Published in:
01-09-2004 | Original article
Intrahepatic intraductal cholangiocarcinoma
Published in: Abdominal Radiology | Issue 5/2004
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Most intrahepatic peripheral cholangiocarcinomas (PCCs) develop in the small peripheral bile ducts and grow in a nodular (mass-forming) or a diffuse (infiltrating) pattern [1,2,3,4,5,6,7]. In some cases, polypoid or papillary cholangiocarcinomas arise from the peripheral duct, and tumor growth is confined to within the bile duct. These tumors form tumor casts along the peripheral tributaries of the bile duct (upstream ducts). This type of tumor is referred to as an intraductal variant of PCC [2, 8, 9, 10, 11] or intraductal-growing cholangiocarcinoma by the Liver Cancer Study Group of Japan [12]. Unlike ordinary PCCs, this tumor has an indolent biologic behavior and a better prognosis [11]. However, if undetected at an early stage and left untreated, the tumor may invade the surrounding hepatic parenchyma. For advanced stage tumors, it might be difficult to differentiate the mass-forming type from the advanced intraductal-growing type with stromal invasion [13, 14] (Figs. 1, 2, 3). Therefore, early detection and a correct preoperative diagnosis are important when preparing a treatment plan [2, 10]. In our hospital, this tumor comprises about 15% of all surgically resected PCCs [11].
Fig. 1.
A 64-year-old man with intraductal cholangiocarcinomas and tumor cast in the bile duct. A CT shows low-attenuation mass (arrows) in the distal end of a dilated bile duct in the left lateral segment; increased attenuation (arrowheads) is present in the peripheral ducts. Reprinted from [11]. B US demonstrates low-echoic masses (arrows) in dilated bile ducts. In this case, pathology showed an intraductal mass in the distal end of the dilated duct with tumor casts in peripheral ducts.
Fig. 2.
A 53-year-old woman with combined mass-forming and intraductal-growth cholangiocarcinoma. A CT depicts intraductal polypoid masses along the dilated bile duct wall (arrows). B CT depicts a large mass in the left hepatic lobe. C Coronal T2-weighted MR displays intraductal and extraductal mass components (arrows). D Resected specimen shows a 5-cm well-defined mass attached to the left hepatic duct. Microscopically, the mass showed infiltrative growth into the hepatic parenchyma. Scale increments = 1 cm. E Cross section of the dilated duct contains papillary intraductal tumors (arrows).
Fig. 3.
A 78-year-old man with combined intraductal-growth and mass-forming cholangiocarcinoma. A CT shows two low-attenuation masses in segments III and VII of the liver. Note mild ductal dilatation adjacent to the tumors (arrows) Reprinted from [13]. B Microphotograph displays the confinement of tumors within the bile duct (arrows). Only focal areas of stromal invasion were noted (not shown). Hematoxylin and eosin; original magnification, 4×.
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