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CT Features of Intraductal Intrahepatic Cholangiocarcinoma

Joon Woo Lee1, Joon Koo Han1, Tae Kyoung Kim1, Young Hoon Kim1, Byung Ihn Choi1, Man Chung Han1, Kyung Suk Suh2 and Sun Whe Kim2

1 Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, 110-744 Seoul, Korea.
2 Department of Surgery, Seoul National University College of Medicine, Chongno-gu, 110-744 Seoul, Korea.



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  		Fig. 1A. —Mucin-hypersecreting intrahepatic papillary cholangiocarcinoma in 48-year-old woman in whom disease was confirmed by left lobectomy. CT scan shows marked dilatation of intrahepatic duct in left lobe. Multiple intraductal papillary masses (arrows) are clearly seen along dilated bile duct.

 


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  		Fig. 1B. —Mucin-hypersecreting intrahepatic papillary cholangiocarcinoma in 48-year-old woman in whom disease was confirmed by left lobectomy. Endoscopic retrograde cholangiopancreatogram shows amorphous filling defect (arrows) in markedly dilated left hepatic duct. Peripheral left hepatic ducts are not opacified. Considering CT features, amorphous filling defect is formed by mucin pool rather than mass itself.

 


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  		Fig. 1C. —Mucin-hypersecreting intrahepatic papillary cholangiocarcinoma in 48-year-old woman in whom disease was confirmed by left lobectomy. Photograph shows papillary masses (arrows) and large amount of mucin seen in dilated duct at surgery.

 


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  		Fig. 2A. —Intraductal intrahepatic cholangiocarcinoma in 73-year-old man in whom disease was confirmed by left lateral segmentectomy. CT scan shows bile duct dilatation in left lateral segment and mass (arrowheads) in distal end of dilated duct.

 


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  		Fig. 2B. —Intraductal intrahepatic cholangiocarcinoma in 73-year-old man in whom disease was confirmed by left lateral segmentectomy. Gross specimen shows 1.5 x 0.8 cm intraductal mass (arrows) in dilated duct (arrowheads).

 


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  		Fig. 3. —Intraductal intrahepatic cholangiocarcinoma in 64-year-old man in whom disease was confirmed by left lobectomy. Preoperative diagnosis was hepatocellular carcinoma with bile duct invasion. In this case, pathology revealed intraductal mass in distal end of dilated duct with tumor casts in peripheral small ducts. CT scan shows low-attenuation mass (arrows) compared with hepatic parenchyma in distal end of dilated bile duct in left lateral segment. Increased attenuation (arrowheads) in duct compared with bile are also seen in peripheral ducts.

 


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  		Fig. 4. —Intraductal intrahepatic cholangiocarcinoma in 53-year-old man in whom disease was confirmed by left lateral segmentectomy. Gross specimen showed 0.5-cm polypoid intraductal mass in confluence of B2 and B3. CT scan shows bile duct dilatation (arrows) in left lateral segment but did not reveal mass.

 


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  		Fig. 5A. —Intraductal intrahepatic cholangiocarcinoma in 63-year-old woman in whom disease was confirmed by right lobectomy. CT scan shows dilated intrahepatic ducts (arrows) in anterior segment of right hepatic lobe. We could not find cause of ductal dilatation on CT.

 


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  		Fig. 5B. —Intraductal intrahepatic cholangiocarcinoma in 63-year-old woman in whom disease was confirmed by right lobectomy. Percutaneous transhepatic cholangiogram shows segmental narrowing (arrows) in distal B8 near bifurcation site. There are multiple small filling defects (arrowheads) in dilated peripheral ducts.

 


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  		Fig. 5C. —Intraductal intrahepatic cholangiocarcinoma in 63-year-old woman in whom disease was confirmed by right lobectomy. Photograph shows discernible mass (arrows) in distal B8 seen at surgery. According to pathologic records, tumor casts in peripheral small ducts were found.

 


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  		Fig. 6A. —Intraductal intrahepatic cholangiocarcinoma in 53-year-old man in whom disease was confirmed by right lobectomy. CT scan shows dilated bile duct (arrowheads) in segment VII of liver. Attenuation of bile duct is higher in right lobe than in left lobe.

 


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  		Fig. 6B. —Intraductal intrahepatic cholangiocarcinoma in 53-year-old man in whom disease was confirmed by right lobectomy. Photograph of gross pathology specimen shows granular, friable, and papillary masses (arrows) in dilated intrahepatic ducts.

 

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