Dynamic CT findings of cholangiolocellular carcinoma: correlation with angiography-assisted CT and histopathology (original) (raw)

Abstract

Objectives

To elucidate the dynamic CT features of pure type of cholangiolocellular carcinoma (pure CoCC) in comparison with those of cholangiocellular carcinoma (CCC) and to analyze their bases by angiography-assisted CT with histopathologic correlation.

Methods

Surgically confirmed 10 pure CoCCs, 10 CCCs and 7 mixed CoCC and CCCs from August 2001 to May 2012 were included in this study. Among them, dynamic CT features were compared. In 8 pure CoCCs, the correlative study between angiography-assisted CT and histopathological study was performed to clarify the basic mechanism of dynamic CT features.

Results

All pure CoCCs showed early and prolonged enhancement homogeneously or inhomogeneously and 8 of 10 pure CoCCs showed early peritumoral enhancement on dynamic CT. Time-attenuation curve provided by dynamic CT showed significant higher Hounsfield unit value of pure CoCC than those of CCC at each phases (p < 0.05). The depiction of peritumoral enhancement in CoCC was nearly simultaneous to tumor stain on dynamic CT during hepatic arteriography. Pathologic analysis revealed there were abundant communications between blood sinusoids of the tumor and intra and peritumoral portal venules and surrounding hepatic sinusoids.

Conclusion

Early tumoral staining and peritumoral enhancement due to early drainage from the tumor and prolonged enhancement are characteristic findings in pure CoCCs.

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Abbreviations

CoCC:

Cholangiolocellular carcinoma

CCC:

Cholangiocellular carcinoma

CTHA:

CT during hepatic arteriography

CTAP:

CT during arterial portography

References

  1. Kuwahara R, Kofman AV, Landis CS, et al. (2008) The hepatic stem cell niche: identification by label-retaining cell assay. Hepatology 47(6):1994–2002. doi:10.1002/hep.22218
    Article PubMed PubMed Central Google Scholar
  2. Komuta M, Spee B, Vander Borght S, et al. (2008) Clinicopathological study on cholangiolocellular carcinoma suggesting hepatic progenitor cell origin. Hepatology 47(5):1544–1556. doi:10.1002/hep.22238
    Article CAS PubMed Google Scholar
  3. Roskams T (2006) Liver stem cells and their implication in hepatocellular and cholangiocarcinoma. Oncogene 25(27):3818–3822. doi:10.1038/sj.onc.1209558
    Article CAS PubMed Google Scholar
  4. Kozaka K, Sasaki M, Fujii T, et al. (2007) A subgroup of intrahepatic cholangiocarcinoma with an infiltrating replacement growth pattern and a resemblance to reactive proliferating bile ductules: ‘bile ductular carcinoma’. Histopathology 51(3):390–400. doi:10.1111/j.1365-2559.2007.02735.x
    Article CAS PubMed Google Scholar
  5. Tickoo SK, Zee SY, Obiekwe S, et al. (2002) Combined hepatocellular-cholangiocarcinoma: a histopathologic, immunohistochemical, and in situ hybridization study. Am J Surg Pathol 26(8):989–997
    Article PubMed Google Scholar
  6. Fujii T, Zen Y, Harada K, et al. (2008) Participation of liver cancer stem/progenitor cells in tumorigenesis of scirrhous hepatocellular carcinoma–human and cell culture study. Hum Pathol 39(8):1185–1196. doi:10.1016/j.humpath.2007.12.010
    Article CAS PubMed Google Scholar
  7. Steiner PE, Higginson J (1959) Cholangiolocellular carcinoma of the liver. Cancer 12(4):753–759
    Article CAS PubMed Google Scholar
  8. Bosman T, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system. Lyon: International Agency for Research on Cancer
    Google Scholar
  9. Kondo F, Fukusato T (2015) Pathogenesis of cholangiolocellular carcinoma: possibility of an interlobular duct origin. Intern Med 54(14):1685–1694. doi:10.2169/internalmedicine.54.3540
    Article PubMed Google Scholar
  10. Aishima S, Oda Y (2015) Pathogenesis and classification of intrahepatic cholangiocarcinoma: different characters of perihilar large duct type versus peripheral small duct type. J Hepatobiliary Pancreat Sci 22(2):94–100. doi:10.1002/jhbp.154
    Article PubMed Google Scholar
  11. Sempoux C, Fan C, Singh P, et al. (2011) Intrahepatic cholangiocarcinoma: new insights in pathology. Semin Liver Dis 31(1):104–110. doi:10.1055/s-0031-1272838
    Article PubMed Google Scholar
  12. S-i Ariizumi, Kotera Y, Katagiri S, et al. (2014) Long-term survival of patients with cholangiolocellular carcinoma after curative hepatectomy. Ann Surg Oncol 21(3):451–458
    Google Scholar
  13. Nakanuma Y, Curado M-P, Franceschi S, et al. (2010) Intrahepatic cholangiocarcinoma. WHO classification of tumours of the digestive system, 4th edn. Geneva: World Health Organization
    Google Scholar
  14. Kitao A, Zen Y, Matsui O, Gabata T, Nakanuma Y (2009) Hepatocarcinogenesis: multistep changes of drainage vessels at CT during arterial portography and hepatic arteriography–radiologic-pathologic correlation. Radiology 252(2):605–614. doi:10.1148/radiol.2522081414
    Article PubMed Google Scholar
  15. Ueda K, Matsui O, Kawamori Y, et al. (1998) Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography. Radiology 206(1):161–166
    Article CAS PubMed Google Scholar
  16. Terayama N, Matsui O, Ueda K, et al. (2002) Peritumoral rim enhancement of liver metastasis: hemodynamics observed on single-level dynamic CT during hepatic arteriography and histopathologic correlation. J Comput Assist Tomogr 26(6):975–980
    Article PubMed Google Scholar
  17. Loyer EM, Chin H, DuBrow RA, et al. (1999) Hepatocellular carcinoma and intrahepatic peripheral cholangiocarcinoma: enhancement patterns with quadruple phase helical CT–a comparative study. Radiology 212(3):866–875
    Article CAS PubMed Google Scholar
  18. Motosugi U, Ichikawa T, Nakajima H, et al. (2009) Cholangiolocellular carcinoma of the liver: imaging findings. J Comput Assist Tomogr 33(5):682–688. doi:10.1097/RCT.0b013e318195400c
    Article PubMed Google Scholar
  19. Fukukura Y, Hamanoue M, Fujiyoshi F, et al. (2000) Cholangiolocellular carcinoma of the liver: CT and MR findings. J Comput Assist Tomogr 24(5):809–812
    Article CAS PubMed Google Scholar
  20. Kim SA, Lee JM, Lee KB, et al. (2011) Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern-correlation with clinicopathologic findings. Radiology 260(1):148–157. doi:10.1148/radiol.11101777
    Article PubMed Google Scholar
  21. Honda H, Onitsuka H, Yasumori K, et al. (1993) Intrahepatic peripheral cholangiocarcinoma: two-phased dynamic incremental CT and pathologic correlation. J Comput Assist Tomogr 17(3):397–402
    Article CAS PubMed Google Scholar
  22. Yoshida Y, Imai Y, Murakami T, et al. (1999) Intrahepatic cholangiocarcinoma with marked hypervascularity. Abdom Imaging 24(1):66–68
    Article CAS PubMed Google Scholar
  23. Kim SJ, Lee JM, Han JK, et al. (2007) Peripheral mass-forming cholangiocarcinoma in cirrhotic liver. AJR Am J Roentgenol 189(6):1428–1434. doi:10.2214/AJR.07.2484
    Article PubMed Google Scholar
  24. Ariizumi SI, Kotera Y, Takahashi Y, et al. (2011) Mass-forming intrahepatic cholangiocarcinoma with marked enhancement on arterial-phase computed tomography reflects favorable surgical outcomes. J Surg Oncol 104(2):130–139
    Article PubMed Google Scholar
  25. Asayama Y, Tajima T, Okamoto D, et al. (2009) Imaging of cholangiolocellular carcinoma of the liver. Eur J Radiol. doi:10.1016/j.ejrad.2009.09.010
    Google Scholar
  26. Matsui O, Takashima T, Kadoya M, et al. (1984) Segmental staining on hepatic arteriography as a sign of intrahepatic portal vein obstruction. Radiology 152(3):601–606
    Article CAS PubMed Google Scholar
  27. Itai Y, Matsui O (1997) Blood flow and liver imaging. Radiology 202(2):306–314
    Article CAS PubMed Google Scholar

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Acknowledgments

We are indebted to Kunikazu Saikawa, CT, Nobuyuki Matsushita, CT, and Hiroko Ikeda, CT for their technical support in preparation of the histologic sections. We thank John Gelblum for the assistance in preparing the manuscript.

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Authors and Affiliations

  1. Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
    Kazuto Kozaka, Osamu Matsui, Satoshi Kobayashi, Wataru Koda, Tetsuya Minami, Azusa Kitao, Dai Inoue, Norihide Yoneda, Kotaro Yoshida, Fumihito Toshima & Toshifumi Gabata
  2. Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan
    Yasuni Nakanuma

Authors

  1. Kazuto Kozaka
  2. Osamu Matsui
  3. Satoshi Kobayashi
  4. Wataru Koda
  5. Tetsuya Minami
  6. Azusa Kitao
  7. Dai Inoue
  8. Norihide Yoneda
  9. Kotaro Yoshida
  10. Fumihito Toshima
  11. Yasuni Nakanuma
  12. Toshifumi Gabata

Corresponding author

Correspondence toKazuto Kozaka.

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Funding

This study has received funding by a Grant-in-Aid for Science Research [24791283] from the Ministry of Education, Culture, Sports, Science and Technology.

Conflict of Interest

All authors declare that they have no conflict of interest.

Ethical approval

Our institutional review board approved this retrospective study and waived the requirement for informed consent.

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Kozaka, K., Matsui, O., Kobayashi, S. et al. Dynamic CT findings of cholangiolocellular carcinoma: correlation with angiography-assisted CT and histopathology.Abdom Radiol 42, 861–869 (2017). https://doi.org/10.1007/s00261-016-0944-z

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