Learning objectives
To understand that cholangiocarcinomas have different imaging appearances depending on the location in the biliary tree.
To recognize the different biologic behaviours of this tumor,
as mass forming,
periductal or intraductal.
To illustrate this with cases from our institution.
Show some of the mimics of this tumor that can lead to misdiagnosis.
Background
Cholangiocarcinoma is an adenocarcinomaand can arise anywhere on the biliary tree.
Besides the location in the biliary tree,
it can also behave in different ways.
Because of this many classifications have been proposed,
being the one from the Liver Cancer Study Group of Japan the one we are going to use for this EPOS.
This tumor can be classifiedbased onthe location on the biliary tree as Intrahepatic and extrahepatic,
being the intrahepatic further divided in peripheric and hilar,
from beyond second order bile ducts.
Based...
Findings and procedure details
Intrahepatic peripheric mass formingcholangiocarcinoma:
These tumors are usually found when symptomatic as large masses,
causing biliar obstruction,
proximal biliar dilation andcapsular retraction.
Hystologically,theyhave a large desmoplastic component,
which is accountable for the enhancement pattern,
irregular peripheric on arterial phase and centripetal enhancement on delayed phase images.
Mass forming cholangiocarcinoma can present as ahypodense nodules on basal CT (Fig.
3) on MRI,it had hyperintensity on T2 (fig.
4),
and had contrastirregular rim earlyenhancement (fig.
5) and centripetal delayed phases contrast persistence (fig.
6-7).
Cholangiocarcinoma can also...
Conclusion
The cholangiocarcinoma can present in different ways,
and these different types have varied imaging features,
like a mass,
periductal infiltration or intraductal growth,that we must keep in mind in order to give a more accurate differential diagnosis to the clinician.
Sonography is usually the first imaging technique that suggests this diagnosis,
and theaccuracy of this technique depends on the type of cholangiocarcinoma,
we can find bile duct dilation,
either extrahepatic,
intrahepatic or segmentary,
a liver mass or a bile duct dilation with castlike content.
Contrast...
References
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Kim MJ,
Park YN,
et al.
Varyingappearances of cholangiocarcinoma: radiologic pathologiccorrelation.RadioGraphics2009;29(3):683–700.
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4th ed.
Tokyo: Kanehara,
2000
Jae Hoon Lim,
Cholangiocarcinoma:Morphologic Classification According to Growth Pattern and Imaging Findings,American Journal of Roentgenology.
2003;181: 819-827
Joon Koo Han,
et al,
Cholangiocarcinoma: Pictorial essay of CT and Cholangiographic Findings.
Radiographics 2002;22:173-187