifying the peripheral, rim-like arterial contrast uptake in larger tumors. 25 This was demonstrated in our study, as more than half of nodules larger than 2 cm displayed a peripheral enhancement compared to only one nodule of the four nodules smaller than 2 cm. Furthermore, in a recent published article that evaluated the ICC appearance on CEUS, the nodules smaller than 3 cm showed more frequently a complete, homogeneous arterial contrast uptake compared to larger nodules, 16 and this finding was also demonstrated by dynamic CT scan.…”

A Case of Castleman's Disease Mimicking a Hepatocellular Carcinoma: A Case Report and Review of Literature

“…11 Cholangiocarcinoma can also form a hypervascular mass, but is generally associated with biliary dilatation. 19 Malignant lesions such as lymphoma, metastasis, sarcoma, or malignant fibrous histiocytoma can be related to extrahepatic masses in the porta hepatis. However, while Castleman's disease frequently presents as a vascular mass, Castleman's disease masses usually show a lack of vascularity.…”

CT Evaluation of Disease Pattern in Hilar Cholangiocarcinoma

“…Hilar cholangiocarcinoma was first described by Klatskin [4]. It is categorized using Bismuth classification in to: On the basis of classification scheme proposed by Japanese Liver Cancer Group, cholangiocarcinomas are classified into three types according to macroscopic appearance of the tumor: mass forming, intraductal growing, and periductal infiltrating; the last type is more prevalent in the hilar portion of the biliary tree [8,9]. This classification is considered to be the most reasonable because it describes the gross appearance, growing characteristics and biologic behavior.…”