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Detection of Combined Hepatocellular and Cholangiocarcinomas on Enhanced CT: Comparison with Histologic Findings

¹ Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka 812-8582, Japan.
² Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku Fukuoka 812-8582, Japan.
³ Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku Fukuoka 812-8582, Japan.
⁴ Department of Radiology, Fukuoka City Hospital, Yoshizukahonmachi, Hikata-ku Fukuoka 812-0046, Japan.

View larger version (134K): [in a new window]   Fig. 1A. —62-year-old man with combined type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Early phase enhanced CT scan shows tumor, with diameter of 4.5 cm, is located in right lobe. Left-sided mass shows high attenuation, and right-sided component shows slightly high attenuation with irregular margin (arrow). Two components are in close contact.

View larger version (140K): [in a new window]   Fig. 1B. —62-year-old man with combined type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Delayed phase enhanced CT scan reveals that left-sided mass shows low attenuation with relatively clear margin and right-sided component shows slightly low attenuation (arrow); both components are recognized as HCC pattern components.

View larger version (129K): [in a new window]   Fig. 1C. —62-year-old man with combined type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Photograph shows macroscopic specimen. Inner part of tumor is yellowish mass with thin capsule and septum, representing HCC, and outside part is white and solid mass with necrosis (arrow), representing CC. In outside part, poorly differentiated adenocarcinoma cells grew in solid nest and focally glandular pattern with small amount of desmoplastic stroma.

View larger version (126K): [in a new window]   Fig. 2A. —48-year-old man with mixed type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Early phase enhanced CT scan shows tumor is mainly located in medial segment with diameter of 5 cm. Mass shows entirely low attenuation of central area with ring enhancement.

View larger version (129K): [in a new window]   Fig. 2B. —48-year-old man with mixed type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Delayed phase enhanced CT scan shows inner part of mass was gradually enhanced. Mass is recognized as CC pattern component.

View larger version (155K): [in a new window]   Fig. 2C. —48-year-old man with mixed type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Photomicrograph shows microscopic findings. Tumor is composed of intermediate polygonal cells arranged in solid nest with fibrous stroma.

View larger version (149K): [in a new window]   Fig. 3A. —73-year-old man with mixed type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Early phase enhanced CT scan shows tumor is located in right lobe with diameter of 3.5 cm. Left-sided main component shows high attenuation, and right-sided component under hepatic capsule shows low attenuation (arrow).

View larger version (158K): [in a new window]   Fig. 3B. —73-year-old man with mixed type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Delayed phase enhanced CT scan reveals left-sided component shows low attenuation with mild ring enhancement, and right-sided component shows low attenuation (arrow). These findings are recognized as HCC pattern component and CC pattern component, respectively.

View larger version (99K): [in a new window]   Fig. 3C. —73-year-old man with mixed type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Photograph shows macroscopic findings. Inner part of tumor is yellowish mass with partial necrosis and capsule, representing HCC, and outside part is white mass without expansion (arrow), representing CC. Enhancing patterns of two components were consistent with histologic findings.

View larger version (67K): [in a new window]   Fig. 4A. —43-year-old man with mixed type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Early phase enhanced CT scan shows lobulated tumor is located in lateral segment, with diameter of 6 cm. Mass shows slightly low attenuation.

View larger version (61K): [in a new window]   Fig. 4B. —43-year-old man with mixed type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Delayed phase enhanced CT scan reveals mass shows isoattenuation relative to that of noncancerous liver tissue. This mass is recognized as CC pattern component.

View larger version (77K): [in a new window]   Fig. 4C. —43-year-old man with mixed type of combined hepatocellular and cholangiocarcinomas (HCC-CCs). Photograph shows macroscopic specimen. Tumor is mainly composed of moderately differentiated HCC with abundant fibrous stroma. Although CC component, with diameter of 1.3 cm, exists within mass (arrow), we could not detect CC component on enhanced CT, probably because its enhancing pattern was similar to that of HCC component that occupied most of mass.

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