Related Experiment Videos
Hepatocellular-cholangiocarcinoma: helical computed tomography findings in 30 patients
Osama Ebied1, Michael P Federle, Arye Blachar
1Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Insights
Hepatocellular-cholangiocarcinoma, a rare liver cancer, presents distinct computed tomography (CT) features. Recognizing these combined hepatocellular carcinoma and cholangiocarcinoma CT signs is crucial for accurate diagnosis and proper biopsy.
Area of Science:
- Hepatobiliary imaging
- Oncology
- Radiology
Background:
- Hepatocellular-cholangiocarcinoma (HCC-CCA) is a rare primary liver cancer.
- Distinguishing HCC-CCA from pure hepatocellular carcinoma or cholangiocarcinoma can be challenging.
- Accurate diagnosis is essential for appropriate patient management and treatment planning.
Purpose of the Study:
- To describe the characteristic findings of hepatocellular-cholangiocarcinoma on helical multiphasic computed tomography (CT).
- To correlate CT imaging features with known characteristics of both hepatocellular carcinoma and cholangiocarcinoma.
Main Methods:
- Retrospective analysis of helical multiphasic CT scans from 30 patients diagnosed with hepatocellular-cholangiocarcinoma.
- Evaluation of patient demographics, risk factors, symptoms, and serum tumor markers.
- Detailed assessment of tumor morphology, enhancement patterns, and associated findings like biliary obstruction and lymphadenopathy.
Main Results:
- The study included 30 patients, predominantly male (86%), with a mean age of 58 years.
- Helical CT revealed well-defined tumors with malignancy signs: hepatic hypervascularity (63%), biliary obstruction (17%), satellite lesions (40%), and lymphadenopathy (27%).
- Tumor enhancement patterns showed arterial phase hyperattenuation and delayed hypoattenuation, with some cases exhibiting capsular retraction, indicative of mixed HCC and CCA features.
Conclusions:
- Hepatocellular-cholangiocarcinoma should be suspected when a liver tumor displays CT features common to both hepatocellular carcinoma and cholangiocarcinoma.
- Radiologists must be aware of this entity to ensure adequate tissue sampling during biopsy for definitive diagnosis.
Objective:
To report the helical multiphasic computed tomography (CT) findings in 30 patients with hepatocellular-cholangiocarcinoma.
Method:
We evaluated age, gender, tumor risk factors, serum tumor markers, symptoms, and tumor morphology and enhancement on helical multiphasic CT in 30 patients.
Results:
Twenty-six of 30 patients (86%) were men. Patients had an age range of 27-78 years (mean = 58 years). Abdominal signs or symptoms were present in 21 of 30 patients, and 25 of 30 (83%) had chronic liver disease. Helical CT demonstrated a well-defined tumor in all patients with signs of malignancy such as hepatic hypervascularity (63%), biliary obstruction (17%), satellite lesions (40%), and lymphadenopathy (27%). Portions of the tumor were hyperattenuated on arterial-phase imaging and hypoattenuated on all other phases, whereas other portions showed delayed persistent enhancement, sometimes (27%) with hepatic capsular retraction, findings that have been reported to be characteristic of hepatocellular carcinoma and cholangiocarcinoma, respectively.
Conclusion:
The diagnosis of hepatocellular-cholangiocarcinoma should be considered when a hepatic tumor has CT features of both hepatocellular carcinoma and cholangiocarcinoma. Radiologists should be aware of this tumor type so that the biopsy is performed properly to allow sufficient tissue sampling.