J Liver Cancer.  2020 Sep;20(2):173-176. 10.17998/jlc.20.2.173.

Rare Clinical and Radiologic Case of Cholangiocarcinoma Mimicking Pyogenic Abscess, Hepatic Echinococcal Cysts, and Metastases

• Lee SH
• Ryu SH
• Lee DH
• Yoon WE
• Park TY
• Lee HK
• Moon JS

• KMID: 2508030
• DOI: http://doi.org/10.17998/jlc.20.2.173

Abstract

Cholangiocarcinoma is a biliary carcinoma with a wide spectrum of imaging, histological, and clinical features. In immunocompromised patients, pyogenic abscesses are relatively common and an echinococcal hepatic cysts are very rare. The authors experienced a very rare case of cholangiocarcinoma showing multiple hypodense masses with wall enhancement mimicking pyogenic liver abscess, echinococcal hepatic cyst, and cystic metastases. An 83-year-old man, complaining of fatigue and poor oral intake, presented to our outpatient clinic. Abdominal computed tomography (CT) revealed multiple, variable-sized hypodense masses with peripheral rim enhancement throughout the liver. Dynamic liver magnetic resonance images also showed findings similar to those of a CT scan. We performed ultrasound-guided biopsy of the mass which revealed cholangiocarcinoma.

Keyword

Cholangiocarcinoma; Liver abscess; Echinococcus; Metastasis

Figure

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  Figure 1 Imaging of the patient. (A) Enhanced computed tomography imaging of the arterial phase shows multiple hypodense masses with cystic components centrally and thin rim of peripheral enhancement. (B) Dynamic liver magnetic resonance images imaging reveals multiple round lesions measuring up to 3.5 cm with peripheral rim enhancement in the entire liver.

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  Figure 2 Histopathologic findings of fine needle aspiration biopsy specimen from liver mass. (A, B) The photomicrograph of the hepatic needle biopsy reveals malignant large round to polygonal cell neoplasm, poorly differentiated, with massive hepatic parenchymal invasion. (C) The viable tumor cells exhibit adenocarcinomatous differentiation, with acinar trabecular or solid sheet pattern of growth, moderately dense desmoplastic stroma and multifocal intracytoplasmic to luminal mucin production (hematoxylin and eosin, ×200 [A, B]; Alcian blue staining, ×400 [C]).

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  Figure 3 Immunohistochemical findings of fine needle aspiration biopsy specimen. The tumor cells demonstrate immunohistochemical biliary differentiation, with immunoreactivities for carbohydrate antigen 19-9 (A, ×200) and cytokeratin 19 (B, ×200), together with adenocarcinomatous differentiation, with immunoreactivity for carcinoembryonic antigen (C, ×200).

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