Contrast-enhanced ultrasonography appearances of intrahepatic peripheral cholangiocarcinoma / 中华超声影像学杂志

Objective To investigate the contrast-enhanced ultrasonography appearances characteristics of intrahepatic peripheral cholangiocarcinoma( ICC) and to improve the diagnosis level of ICC on contrast-enhanced ultrasonography . Methods Thirty cases with ICC confirmed by pathological examinations of surgeries were retrospectively analyzed for findings of ultrasonography , clinic and pathology ,to explore the typical contrast-enhanced ultrasonography appearances and the correlation with pathological differentiation . ResultsOn contrast-enhanced ultrasonography , 30 lesions showed enhancement on the arterial phase and appeared hypo-echoic enhancement on the portal phase ,which displayed fast-in and fast-out" enhancement pattern . During the hepatic arterial phase of contrast-enhanced ultrasonography ,10 lesions showed peripheral enhancement ,10 lesions showed relatively homogeneous hyper-enhancement ,6 lesions showed heterogeneous enhancement ,2 lesions showed iso-enhancement ,and 2 lesions showed hypo-enhancement . To the 30 lesions ,the average initial time of enhancement was ( 18 .81 ± 4 .66)s (12 －28 s) ,the average time of washing-out was (36 .00 ± 12 .30) s (18 －60 s) . There was no significant difference in time of washing-in and washing-out among different pathological differentiation groups ( P＞0 .05) . Conclusions ICC often shows fast-in and fast-out" enhancement pattern on contrast-enhanced ultrasonography ,and the time of washing-out is generally in late arterial phase or early portal phase ,but there is no significant difference in time of washing-in and washing-out among different pathological differentiation groups .

A Clinical Review for Resected Intrahepatic Cholangiocarcinoma / 한국간담췌외과학회지

BACKGROUND/AIMS: An intrahepatic cholangiocarcinoma, which has been defined as a primary adenocarcinoma from the intrahepatic bile duct to the second-order branch of the main hepatic duct, has a poor prognosis due to late diagnosis and low resectability. The purpose of this study is to define the prognostic factors that affected the survival of patients. METHODS: To evaluate the clinical manifestation and pathologic characteristics and the value of surgical management in relation to survival, we retrospectively reviewed the clinical records of 37 patients with an intrahepatic cholangiocarcinoma who had been underwent hepatic resection at the department of surgery, Hanyang University Hospital from April 1986 to April 2001. Cumulative survival rate and clinicopa-thologic factors that may influence the prognosis were analyzed statistically. Statistical significance was calculated by the Kaplan-Meier and compared by log rank test with statistical significance defined as p<0.05. RESULTS: The median survival time of the patients was 24.6 months (mean, 23.97 months), with 2 and 3-year survival rates of 33.3% and 27.3%, respectively. Univariate analysis showed that TMN stage and gross type correlated significantly with prognosis. Age, sex, tumor marker, Clonorchis Sinensis, intrahepatic duct stone and cell differentiation were not significantly correlated with prognosis. CONCLUSION: In case of the intrahepatic cholangiocarcinoma, without surgical treatment, survival time is not longer than mean 6 months from the first diagnosis. According to this study, we strongly recommend to early diagnosis and proper hepatic resection with lymph node dissection, be recommended to raise the long-term survival rate and improve the quality of life.

A Clinical Review for Peripheral Cholangiocarcinoma

PURPOSE: A peripheral cholangiocarcinoma, which has been defined as a primary adenocarcinoma from the intrahepatic bile ducts proximal to the second-order branch of the main hepatic duct, has a poor prognosis against various treatment modalities. We analyzed the clinical characteristics of peripheral cholangiocarcinomas and evaluated the outcomes of surgical treatment. METHODS: A retrospective study of 46 peripheral cholangiocarcinoma cases for which surgical exploration was performed at the Asan Medical Center over a 7-year period was conducted. RESULTS: Clinical manifestations on admission were abdominal pain including epigastric pain (89%), weight loss (33%), fever (28%), jaundice (24%), a palpable mass (20%), and general weakness (11%). Associated diseases were hepatolithiasis in 54.3% and clonorchiasis in 9%. Positive findings showing a hepatic mass were found in 75% of the cases by using computed tomography and in 52% of the cases by using ultrasonography. Angiographic hypervascularity was seen in 17.4% of the cases and hypovascularity in 82.6%. The gross morphologic types of the peripheral cholangiocarcinomas were mass-forming (74%), periductal infiltrative (17%), and intraductal growing (17%). Nodal metastasis was found in 48% of the patients. The location of the peripheral cholangiocarcinoma was the left lobe (54%), the right lobe (35%), the caudate lobe (4%) and both lobes (6%). Of the 46 patients, 29 underwent a hepatic resection from the lateral segmentectomy to the right trisegmentectomy, and 17 cases underwent palliative surgery. The 1-year and 2-year survival rates of the hepatic-resection cases were 62% and 50%, respectively. The 1-year and 2-year survival rates of the palliative-surgery cases were 32% and 21%, respectively univariate analysis showed that tumor size, growth pattern, nodal metastasis, the extent of the hepatic resection, and node dissection did not significantly affect the survival of the patients. CONCLUSIONS: Careful preoperative evaluation using computed tomography, ultrasonography, and angiography and a study of tumor markers for the possibility of a peripheral cholangiocarcinoma is necessary in risk groups with hepatolithiasis or clonorchiasis. Hepatic resection should be used in hepatolithiasis patients to improve the chance of survival.

Intraductal Variant of Peripheral Cholangiocarcinoma of the Liver A report of three cases

Intraductal variant of peripheral cholangiocarcinoma is extremely rare. This variant shows intraductal growth and intraluminal extension without any infiltrative growth. The mode of intraductal growth is not known. The prognosis of this variant is better than that of usual cholangiocarcinoma. We report three cases, one of which is associated with Clonorchis sinensis (CS) infection. The tumors were entirely confined within the dilated peripheral tributaries of the intrahepatic bile duct. Microscopically, the tumors were well to moderately well differentiated, with a papillary or a micropapillary growth pattern. Focal clear cytoplasmic change and mucin production were noted. The tumors showed intraductal spreading without any invasion to the liver parenchyme. Mucosal hyperplasia and dysplasia were noted in the adjacent ducts. The authors assume that intraductal cholangiocarcinoma is a distinct subtype, and persistent irritation, such as, CS infection may undergo a malignant transformation through mucosal dysplasia.

Peripheral Cholangicoarcinoma

Peripheral cholangiocarcinoma (PCC) is defined as a malignancy of intrahepatic bile duct presenting as a focal liver mass, specifically, those located peripheral to the 2nd-order branchings of the bile duct. During the study period of 11 years from Jan. 1985 through Dec. 1995, a total of 12 patients underwent liver resection for PCC at the Department of Surgery, Inje University Paik Hospital, Seoul. This figure accounts for 8.3% of primary liver cancer. There were 9 men and 3 women with a ratio of 3:1, the mean age was 53.3 years with a range of 39 to 67 years. Twenty-five per cent of the patients had concomitant intrahepatic stone (IHS). HBsAg was positive in one case (8.3%) who had chronic hepatitis. No patient had liver cirrhosis. The accurate preoperative diagnosis of PCC in 3 cases was difficult because of the association with IHS. These 3 patients underwent surgery under the diagnosis of chronic cholangitis rather than PCC. CEA and CA 19-9 were elevated in 70% and 50% of the patients, respectively. In most cases concomitant measurement of CEA and AFP facilitated the differentiation between PCC and hepatocellular carcinoma. As to the tumor characteristics, 83% of the patients had tumors greater than 5 cm in diameter, indicating the advanced stage of the tumor at the time of resection. The site of origin of tumor mass was distributed more or less evenly between the hepatic lobes. The patients with mass-forming, expanding type of tumors made up 58% of the cases, infiltrating type 25%, and the remainder being the combination of both. A significant number of patients, 27%, had nodal metastasis. Two thirds of the patients underwent major hepatic resections. Segmentectomies here include the resection of lateral segment done as a treatment for IHS, which later proved to be cancer on histologic examination. There was no operative death among the 12 patients. The overall median survival time was 12 months. The overall survival rates at 1, 3, and 5 years were 42.4%, 42.4%, and 42.4%, respectively. Only the radicality of the resection was the statistically significant risk factor for survival by univariate analysis. The 5-year survival rate was 100% in 6 patients who had curative resection (no lymph node invasion, no peritoneal seeding, clear resection margin). The prognosis of patients with advanced PCC is unfavorable unless the tumor is entirely removed. In view of the association of IHS in a significant portion of the cases, the possible coexistence of the carcinoma should always be borne in mind when dealing with patients with IHS.