J Korean Soc Radiol.  2012 May;66(5):443-450. 10.3348/jksr.2012.66.5.443.

Three-Phase CT Findings of Combined Hepatocellular and Cholangiocarcinomas

• Lee JE
• Cho JS
• Shin KS
• Ohm JY
• Kang DY

• KMID: 1439447
• DOI: http://doi.org/10.3348/jksr.2012.66.5.443

Abstract

PURPOSE
To evaluate three-phase CT findings of combined hepatocellular and cholangiocarcinomas (cHCC-CCs), with an emphasis on the enhancement pattern.
MATERIALS AND METHODS
We retrospectively analyzed CT findings in 11 patients with histopathologically proven 11 cHCC-CCs. Three-phase CT findings of cHCC-CCs during the arterial phase (AP), portal venous phase (PVP), and equilibrium phase (EP) were evaluated, based on the morphologic and enhancement pattern.
RESULTS
Two (18%) of all the tumors showed arterial enhancement during the AP and delayed washout during the PVP and EP. Three tumors (27%) showed no arterial enhancement and delayed washout or delayed enhancement during the same phases. The remaining six tumors (55%) showed both arterial enhancement and delayed enhancement during the same phases.
CONCLUSION
Three-phase CT findings of cHCC-CCs were found to be variable, according to the histologic proportion of HCC or CC components. However, cHCC-CC could be considered when a tumor shows both arterial enhancement and delayed enhancement at three-phase CT.

MeSH Terms

Carcinoma, Hepatocellular
Cholangiocarcinoma
Humans
Retrospective Studies

Reference

1. Ozyilkan E, Ozyilkan O, Firat D, Telatar H. Hepatitis C virus antibody in patients with primary liver cancer (hepatocellular carcinoma, cholangiocarcinoma, and combined hepatocellular-cholangiocarcinoma) in Japan. Cancer. 1994. 73:2002–2003.

2. Yano Y, Yamamoto J, Kosuge T, Sakamoto Y, Yamasaki S, Shimada K, et al. Combined hepatocellular and cholangiocarcinoma: a clinicopathologic study of 26 resected cases. Jpn J Clin Oncol. 2003. 33:283–287.

3. Allen RA, Lisa JR. Combined liver cell and bile duct carcinoma. Am J Pathol. 1949. 25:647–655.

4. Jarnagin WR, Weber S, Tickoo SK, Koea JB, Obiekwe S, Fong Y, et al. Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors. Cancer. 2002. 94:2040–2046.

5. Yeh MM. Pathology of combined hepatocellular-cholangiocarcinoma. J Gastroenterol Hepatol. 2010. 25:1485–1492.

6. Goodman ZD, Ishak KG, Langloss JM, Sesterhenn IA, Rabin L. Combined hepatocellular-cholangiocarcinoma. A histologic and immunohistochemical study. Cancer. 1985. 55:124–135.

7. Taguchi J, Nakashima O, Tanaka M, Hisaka T, Takazawa T, Kojiro M. A clinicopathological study on combined hepatocellular and cholangiocarcinoma. J Gastroenterol Hepatol. 1996. 11:758–764.

8. Theise ND, Nakashima O, Park YN, Nakanuma Y. Bosman FT, Garneiro F, Hruban RH, Theise ND, editors. Combined hepatocellular-cholangiocarcinoma. WHO classification of tumours of the digestive system. 2010. 4th ed. Lyon: IARC Press;225–227.

9. Kim KH, Lee SG, Park EH, Hwang S, Ahn CS, Moon DB, et al. Surgical treatments and prognoses of patients with combined hepatocellular carcinoma and cholangiocarcinoma. Ann Surg Oncol. 2009. 16:623–629.

10. Zuo HQ, Yan LN, Zeng Y, Yang JY, Luo HZ, Liu JW, et al. Clinicopathological characteristics of 15 patients with combined hepatocellular carcinoma and cholangiocarcinoma. Hepatobiliary Pancreat Dis Int. 2007. 6:161–165.

11. Lee JH, Chung GE, Yu SJ, Hwang SY, Kim JS, Kim HY, et al. Long-term prognosis of combined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinoma and cholangiocarcinoma. J Clin Gastroenterol. 2011. 45:69–75.

12. Nishie A, Yoshimitsu K, Asayama Y, Irie H, Aibe H, Tajima T, et al. Detection of combined hepatocellular and cholangiocarcinomas on enhanced CT: comparison with histologic findings. AJR Am J Roentgenol. 2005. 184:1157–1162.

13. Choi BI, Han JK, Kim YI, Kim HC, Park JH, Kim CW, et al. Combined hepatocellular and cholangiocarcinoma of the liver: sonography, CT, angiography, and iodized-oil CT with pathologic correlation. Abdom Imaging. 1994. 19:43–46.

14. Sanada Y, Shiozaki S, Aoki H, Takakura N, Yoshida K, Yamaguchi Y. A clinical study of 11 cases of combined hepatocellular-cholangiocarcinoma Assessment of enhancement patterns on dynamics computed tomography before resection. Hepatol Res. 2005. 32:185–195.

15. Aoki K, Takayasu K, Kawano T, Muramatsu Y, Moriyama N, Wakao F, et al. Combined hepatocellular carcinoma and cholangiocarcinoma: clinical features and computed tomographic findings. Hepatology. 1993. 18:1090–1095.

16. Ebied O, Federle MP, Blachar A, Brancatelli G, Grazioli L, Cazals-Hatem D, et al. Hepatocellular-cholangiocarcinoma: helical computed tomography findings in 30 patients. J Comput Assist Tomogr. 2003. 27:117–124.

17. Fukukura Y, Taguchi J, Nakashima O, Wada Y, Kojiro M. Combined hepatocellular and cholangiocarcinoma: correlation between CT findings and clinicopathological features. J Comput Assist Tomogr. 1997. 21:52–58.

18. Kassahun WT, Hauss J. Management of combined hepatocellular and cholangiocarcinoma. Int J Clin Pract. 2008. 62:1271–1278.

19. Liver Cancer Study Group of Japan. Survey and follow-up study of primary liver cancer in Japan. Report 13. Acta Hepatol Jpn. 1999. 40:288–300.

20. Chantajitr S, Wilasrusmee C, Lertsitichai P, Phromsopha N. Combined hepatocellular and cholangiocarcinoma: clinical features and prognostic study in a Thai population. J Hepatobiliary Pancreat Surg. 2006. 13:537–542.

21. Kim SA, Lee JM, Lee KB, Kim SH, Yoon SH, Han JK, et al. Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern--correlation with clinicopathologic findings. Radiology. 2011. 260:148–157.

22. Lim JH. Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol. 2003. 181:819–827.

23. Chung YE, Park MS, Park YN, Lee HJ, Seok JY, Yu JS, et al. Hepatocellular carcinoma variants: radiologic-pathologic correlation. AJR Am J Roentgenol. 2009. 193:W7–W13.

24. Yamashita Y, Fan ZM, Yamamoto H, Matsukawa T, Arakawa A, Miyazaki T, et al. Sclerosing hepatocellular carcinoma: radiologic findings. Abdom Imaging. 1993. 18:347–351.

25. Lee JW, Han JK, Kim TK, Kim YH, Choi BI, Han MC, et al. CT features of intraductal intrahepatic cholangiocarcinoma. AJR Am J Roentgenol. 2000. 175:721–725.