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Song Z, Lin S, Wu X, Ren X, Wu Y, Wen H, Qian B, Lin H, Huang Y, Zhao C, Wang N, Huang Y, Peng B, Li X, Peng H, Shen S. Hepatitis B virus-related intrahepatic cholangiocarcinoma originates from hepatocytes. Hepatol Int 2023; 17:1300-1317. [PMID: 37368186 PMCID: PMC10522522 DOI: 10.1007/s12072-023-10556-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/27/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is one of the most common risk factors for intrahepatic cholangiocarcinoma (ICC). However, there is no direct evidence of a causal relationship between HBV infection and ICC. In this study, we attempted to prove that ICC may originate from hepatocytes through a pathological study involving ICC tissue-derived organoids. METHOD The medical records and tumor tissue samples of 182 patients with ICC after hepatectomy were collected. The medical records of 182 patients with ICC were retrospectively analyzed to explore the prognostic factors. A microarray of 182 cases of ICC tumor tissue and 6 cases of normal liver tissue was made, and HBsAg was stained by immunohistochemistry (IHC) to explore the factors closely related to HBV infection. Fresh ICC tissues and corresponding adjacent tissues were collected to make paraffin sections and organoids. Immunofluorescence (IF) staining of factors including HBsAg, CK19, CK7, Hep-Par1 and Albumin (ALB) was performed on both fresh tissues and organoids. In addition, we collected adjacent nontumor tissues of 6 patients with HBV (+) ICC, from which biliary duct tissue and normal liver tissue were isolated and RNA was extracted respectively for quantitative PCR assay. In addition, the expression of HBV-DNA in organoid culture medium was detected by quantitative PCR and PCR electrophoresis. RESULTS A total of 74 of 182 ICC patients were HBsAg positive (40.66%, 74/182). The disease-free survival (DFS) rate of HBsAg (+) ICC patients was significantly lower than that of HBsAg (-) ICC patients (p = 0.0137). IF and IHC showed that HBsAg staining was only visible in HBV (+) ICC fresh tissues and organoids, HBsAg expression was negative in bile duct cells in the portal area. Quantitative PCR assay has shown that the expression of HBs antigen and HBx in normal hepatocytes were significantly higher than that in bile duct epithelial cells. Combined with the IF and IHC staining, it was confirmed that HBV does not infect normal bile duct epithelial cells. In addition, IF also showed that the staining of bile duct markers CK19 and CK7 were only visible in ICC fresh tissue and organoids, and the staining of hepatocyte markers Hep-Par1 and ALB was only visible in normal liver tissue fresh tissue. Real-time PCR and WB had the same results. High levels of HBV-DNA were detected in the culture medium of HBV (+) organoids but not in the culture medium of HBV (-) organoids. CONCLUSION HBV-related ICC might be derived from hepatocytes. HBV (+) ICC patients had shorter DFS than HBV (-) ICC patients.
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Affiliation(s)
- Zimin Song
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China
| | - Shuirong Lin
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China
| | - Xiwen Wu
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China
- Department of Clinical Nutrition, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xiaoxue Ren
- Department of Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China
| | - Yifan Wu
- Department of Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China
| | - Haoxiang Wen
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China
| | - Baifeng Qian
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China
| | - Haozhong Lin
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China
| | - Yihao Huang
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China
| | - Chenfeng Zhao
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China
| | - Nian Wang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510030, China
| | - Yan Huang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510030, China
| | - Baogang Peng
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China
| | - Xiaoxing Li
- Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China.
| | - Hong Peng
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China.
| | - Shunli Shen
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510030, China.
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Honda T, Onishi H, Fukui H, Yano K, Kiso K, Nakamoto A, Tsuboyama T, Ota T, Tatsumi M, Tahara S, Kobayashi S, Eguchi H, Tomiyama N. Extracellular volume fraction using contrast-enhanced CT is useful in differentiating intrahepatic cholangiocellular carcinoma from hepatocellular carcinoma. Front Oncol 2023; 13:1214977. [PMID: 37483497 PMCID: PMC10359704 DOI: 10.3389/fonc.2023.1214977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Objectives To evaluate whether tumor extracellular volume fraction (fECV) on contrast-enhanced computed tomography (CT) aids in the differentiation between intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC). Methods In this retrospective study, 113 patients with pathologically confirmed ICC (n = 39) or HCC (n = 74) who had undergone preoperative contrast-enhanced CT were enrolled. Enhancement values of the tumor (Etumor) and aorta (Eaorta) were obtained in the precontrast and equilibrium phase CT images. fECV was calculated using the following equation: fECV [%] = Etumor/Eaorta × (100 - hematocrit [%]). fECV values were compared between the ICC and HCC groups using Welch's t-test. The diagnostic performance of fECV for differentiating ICC and HCC was assessed using receiver-operating characteristic (ROC) analysis. fECV and the CT imaging features of tumors were evaluated by two radiologists. Multivariate logistic regression analysis was performed to identify factors predicting a diagnosis of ICC. Results Mean fECV was significantly higher in ICCs (43.8% ± 13.2%) than that in HCCs (31.6% ± 9.0%, p < 0.001). The area under the curve for differentiating ICC from HCC was 0.763 when the cutoff value of fECV was 41.5%. The multivariate analysis identified fECV (unit OR: 1.10; 95% CI: 1.01-1.21; p < 0.05), peripheral rim enhancement during the arterial phase (OR: 17.0; 95% CI: 1.29-225; p < 0.05), and absence of washout pattern (OR: 235; 95% CI: 14.03-3933; p < 0.001) as independent CT features for differentiating between the two tumor types. Conclusions A high value of fECV, peripheral rim enhancement during the arterial phase, and absence of washout pattern were independent factors in the differentiation of ICC from HCC.
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Affiliation(s)
- T. Honda
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - H. Onishi
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - H. Fukui
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - K. Yano
- Department of Radiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - K. Kiso
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - A. Nakamoto
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - T. Tsuboyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - T. Ota
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - M. Tatsumi
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - S. Tahara
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - S. Kobayashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - H. Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - N. Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
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Sun D, Xu Z, Cao S, Wu H, Lu M, Xu Q, Wang K, Ji G. Imaging features based on CT and MRI for predicting prognosis of patients with intrahepatic cholangiocarcinoma: a single-center study and meta-analysis. Cancer Imaging 2023; 23:56. [PMID: 37287062 DOI: 10.1186/s40644-023-00576-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND To evaluate the prognostic role of imaging features based on CT and MRI in intrahepatic cholangiocarcinoma (ICC). METHODS Two hundred and four patients from a single-center database who underwent radical ICC surgery from 2010 to 2019 were enrolled in the study. Cox proportional hazard model was used for survival analysis of imaging features. A meta-analysis was performed to determine imaging features that predict overall survival (OS) and event-free survival (EFS) in ICC. RESULTS In the CT group of the retrospective cohort, tumor multiplicity, infiltrative tumor margin, lymph node metastasis, enhancement pattern in hepatic arterial phase and tumor necrosis correlated with poorer EFS and OS; moreover, enhancing capsules, high carcinoembryonic antigen levels contributed to poor OS. In the MRI group, tumor multiplicity and enhancement pattern were prognostic factors for OS; tumor multiplicity and enhancement pattern resulted in poor EFS. A total of 13 articles containing 1822 patients with ICC were enrolled in the adjusted hazard ratios meta-analysis. The results showed that enhancement pattern and infiltrative tumor margin were predictors of OS and EFS, whereas bile duct invasion was a predictor of OS. CONCLUSIONS Arterial enhancement patterns and tumor margin status were associated with both OS and EFS of ICC patients following resection.
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Affiliation(s)
- Dongwei Sun
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, 300 Guangzhou RoadJiangsu Province, Nanjing, People's Republic of China
| | - Zhenggang Xu
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, 300 Guangzhou RoadJiangsu Province, Nanjing, People's Republic of China
| | - Shuya Cao
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, 300 Guangzhou RoadJiangsu Province, Nanjing, People's Republic of China
| | - Huaiyu Wu
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, 300 Guangzhou RoadJiangsu Province, Nanjing, People's Republic of China
| | - Ming Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu Province, China
| | - Qing Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu Province, China
| | - Ke Wang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China.
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China.
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, 300 Guangzhou RoadJiangsu Province, Nanjing, People's Republic of China.
| | - Guwei Ji
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China.
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China.
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, 300 Guangzhou RoadJiangsu Province, Nanjing, People's Republic of China.
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Savino MS, Cavinato L, Costa G, Fiz F, Torzilli G, Vigano L, Ieva F. Distant supervision for imaging-based cancer sub-typing in Intrahepatic Cholangiocarcinoma. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1032-1035. [PMID: 36086172 DOI: 10.1109/embc48229.2022.9871262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Finding effective ways to perform cancer sub-typing is currently a trending research topic for therapy opti-mization and personalized medicine. Stemming from genomic field, several algorithms have been proposed. In the context of texture analysis, limited efforts have been attempted, yet imaging information is known to entail useful knowledge for clinical practice. We propose a distant supervision model for imaging-based cancer sub-typing in Intrahepatic Cholangiocar-cinoma patients. A clinically informed stratification of patients is built and homogeneous groups of patients are characterized in terms of survival probabilities, qualitative cancer variables and radiomic feature description. Moreover, the contributions of the information derived from the ICC area and from the peri tumoral area are evaluated. The findings suggest the reliability of the proposed model in the context of cancer research and testify the importance of accounting for data coming from both the tumour and the tumour-tissue interface. Clinical relevance - In order to accurately predict cancer prognosis for patients affected by ICC, radiomic variables of both core cancer and surrounding area should be exploited and employed in a model able to manage complex information.
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Panettieri E, Maki H, Kim BJ, Kang HC, Cox V, Vega EA, Mizuno T, Pant S, Javle M, Vauthey JN, Kawaguchi Y. Arterial enhancement pattern predicts survival in patients with resectable and unresectable intrahepatic cholangiocarcinoma. Surg Oncol 2022; 40:101696. [PMID: 34995974 PMCID: PMC8863406 DOI: 10.1016/j.suronc.2021.101696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND In patients undergoing resection of intrahepatic cholangiocarcinoma (ICC), hypervascularity during the arterial phase of contrast-enhanced computed tomography (CT) is associated with better prognosis than hypovascularity. However, the prognostic implications of arterial enhancement pattern in patients with unresectable ICC are unknown. We assessed the prognostic implications of arterial enhancement pattern in patients with resectable and unresectable ICC. METHODS Consecutive patients who underwent surgery or gemcitabine-plus-cisplatin chemotherapy for ICC during 2003-2015 and CT with dynamic enhancement for diagnosis were included. After review by 2 radiologists, tumors were categorized according to the percentage of the tumor exhibiting arterial enhancement as hypervascular (>50% of tumor exhibiting enhancement), peripherally enhancing (10%-50%), and hypovascular (<10%). In each cohort (surgical and medical), overall survival (OS) curves were generated using the Kaplan-Meier method, and differences between curves were evaluated with Cox analysis. RESULTS The study included 56 patients treated surgically and 89 patients with unresectable ICC. Mean (standard deviation) tumor density in the hypervascular, peripherally enhancing, and hypovascular groups was 119.3 (45.2) Hounsfield units (HU), 72.1 (15.9) HU, and 59.9 (14.4) HU, respectively, in the surgical cohort and 93.6 (17.5) HU, 66.6 (16.2) HU, and 48.7 (14.3) HU, respectively, in the medical cohort. In both cohorts, the 5-year OS rate was significantly higher in the hypervascular group than in the hypovascular group (surgical, 67.6% vs 22.5%, P = .038; medical, 15.4% vs 0%, P = .030). In both cohorts, a Cox proportional hazards model analysis showed that hypervascularity was significantly associated with better OS. CONCLUSION Hypervascularity during the arterial CT phase is a prognostic biomarker in patients undergoing ICC resection and patients with unresectable ICC.
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Affiliation(s)
- Elena Panettieri
- Department of Surgical Oncology, The University of Texas MD
Anderson Cancer Center, Houston, Texas, USA
| | - Harufumi Maki
- Department of Surgical Oncology, The University of Texas MD
Anderson Cancer Center, Houston, Texas, USA
| | - Bradford J. Kim
- Department of Surgical Oncology, The University of Texas MD
Anderson Cancer Center, Houston, Texas, USA
| | - HyunSeon Christine Kang
- Department of Abdominal Imaging, The University of Texas MD
Anderson Cancer Center, Houston, Texas, USA
| | - Veronica Cox
- Department of Abdominal Imaging, The University of Texas MD
Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo A. Vega
- Department of Surgical Oncology, The University of Texas MD
Anderson Cancer Center, Houston, Texas, USA
| | - Takashi Mizuno
- Department of Surgical Oncology, The University of Texas MD
Anderson Cancer Center, Houston, Texas, USA
| | - Shubham Pant
- Department of Investigational Cancer Therapeutics, The
University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, The
University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD
Anderson Cancer Center, Houston, Texas, USA
| | - Yoshikuni Kawaguchi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Sposito C, Droz Dit Busset M, Virdis M, Citterio D, Flores M, Bongini M, Niger M, Mazzaferro V. The role of lymphadenectomy in the surgical treatment of intrahepatic cholangiocarcinoma: A review. Eur J Surg Oncol 2021; 48:150-159. [PMID: 34412956 DOI: 10.1016/j.ejso.2021.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/09/2021] [Accepted: 08/09/2021] [Indexed: 12/11/2022] Open
Abstract
Cholangiocarcinoma is the second most common primary tumor of the liver. The incidence and mortality of its intrahepatic form has been increasing over the past 2 decades. Currently, the only available curative treatment for intrahepatic cholangiocarcinoma is surgical resection. There is still no prospective evidence to support neoadjuvant systemic treatments in resectable disease, while adjuvant chemotherapy with Capecitabine is currently the only recommended systemic treatment after liver resection based on the results of randomised trial. Despite the implementation of perioperative treatments and improvements in resective surgery, intrahepatic cholangiocarcinoma remains a disease characterized by high incidence of recurrence and poor long-term survival. Lymph node metastases can be found in 45-65% of patients and are one of the most impacting prognostic factors after surgical resection. Preoperative imaging is not always sufficient in assessing lymph node status, thus hepatic pedicle lymphadenectomy can be important to ensure precise staging in surgical patients. An increasing trend in performing lymph node dissection during liver resection for intrahepatic cholangiocarcinoma has been observed in the last 20 years, although its actual efficacy compared to the potential complications remains debated. The current evidence on the prognostic role of the lymph node status, its preoperative predictability, the basis for a correct hepatic pedicle lymphadenectomy and its prognostic role in the surgical treatment of intrahepatic cholangiocarcinoma are presented.
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Affiliation(s)
- Carlo Sposito
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy.
| | - Michele Droz Dit Busset
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Matteo Virdis
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Davide Citterio
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Maria Flores
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Marco Bongini
- HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Vincenzo Mazzaferro
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
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Mantripragada S, Chawla A. Cholangiocarcinoma: Part 1, Pathological and Morphological Subtypes, Spectrum of Imaging Appearances, Prognostic Factors and Staging. Curr Probl Diagn Radiol 2021; 51:351-361. [PMID: 33827768 DOI: 10.1067/j.cpradiol.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/12/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
Cholangiocarcinoma (CC) is the most frequent malignant tumor of the biliary tract. The vast majority of cholangiocarcinomas are adenocarcinomas with a high proportion of fibrous stroma. Based on the macroscopic growth pattern, CC is classified as mass-forming, periductal infiltrating, or intraductal, with each type having its own characteristic imaging findings and prognostic outcome. The recently proposed pathological classification of cholangiocarcinoma into two types: perihilar large duct type and peripheral small duct and/or ductular type helps in better understanding of the morphology and the imaging appearances. Computed tomography (CT) and magnetic resonance imaging (MRI) remain the main tools of imaging. We aim to provide a comprehensive outline of the different subtypes and the rationale behind various imaging features of these subtypes. Cholangiocarcinoma is one of the more difficult tumors to treat and till date, surgery remains the only definitive curative treatment.
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Affiliation(s)
- Sravanthi Mantripragada
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Republic of Singapore.
| | - Ashish Chawla
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Republic of Singapore
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Yamada S, Morine Y, Imura S, Ikemoto T, Arakawa Y, Saito Y, Yoshikawa M, Miyazaki K, Shimada M. Prognostic prediction of apparent diffusion coefficient obtained by diffusion-weighted MRI in mass-forming intrahepatic cholangiocarcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:388-395. [PMID: 32162483 DOI: 10.1002/jhbp.732] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/11/2020] [Accepted: 03/02/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND We evaluated apparent diffusion coefficient (ADC) of diffusion-weighted image MRI as a prognostic factor for mass-forming intrahepatic cholangiocarcinoma (IHCC). METHODS We enrolled 26 patients who had undergone hepatic resections for mass-forming-type IHCC in this study, and calculated their mean ADC, using diffusion-weighted image MRI (b: 0, 20, 800 seconds/mm2 ; 1.5 T MRI). Patients were divided into the ADCHigh and the ADCLow groups at the median ADC value (n = 13 for both). We also immunohistochemically evaluated hypoxia-inducible factor (HIF)-1α in tumor tissue. RESULTS Median age in the ADCLow was older (P = .03), and showed significant higher rate of scirrhous tumor (P = .02). The 5-year overall survival rate in the ADCLow group was significantly worse than in the ADCHigh group (P = .04). In multivariate analysis, hilar tumor, portal vein invasion and low ADC were independent prognostic factors (P < .05). The ADCLow group also had a higher rate of high HIF-1α expression than the ADCHigh group (P < .05). Representative case of ADCLow group showed rich stroma and high HIF-1α expression. CONCLUSIONS The ADC values in MRIs can predict IHCC prognosis, and correlated with stromal density and HIF-1α expression.
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Affiliation(s)
| | - Yuji Morine
- Department of Surgery, Tokushima University, Tokushima City, Japan
| | - Satoru Imura
- Department of Surgery, Tokushima University, Tokushima City, Japan
| | - Tetsuya Ikemoto
- Department of Surgery, Tokushima University, Tokushima City, Japan
| | - Yusuke Arakawa
- Department of Surgery, Tokushima University, Tokushima City, Japan
| | - Yu Saito
- Department of Surgery, Tokushima University, Tokushima City, Japan
| | - Masato Yoshikawa
- Department of Surgery, Tokushima University, Tokushima City, Japan
| | - Katsuki Miyazaki
- Department of Surgery, Tokushima University, Tokushima City, Japan
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University, Tokushima City, Japan
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Mao Y, Zhu Y, Qiu Y, Kong W, Mao L, Zhou Q, Chen J, He J. Predicting peritumoral Glisson's sheath invasion of intrahepatic cholangiocarcinoma with preoperative CT imaging. Quant Imaging Med Surg 2019; 9:219-229. [PMID: 30976546 DOI: 10.21037/qims.2018.12.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background To investigate the differences of clinicopathological characteristics and computed tomography (CT) features between intrahepatic cholangiocarcinomas (ICC) with and without peritumoral Glisson's sheath invasion (PGSI), and to construct a nomogram to predict PGSI of ICCs preoperatively. Methods The clinicopathological characteristics and CT features of 84 ICCs were retrospectively analyzed and compared between ICCs with (30/84, 35.7%) and without PGSI (54/84, 64.3%). Multivariate logistic regression analysis was used to identify preoperative independent predictors of PGSI in ICCs. A nomogram was constructed to predict PGSI preoperatively. Results ICCs with and without PGSI differed significantly in the presence of abdominal pain, serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels, TNM and T stages, tumor location, intratumoral calcifications, intrahepatic bile duct dilatation, intrahepatic bile duct calculus, morphologic type and dynamic enhancement pattern on CT images (all P<0.05). Abdominal pain, serum CEA level, intrahepatic bile duct dilatation, and morphologic type were independent predictors of PGSI in ICCs. A nomogram based on those predictors was constructed to predict PGSI preoperatively with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.908 (P<0.001). Conclusions Clinicopathological characteristics and CT features differed significantly between ICCs with and without PGSI. A nomogram including abdominal pain, serum CEA level, intrahepatic bile duct dilatation, and morphologic type could predict PGSI accurately.
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Affiliation(s)
- Yingfan Mao
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yong Zhu
- Department of Radiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of the Nanjing University of Chinese Medicine, Nanjing 210008, China
| | - Yudong Qiu
- Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Weiwei Kong
- Department of Oncology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Liang Mao
- Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Qun Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Jun Chen
- Department of Pathology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
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Zhu Y, Mao Y, Chen J, Qiu Y, Wang Z, He J. Preoperative Computed Tomography Features of Intrahepatic Cholangiocarcinoma for Predicting Lymph Node Metastasis and Overall Survival. J Comput Assist Tomogr 2019; 43:729-735. [DOI: 10.1097/rct.0000000000000922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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11
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Ni T, Shang XS, Wang WT, Hu XX, Zeng MS, Rao SX. Different MR features for differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma according to tumor size. Br J Radiol 2018; 91:20180017. [PMID: 29791202 DOI: 10.1259/bjr.20180017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify reliable magnetic resonance (MR) features for distinguishing mass-forming type of intrahepatic cholangiocarcinoma (IMCC) from hepatocellular carcinoma (HCC) based on tumor size. METHODS This retrospective study included 395 patients with pathologically confirmed IMCCs (n = 180) and HCCs (n = 215) who underwent pre-operative contrast-enhanced MRI including diffusion-weighted imaging (DWI). MR features were evaluated and clinical data were also recorded. All the characteristics were compared in small (≤3 cm) and large tumor (>3 cm) groups by univariate analysis and subsequently calculated by multivariable logistic regression analysis. RESULTS Multivariable analysis revealed that rim arterial phase hyperenhancement [odds ratios (ORs) = 13.16], biliary dilation (OR = 23.42) and CA19-9 (OR = 21.45) were significant predictors of large IMCCs (n = 138), and washout appearance (OR = 0.036), enhancing capsule appearance (OR = 0.039), fat in mass (OR = 0.057), chronic liver disease (OR = 0.088) and alpha fetoprotein (OR = 0.019) were more frequently found in large HCCs (n = 143). For small IMCCs (n = 42) and HCCs (n = 72), rim arterial phase hyperenhancement (OR = 9.68), target appearance at DWI (OR = 12.51), alpha fetoprotein (OR = 0.12) and sex (OR = 0.20) were independent predictors in multivariate analysis. CONCLUSION Valuable MR features and clinical factors varied for differential diagnosis of IMCCs and HCCs according to tumor size. Advances in knowledge: MR features for differential diagnosis of large IMCC and HCC (>3 cm) are in keeping with that recommended by LI-RADS. However, for small IMCCs and HCCs (≤3 cm), only rim enhancement on arterial phase and target appearance at DWI are reliable predictors.
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Affiliation(s)
- Ting Ni
- 1 Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute , Shanghai , China
| | - Xiao-Sha Shang
- 1 Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute , Shanghai , China
| | - Wen-Tao Wang
- 1 Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute , Shanghai , China
| | - Xin-Xing Hu
- 1 Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute , Shanghai , China
| | - Meng-Su Zeng
- 1 Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute , Shanghai , China
| | - Sheng-Xiang Rao
- 1 Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Medical Imaging Institute , Shanghai , China
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Differentiating peripheral cholangiocarcinoma in stages T1N0M0 and T2N0M0 from hepatic hypovascular nodules using dynamic contrast-enhanced MRI. Sci Rep 2017; 7:8084. [PMID: 28808285 PMCID: PMC5556016 DOI: 10.1038/s41598-017-08634-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/12/2017] [Indexed: 11/08/2022] Open
Abstract
Because cholangiocarcinoma shows no specific clinical signs or symptoms and presents with non-specific biological and tumor markers in the early stages, MRI findings often lack typical features before this lesion becomes symptomatic and might be mistaken for other liver lesions. An evaluation of relevant radiological findings in nodular cholangiocarcinoma (≤3 cm) in stages T1N0M0 and T2N0M0 is urgently needed. In our study, we compared two groups of liver hypovascular nodules and found that a distinct margin and enhanced area/nodule size >2/3 in the delayed phase were more frequently observed in cholangiocarcinoma cases than in metastatic nodule cases in which markedly high signal intensity on T2WI was common (p < 0.05). The results also revealed that in the both the portal and delayed phases, an enhanced area/nodule size >2/3 favored cholangiocarcinoma, whereas the presence of regional markedly higher SI on T2WI favored benign nodules. Furthermore, signs of peripheral washout in the delayed phase only appeared in cholangiocarcinoma cases.
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Cross-Sectional Imaging of Intrahepatic Cholangiocarcinoma: Development, Growth, Spread, and Prognosis. AJR Am J Roentgenol 2017; 209:W64-W75. [PMID: 28570102 DOI: 10.2214/ajr.16.16923] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Intrahepatic cholangiocarcinoma (ICC) is a malignant tumor that arises from the intrahepatic bile ducts. Although the pathologic and imaging features of ICC have been clearly identified, recent updates have addressed the pathologic classification and imaging features of ICC using new imaging techniques. First, a proposed new pathologic ICC subclassification includes perihilar large duct and peripheral small duct ICCs. Second, advanced MR-based imaging features of ICC, such as hepatobiliary phase imaging using hepatocytespecific contrast material and DWI, have recently been described. These imaging features are important when differentiating ICCs from hepatocellular carcinomas. Finally, some imaging features of ICC, such as prominent arterial enhancement or degree of delayed enhancement, exhibit potential as prognostic imaging biomarkers. CONCLUSION Comprehensive and updated knowledge of ICC is necessary for accurate diagnosis and could facilitate prediction of clinical outcomes for patients with ICC.
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Türkoğlu MA, Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, Uemura S, Miyata T, Kakuda Y, Nakanuma Y, Uesaka K. The favorable prognosis after operative resection of hypervascular intrahepatic cholangiocarcinoma: A clinicopathologic and immunohistochemical study. Surgery 2016; 160:683-90. [DOI: 10.1016/j.surg.2016.03.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/22/2016] [Accepted: 03/17/2016] [Indexed: 01/14/2023]
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Yamamoto Y, Türkoğlu MA, Aramaki T, Sugiura T, Okamura Y, Ito T, Ashida R, Uemura S, Miyata T, Kato Y, Kakuta Y, Nakanuma Y, Uesaka K. Vascularity of Intrahepatic Cholangiocarcinoma on Computed Tomography is Predictive of Lymph Node Metastasis. Ann Surg Oncol 2016; 23:485-493. [DOI: 10.1245/s10434-016-5382-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Indexed: 12/13/2022]
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Lu Q, Xue LY, Wang WP, Huang BJ, Li CX. Dynamic enhancement pattern of intrahepatic cholangiocarcinoma on contrast-enhanced ultrasound: the correlation with cirrhosis and tumor size. ACTA ACUST UNITED AC 2016; 40:1558-66. [PMID: 25725793 DOI: 10.1007/s00261-015-0379-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To retrospectively evaluate the dynamic enhancement pattern of contrast-enhanced ultrasound (CEUS) in intrahepatic cholangiocarcinoma (ICC) of varying sizes and hepatic backgrounds. MATERIALS AND METHODS CEUS was performed in 98 pathologically confirmed ICCs (n = 39 < 30 mm, n = 59 > 30 mm; n = 45 with cirrhosis and n = 53 with normal liver). The dynamic enhancement pattern of CEUS was retrospectively analyzed. RESULTS In the arterial phase, heterogeneous hyper-enhancement was more frequent in ICCs with cirrhosis (21/45, 46.7% vs. 11/53, 20.8% in ICCs with normal liver, p = 0.009), while peripheral hyper-enhancement and hypo-enhancement were more common in ICCs with normal liver (14/53, 26.4%; 11/53, 20.8% vs. 2/45, 4.4%; 2/45, 4.4% in ICCs with cirrhosis, p = 0.005 and 0.033, respectively). There were no significant differences between portal and delayed phases. In ICCs < 30 mm, homogeneous hyper-enhancement was more frequently identified (27/39, 69.2% vs. 10/59, 16.9% in ICCs > 30 mm, p < 0.001), whereas in ICCs > 30 mm, heterogeneous, and peripheral hyper-enhancement were more commonly observed (26/59, 44.1% vs. 6/39, 15.4% in ICCs < 30 mm, p = 0.004, and 14/59, 23.7% vs. 2/39, 5.1% in ICCs < 30 mm, p = 0.023, respectively). The washout pattern in portal and delayed phases were not significantly different in ICCs with different sizes. 60.7% (17/28) ICCs < 30 mm and 85.2% (23/27) ICCs > 30 mm with cirrhosis, together with 66.7% (14/21) ICCs < 30 mm with normal liver displayed intense contrast agent uptake (homogeneous or heterogeneous hyper-enhancement) in arterial phase followed by washout in portal and delayed phase, which was much higher than that in ICCs > 30 mm with normal liver (34.4%, 11/32, p < 0.001, <0.001 and =0.027, respectively). CONCLUSION The CEUS dynamic enhancement pattern of ICC varies with size and hepatic background. The enhancement pattern is indistinguishable from hepatocellular carcinoma on CEUS in most ICCs with cirrhosis and in most ICCs < 30 mm with normal liver.
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Affiliation(s)
- Qing Lu
- Department of Ultrasound, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China,
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Lee J, Kim SH, Kang TW, Song KD, Choi D, Jang KT. Mass-forming Intrahepatic Cholangiocarcinoma: Diffusion-weighted Imaging as a Preoperative Prognostic Marker. Radiology 2016; 281:119-28. [PMID: 27115053 DOI: 10.1148/radiol.2016151781] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To assess the value of diffusion-weighted (DW) imaging as a prognostic marker in preoperative evaluation of patients with mass-forming intrahepatic cholangiocarcinoma (ICC). Materials and Methods This retrospective study was approved by the institutional review board, and the informed consent requirement was waived. A total of 91 patients who underwent hepatic resection and DW imaging for mass-forming ICC were included. Two radiologists evaluated the degree of diffusion restriction of the tumors by using qualitative (visual) interpretation combined with quantitative analysis by volumetric evaluation of the whole tumor on DW images. Patients were classified into two groups: those in whom less than one-third of the tumor showed diffusion restriction (group 1) and those in whom more than one-third of the tumor showed diffusion restriction (group 2). Imaging findings in tumors were compared with pathology findings. Disease-free and overall survival rates were compared between the two groups by using the Kaplan-Meier method with the log-rank test. Results There were 43 patients in group 1 and 48 patients in group 2. The 1- and 3-year disease-free survival rates were 30% and 16%, respectively, in group 1 and 75% and 64%, respectively, in group 2 (P < .001). The 1- and 3-year overall survival rates were 77% and 26%, respectively, in group 1 and 92% and 67%, respectively, in group 2 (P = .001). Multivariate analysis revealed that diffusion restriction (P = .024), differentiation (P = .030), and intrahepatic metastasis (P = .001) were independent prognostic factors for overall survival. Conclusion The degree of diffusion restriction on DW images may be a prognostic marker in preoperative evaluation of patients with mass-forming ICC. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Jisun Lee
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
| | - Seong Hyun Kim
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
| | - Tae Wook Kang
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
| | - Kyoung Doo Song
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
| | - Dongil Choi
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
| | - Kee Taek Jang
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
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Nanashima A, Hatachi G, Tominaga T, Murakami G, Takagi K, Arai J, Wada H, Nagayasu T, Sumida Y. Down-Regulation of Nogo-B Expression as a Newly Identified Feature of Intrahepatic Cholangiocarcinoma. TOHOKU J EXP MED 2015; 238:9-16. [PMID: 26656426 DOI: 10.1620/tjem.238.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nogo-B, located in the endoplasmic reticulum, is an isoform belonging to the reticulon protein family, which is expressed specifically in cholangiocytes and non-parenchymal cells in the liver. Nogo-B expression is down-regulated with the progression of liver fibrosis, but its distinct function in liver malignancies has not been fully clarified. We have hypothesized that Nogo-B expression may be altered in intrahepatic cholangiocarcinoma (ICC), a relatively rare type of primary liver cancer with highly malignant behavior. The present study aimed to investigate the relationship between Nogo-B expression, assessed by immunohistochemical staining, and clinicopathological factors and prognosis in 34 ICC patients. Positive expression was observed in 19 (56%) of 34 ICC specimens: 6 patients (18%) with positivity levels of 1+ (positive cells in 10-50% of cancer cells) and 13 patients (38%) with 2+ (positive cells over 50%). Importantly, the remaining 15 patients (44%) were categorized as negative expression (Nogo-B-positive cells, less than 10%). Conversely, the mass-forming type of ICC tended to express Nogo-B with the degree of 2+ positivity, compared to the periductal infiltration type (p = 0.064), and the mass-forming type showed a better 5-year survival rate (66% vs. 5%) after hepatectomy (p < 0.05). However, the degree of positivity was not associated with tumor relapse rate, disease-free and overall survival, although each of the periductal infiltration type, intrahepatic metastasis, larger tumor size, and lower microvessel counts was associated with lower survival rates. We propose that Nogo-B expression is down-regulated in ICC, the implication of which, however, remains to be investigated.
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Affiliation(s)
- Atsushi Nanashima
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences
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Matos AP, Velloni F, Ramalho M, AlObaidy M, Rajapaksha A, Semelka RC. Focal liver lesions: Practical magnetic resonance imaging approach. World J Hepatol 2015; 7:1987-2008. [PMID: 26261689 PMCID: PMC4528273 DOI: 10.4254/wjh.v7.i16.1987] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 06/24/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
With the widespread of cross-sectional imaging, a growth of incidentally detected focal liver lesions (FLL) has been observed. A reliable detection and characterization of FLL is critical for optimal patient management. Maximizing accuracy of imaging in the context of FLL is paramount in avoiding unnecessary biopsies, which may result in post-procedural complications. A tremendous development of new imaging techniques has taken place during these last years. Nowadays, Magnetic resonance imaging (MRI) plays a key role in management of liver lesions, using a radiation-free technique and a safe contrast agent profile. MRI plays a key role in the non-invasive correct characterization of FLL. MRI is capable of providing comprehensive and highly accurate diagnostic information, with the additional advantage of lack of harmful ionizing radiation. These properties make MRI the mainstay for the noninvasive evaluation of focal liver lesions. In this paper we review the state-of-the-art MRI liver protocol, briefly discussing different sequence types, the unique characteristics of imaging non-cooperative patients and discuss the role of hepatocyte-specific contrast agents. A review of the imaging features of the most common benign and malignant FLL is presented, supplemented by a schematic representation of a simplistic practical approach on MRI.
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Affiliation(s)
- António P Matos
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Fernanda Velloni
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Miguel Ramalho
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Mamdoh AlObaidy
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Aruna Rajapaksha
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Richard C Semelka
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
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Al Ansari N, Kim BS, Srirattanapong S, Semelka CTA, Ramalho M, Altun E, Woosley JT, Calvo B, Semelka RC. Mass-forming cholangiocarcinoma and adenocarcinoma of unknown primary: can they be distinguished on liver MRI? ACTA ACUST UNITED AC 2015; 39:1228-40. [PMID: 24929668 DOI: 10.1007/s00261-014-0172-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine MR features suggestive of mass-forming cholangiocarcinoma (CCA) or liver metastases of adenocarcinoma of unknown primary (AUP), and to compare the ability of two experienced radiologists to establish the correct diagnosis. MATERIALS AND METHODS 61 patients with CCA or AUP, with MRIs were placed into two groups: population 1, 28 patients with certain diagnosis of either CCA or AUP; and population 2, 33 patients with uncertain diagnosis. Using population 1 with known diagnosis, two investigators formulated imaging criteria for CCA or AUP, which represented phase 1 of the study. In phase 2, two independent radiologists categorized the patients in populations 1 and 2 as CCA or AUP using the formulated criteria. This categorization was compared with the patient medical records and pathologist review. Findings were tested for statistical significance. RESULTS In phase 1, solitary lesion, multifocal lesions with dominant lesion, capsule retraction, and porta hepatis lymphadenopathy were features of CCA; multifocal lesions with similar size, and ring enhancement were features of AUP. The number of lesions, capsule retraction, and early tumor enhancement pattern were observed to be significant features (P < 0.05). In phase 2, agreement between the two radiologists was good (k = 0.663). For population 1, the agreement was good (k = 0.659), and was fair for population 2 (k = 0.293). Concordance between the two radiologists, medical record, and the pathologist was found in 41/61 (67%) patients. CONCLUSION Distinctive features of CCA and AUP are identifiable on MRI images, which may aid the radiologist to establish the correct diagnosis.
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Affiliation(s)
- Najwa Al Ansari
- Department of Radiology, University of North Carolina at Chapel Hill, CB 7510 - 2001 Old Clinic Bldg, Chapel Hill, NC, 27599-7510, USA
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Intrahepatic mass-forming cholangiocarcinoma: prognostic value of preoperative gadoxetic acid-enhanced MRI. Eur Radiol 2015; 26:407-16. [DOI: 10.1007/s00330-015-3846-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 12/18/2022]
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Nanashima A, Abo T, Takagi K, Arai J, To K, Kunizaki M, Hidaka S, Takeshita H, Sawai T, Nagayasu T. Prognostic influence of the liver hanging maneuver for patients with hepatobiliary malignancies who underwent hepatic resections. Eur J Surg Oncol 2014; 40:1540-9. [DOI: 10.1016/j.ejso.2014.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/14/2014] [Accepted: 06/26/2014] [Indexed: 12/21/2022] Open
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Sato Y, Ojima H, Onaya H, Mori T, Hiraoka N, Kishi Y, Nara S, Esaki M, Shimada K, Kosuge T, Sugihara K, Kanai Y. Histopathological characteristics of hypervascular cholangiocellular carcinoma as an early stage of cholangiocellular carcinoma. Hepatol Res 2014; 44:1119-29. [PMID: 24033892 DOI: 10.1111/hepr.12236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 08/06/2013] [Accepted: 09/02/2013] [Indexed: 01/14/2023]
Abstract
AIM Prognosis of hypervascular cholangiocellular carcinoma (h-CCC) is reportedly better than that of ordinary hypovascular CCC (o-CCC). The aim of this study is to clarify the histopathological characteristics of h-CCC. METHODS On the basis of the findings in the arterial phase of contrast-enhanced computed tomography, 16 cases of mass-forming-type CCC were divided into two groups (h-CCC, n = 8; o-CCC, n = 8). Areas of high (Area H-a) and low (Area H-b) attenuation in h-CCC cases and areas of low attenuation in o-CCC cases (Area O) were delineated. These areas were then evaluated histopathologically to determine the proportion of tumor cells, fibrous stroma, arterial vessel density, and immunohistochemical expression of Vascular endothelial growth factor; angiopoietin-2; cytokeratin 7, CK19, SOX9 and SOX17 genes; epithelial cell adhesion molecule; and the Bmi-1, Ki-67, epithelial membrane antigen and polyclonal carcinoembryonic antigen. RESULTS The areal ratio of tumor cells decreased and that of fibrous stroma increased in the following order: Area H-a, Area H-b and Area O. Values for AVD and neural cell adhesion molecule positivity rate were significantly higher in Area H-a than in Areas H-b or O. Expressions of vascular endothelial growth factor and angiopoietin-2 were significantly higher in Areas H-a and H-b than in Area O. The Ki-67 labeling index increased in the following order: Area H-a, Area H-b and Area O. CONCLUSION A high areal ratio of tumor cells and AVD as well as a high expression of stem cells and angiogenic markers were observed in cases of h-CCC, whereas the areal ratio of fibrous stroma and malignant potential were low. These results suggest that h-CCC may represent the early stage of CCC.
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Affiliation(s)
- Yuya Sato
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan; Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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Intrahepatic cholangiocarcinoma and cholangiolocellular carcinoma in cirrhosis and chronic viral hepatitis. Surg Today 2014; 45:682-7. [PMID: 25253466 DOI: 10.1007/s00595-014-1031-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/15/2014] [Indexed: 12/14/2022]
Abstract
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer. Cirrhosis and chronic viral hepatitis are known to be important risk factors for ICC, especially the mass-forming (MF) type of ICC at the periphery of the liver. Cholangiolocellular carcinoma (CoCC) is a rare type of primary liver cancer, which is thought to originate from hepatic progenitor or stem cells. CoCC often exhibits the similar MF type at the periphery of the liver, as ICC, and CoCC is also associated with cirrhosis or chronic viral hepatitis. Better survival rates after surgery have been reported for ICC patients with chronic viral hepatitis than for those without chronic viral hepatitis, although survival rates did not differ significantly in relation to cirrhosis. On the other hand, patients with CoCC had better surgical results than those with MF-type ICC. This review summarizes the clinical characteristics and surgical outcomes of ICC and CoCC associated with cirrhosis or chronic viral hepatitis.
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Sheng RF, Zeng MS, Rao SX, Ji Y, Chen LL. MRI of small intrahepatic mass-forming cholangiocarcinoma and atypical small hepatocellular carcinoma (≤3 cm) with cirrhosis and chronic viral hepatitis: a comparative study. Clin Imaging 2014; 38:265-72. [PMID: 24559750 DOI: 10.1016/j.clinimag.2013.12.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/24/2013] [Accepted: 12/31/2013] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The objective was to identify the decision-making magnetic resonance (MR) features in differentiating small intrahepatic mass-forming cholangiocarcinoma (sIMCC) from atypical small hepatocellular carcinoma (sHCC) (≤3 cm) in patients with cirrhosis and chronic viral hepatitis. METHODS Signal features and relative contrast of sHCCs and sIMCCs in T2-weighted and dynamic enhanced imaging were analyzed. A subgroup comparison between the cirrhosis and noncirrhosis chronic viral hepatitis group was also made. RESULTS Univariate analysis revealed that tumor contours (P<.001), signals in T2-weighted (P<.001) and each phase of contrast-enhanced scanning (P<.001), enhancement patterns (P<.001), as well as accompanying findings of tumor capsule (P<.001), hepatic capsule retraction (P<.001), bile duct dilation (P=.031), and transient hepatic intensity difference (P=.002) were different between sIMCC and atypical sHCC. Multivariate analysis indicated that dynamic enhancement patterns (P<.001) and signals in T2-weighted images (P=.024) were independent predictors for differentiation. Confusing MR features were more often observed in the cirrhosis group compared with those in the noncirrhosis chronic viral hepatitis group. CONCLUSION Dynamic enhancement patterns and signals in T2-weighted images were the most important MR features to differentiate sIMCC from atypical sHCC with cirrhosis and chronic viral hepatitis.
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Affiliation(s)
- Ruo-Fan Sheng
- Department of Radiology, Zhongshan Hospital, Shanghai Medical School, Fudan, University, Shanghai Medical Imaging Institute, No. 180 Fenglin Road, Xuhui, District, Shanghai 200032, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Shanghai Medical School, Fudan, University, Shanghai Medical Imaging Institute, No. 180 Fenglin Road, Xuhui, District, Shanghai 200032, China.
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Shanghai Medical School, Fudan, University, Shanghai Medical Imaging Institute, No. 180 Fenglin Road, Xuhui, District, Shanghai 200032, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Shanghai Medical School, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Ling-Li Chen
- Department of Pathology, Zhongshan Hospital, Shanghai Medical School, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
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Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics. ACTA ACUST UNITED AC 2013; 38:785-92. [PMID: 23232581 DOI: 10.1007/s00261-012-9974-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Arterial enhancement of intrahepatic cholangiocarcinoma (ICC) has been noted. To precisely identify the characteristics of tumor enhancement patterns, we examined the relationship between CT attenuation in the tumor and clinicopathological parameters or prognosis. METHODS Subjects were 42 ICC patients who had undergone hepatectomy. microvessel density (MVD) determined by CD34 staining was compared with imaging. Attenuation was calculated in images from multidetector CT of tumor and non-tumorous regions. Enhancement patterns were divided into two groups: arterial enhancement with higher attenuation (>16 HU; Hyper group, n = 12); and arterial enhancement with lower attenuation (Hypo group, n = 30). RESULTS Univariate analysis identified high tumor marker level, increased size, less-differentiation, incomplete resection, increased bleeding, and lower MVD as significantly associated with poor survival (p < 0.05). Increased attenuation throughout the whole ICC correlated significantly with radiological findings and MVD. Concomitant hepatitis, well-differentiation, and smaller tumor were more significantly frequent in the Hyper group than in the Hypo group (p < 0.05). Postoperative early recurrence was significantly less frequent in the Hyper group, and overall survival was significantly better in the Hyper group (p < 0.05). CONCLUSIONS Increased CT attenuation correlated with ICC tumor vascularity. Increased tumor enhancement in the arterial phase was associated with chronic hepatitis, lower malignancy, and better survival.
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Gadoxetate disodium-enhanced MRI of mass-forming intrahepatic cholangiocarcinomas: imaging-histologic correlation. AJR Am J Roentgenol 2013; 201:W603-11. [PMID: 24059399 DOI: 10.2214/ajr.12.10262] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the enhancement patterns of mass-forming intrahepatic cholangiocarcinomas on gadoxetate disodium-enhanced MR images using imaging-histologic correlation. MATERIALS AND METHODS We retrospectively evaluated the preoperative gadoxetate disodium-enhanced MR images of 19 patients with mass-forming intrahepatic cholangiocarcinomas. Two readers independently interpreted enhancement patterns on arterial (globally high, rimlike), dynamic (washout, progressive), and hepatobiliary (target, nontarget) phase images. Dynamic enhancement was categorized as washout (hypoenhancement on later phase compared with arterial phase images) or progressive (persistent or gradually increased enhancement). Tumor enhancement ratio and tumor-to-liver signal difference curves were analyzed. The enhancement patterns were correlated with the extent of stromal fibrosis within the tumors. RESULTS Rimlike arterial enhancement (89%, reader 1; 84%, reader 2) and a progressive dynamic pattern (89%, both readers) were predominant. Tumor enhancement ratio increased gradually from the arterial to the equilibrium phase then decreased in the hepatobiliary phase, but the tumor signal intensities were lower than liver signal intensity in all phases. The two lesions that both readers considered to have globally high arterial enhancement and a washout dynamic pattern presented with minimal or scattered stromal fibrosis. Target appearance in the hepatobiliary phase (reader 1, 42%; reader 2, 47%) was more commonly seen in tumors with central stromal fibrosis (reader 1, p = 0.025; reader 2, p = 0.001). CONCLUSION Mass-forming intrahepatic cholangiocarcinomas may be characterized by rimlike enhancement and a progressive dynamic pattern on gadoxetate disodium-enhanced MR images, and these features seem related to the extent of stromal fibrosis in the tumor. Furthermore, mass-forming intrahepatic cholangiocarcinomas may have a pseudowashout pattern on gadoxetate disodium-enhanced MR images because of progressive background liver enhancement. Therefore, radiologists need to be aware of this pattern as a possible pitfall.
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Liu RQ, Shen SJ, Hu XF, Liu J, Chen LJ, Li XY. Prognosis of the intrahepatic cholangiocarcinoma after resection: hepatitis B virus infection and adjuvant chemotherapy are favorable prognosis factors. Cancer Cell Int 2013; 13:99. [PMID: 24139471 PMCID: PMC3852727 DOI: 10.1186/1475-2867-13-99] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 10/11/2013] [Indexed: 12/15/2022] Open
Abstract
Aim The incidence and mortality associated with intrahepatic cholangiocarcinoma is increasing in many countries and documentation of disease outcome is sparse. The present study was undertaken to investigate the prognostic factors for intrahepatic cholangiocarcinoma (ICC) following surgical resection. The impact of pre-existing HBV virus infection and adjuvant chemotherapy on the overall survival was also evaluated. Methods Clinical and pathological data were collected retrospectively from 81 patients undergoing surgery for ICC between 2005 and 2011, at The Henan Province Tumor Hospital and the First Affiliated Hospital of Zheng Zhou University. Survival and prognosis were analyzed using the Kaplan-Meier method and COX regression model. Results The population included 37 patients who were HBsAg + or anti-HBc+, 21 patients who were anti-HBs + positive and 18 patients who received adjuvant chemotherapy. The overall 1- and 3-year survival rates were 51% and 20%, respectively. The median survival was 12.2 months. Univariate analysis identified the following prognostic factors: HBV virus infection or HBV vaccine prior to resection (P = 0.017); adjuvant chemotherapy (P = 0.001); preoperative serum CA19-9 (> 200 U/mL; P = 0.015); GGT (> 64 U/L; P = 0.008), ALP (> 119 U/L; P = 0.01); lymph node metastasis (P = 0.005); radical resection (P = 0.021); intrahepatic metastasis (P = 0.015) and diabetes (P = 0.07). Multivariate analysis identified chronic HBV infection (RR = 0.583; P = 0.041), anti-HBs positivity (RR = 0.680; P = 0.050), adjuvant chemotherapy (RR = 0.227; P < 0.001), lymph node metastasis (RR = 2.320; P = 0.001), and intrahepatic duct stones (RR = 0.473; P = 0.032) as independent prognostic factors. Conclusions HBV virus infection or HBV vaccination prior to resection, together with adjuvant chemotherapy, were independently associated with improved survival in patients undergoing surgery for ICC.
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Affiliation(s)
| | | | | | | | | | - Xing-Ya Li
- First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Typical and atypical imaging findings of intrahepatic cholangiocarcinoma using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging. J Comput Assist Tomogr 2013. [PMID: 23192208 DOI: 10.1097/rct.0b013e3182706562] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The objective of this study was to examine the imaging features of classic mass-forming intrahepatic cholangiocarcinoma (MICC) and nonclassic hypervascular MICC on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging. METHODS Twenty pathologically confirmed MICCs were included. Two radiologists retrospectively reviewed the imaging characteristics on T2-weighted imaging, diffusion-weighted imaging, dynamic contrast-enhanced images, and hepatobiliary phase (HBP) of each MICC. For the morphologic feature of defect, HBP signal intensity (SI) ratio was calculated by dividing the SI of the MICC by nearby normal liver parenchyma SI. RESULTS Classic MICCs (n = 14) showed classic rim or peripheral enhancement at arterial dominant phase with centripetal enhance in the delayed phases. Hypervascular MICCs (n = 6) showed complete (n = 4) or near-complete (n = 2) arterial enhancement and washout (n = 6) on delayed phases. On HBP, 13 classic MICCs (93%) and 2 hypervascular MICCs (33%) showed cloud-like SI in the center ("EOB cloud") with peripheral defect. Mean SI ratio was 0.77 in classic MICCs and 0.59 in hypervascular MICC (P = 0.057). CONCLUSIONS Classic MICCs (70%) frequently showed progressive centripetal enhancement on dynamic phase, and central EOB-cloud appearance with distinct peripheral defect on HBP. Nonclassic hypervascular MICCs comprised 30% of the MICCs in this study. Compared with classic MICCs, hypervascular MICCs showed wash-in on arterial dominant phase and washout on delayed phase.
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Xu J, Igarashi S, Sasaki M, Matsubara T, Yoneda N, Kozaka K, Ikeda H, Kim J, Yu E, Matsui O, Nakanuma Y. Intrahepatic cholangiocarcinomas in cirrhosis are hypervascular in comparison with those in normal livers. Liver Int 2012; 32:1156-64. [PMID: 22417172 DOI: 10.1111/j.1478-3231.2012.02783.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 02/14/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Intrahepatic cholangiocarcinomas (ICCs) are usually adenocarcinomas with fibrotic and hypovascular stroma. Intrahepatic cholangiocarcinomas in cirrhosis and precirrhotic liver (ICC-cirrhosis) are increasingly being diagnosed, and can display hypervascular enhancement resembling a hepatocellular carcinoma on dynamic imaging. METHODS In this study using ICC-cirrhosis (71 cases), ICC with non-specific reactive changes (ICC-reactive) (72 cases) and the cholangiocarcinoma component of combined hepatocellular cholangiocarcinoma (HCC-ICC) (30 cases), we tried to compare the tumour vasculature. RESULTS It was found that ICC-cirrhosis and the cholangiocarcinoma component of HCC-ICC showed a higher density of arteries and microvessels (1.59 ± 0.58/mm(2) (mean ± SD) and 140 ± 43/mm(2) in ICC-cirrhosis and 1.74 ± 0.67/mm(2) and 131 ± 46/mm(2) in the cholangiocarcinoma component of HCC-ICC) than in ICC-reactive (1.26 ± 0.61/mm(2) and 103 ± 45/mm(2) ). Dynamic computed tomography (CT) and magnetic resonance imaging (MRI) showed that a majority of ICC-cirrhosis displayed strong hypervascular enhancement, whereas one-third of ICC-reactive each showed strong, weak and no or minimal enhancement respectively. The increased vascular density was positively correlated with enhanced arterial phase of dynamic CT and MRI. CONCLUSION The density of arteries and microvessels of ICC-cirrhosis was higher than that in ICC-reactive and comparable to that in the cholangiocarcinoma component of HCC-ICC, and the higher density of arteries and microvessels in ICC may be responsible for the hypervascular enhancement of ICC-cirrhosis.
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Affiliation(s)
- Jing Xu
- Department of Human Pathology, Kanazawa University Hospital, Kanazawa, Japan
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Zhou JX, Dai HX, Yang J. Correlation between CT arterial enhancement patterns and clinicopathologic findings for intrahepatic mass-forming cholangiocarcinomas. Shijie Huaren Xiaohua Zazhi 2012; 20:694-698. [DOI: 10.11569/wcjd.v20.i8.694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the computed tomography (CT) imaging features of intrahepatic mass-forming cholangiocarcinomas (IMCCs), with a special emphasis on the degree and pattern of arterial enhancement, and to determine whether the clinicopathologic features of IMCCs with arterial enhancement differ from those of IMCCs with less arterial enhancement.
METHODS: Thirty-two patients with 34 pathologically confirmed IMCCs after surgical resection underwent multiphasic CT-unenhanced, hepatic arterial phase (HAP), portal venous phase, and/or equilibrium phase imaging. CT images were retrospectively evaluated for tumor morphology and enhancement features. Patients were placed into typical or atypical enhancement groups according to the presence of enhancement in the largest volume (> 50%) of the tumors during the HAP. Imaging features of IMCCs were correlated with pathologic features. The typical and atypical enhancement groups were compared with respect to disease-free survival and overall survival. Survival rates were calculated by using the Kaplan-Meier method, and differences in survival were compared by using the log-rank test. A Cox proportional hazards model was used for multivariate survival analysis.
RESULTS: Twenty-four (71%) of 34 IMCCs showed typical arterial enhancement, and 10 (29%) showed atypical enhancement. The mean diameter of atypical IMCCs was significantly smaller than that of typical IMCCs (P = 0.001). Chronic liver disease was more frequent in the group with atypical lesions (P = 0.021). During the HAP, the prevalent enhancement pattern in this group was a mixed pattern of peripheral rim and internal heterogeneous enhancement. At pathologic evaluation, atypically enhancing IMCCs showed less central stroma and necrosis and larger cellular areas and more frequently had a cholangiolocellular component than typically enhancing IMCCs. Arterial enhancement of IMCCs was found to be an independent prognostic factor for longer disease-free survival.
CONCLUSION: Arterially enhancing IMCCs are not rare; thus, enhancement pattern analysis of arterially enhancing IMCCs will be helpful in differentiating them from hepatocellular carcinomas. In addition, arterial enhancement of IMCCs appears to correlate with disease-free survival.
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Kim SA, Lee JM, Lee KB, Kim SH, Yoon SH, Han JK, Choi BI. Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern--correlation with clinicopathologic findings. Radiology 2011; 260:148-57. [PMID: 21474703 DOI: 10.1148/radiol.11101777] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the imaging features of intrahepatic mass-forming cholangiocarcinomas (IMCCs) at computed tomography (CT), with a special emphasis on the degree and pattern of arterial enhancement, and to determine whether the clinicopathologic features of IMCCs with arterial enhancement differ from those of IMCCs with less arterial enhancement. MATERIALS AND METHODS The institutional review board of Seoul National University Hospital approved this retrospective study, and informed patient consent was waived. Sixty-four patients with 70 pathologically confirmed IMCCs after surgical resection underwent multiphasic CT-unenhanced, hepatic arterial phase (HAP), portal venous phase, and/or equilibrium phase imaging. CT images were retrospectively evaluated for tumor morphology and enhancement features. Patients were placed into typical or atypical enhancement groups according to the presence of enhancement in the largest volume (>50%) of the tumors during the HAP. Imaging features of IMCCs were correlated with pathologic features. The typical and atypical enhancement groups were compared with respect to disease-free survival and overall survival. Survival rates were calculated by using the Kaplan-Meier method, and differences in survival were compared by using the log-rank test. A Cox proportional hazards model was used for multivariate survival analysis. RESULTS Fifty (71%) of 70 IMCCs showed typical arterial enhancement, and 20 (29%) showed atypical enhancement. The mean diameter of atypical IMCCs was significantly smaller than that of typical IMCCs (P = .001). Chronic liver disease was more frequent in the group with atypical lesions (P = .021). During the HAP, the prevalent enhancement pattern in this group was a mixed pattern of peripheral rim and internal heterogeneous enhancement. At pathologic evaluation, atypically enhancing IMCCs showed less central stroma and necrosis and larger cellular areas and more frequently had a cholangiolocellular component than typically enhancing IMCCs. Arterial enhancement of IMCCs was found to be an independent prognostic factor for longer disease-free survival. CONCLUSION Arterially enhancing IMCCs were not rare; thus, enhancement pattern analysis of arterially enhancing IMCCs will be helpful in differentiating them from hepatocellular carcinomas. In addition, arterial enhancement of IMCCs appears to correlate with disease-free survival.
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Affiliation(s)
- Sun Ah Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea
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Ariizumi SI, Kotera Y, Takahashi Y, Katagiri S, Chen IP, Ota T, Yamamoto M. Mass-forming intrahepatic cholangiocarcinoma with marked enhancement on arterial-phase computed tomography reflects favorable surgical outcomes. J Surg Oncol 2011; 104:130-9. [PMID: 21448898 DOI: 10.1002/jso.21917] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 03/07/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Outcomes after hepatectomy in patients with mass-forming (MF) type intrahepatic cholangiocarcinoma (ICC) with marked enhancement within the tumor on arterial-phase computed tomography (CT) scans have not been clarified in detail. METHODS We retrospectively studied 140 patients with MF type ICC who underwent hepatectomy from 1989 through 2008. Surgical outcomes were compared between 25 patients with MF type ICC with marked enhancement within the tumor (hypervascular ICC) and 109 patients without enhancement within the tumor (hypovascular ICC) on arterial-phase CT scans. RESULTS Portal invasion and intrahepatic metastasis were significantly lower in patients with hypervascular ICC than in those with hypovascular ICC. The 5-year survival rate was significantly higher in patients with hypervascular ICC (86%) than in patients with hypovascular ICC (27%, P < 0.0001). Multivariate analysis showed hypervascular ICC on arterial-phase CT scans, normal level of cancer-associated carbohydrate antigen 19-9, absence of portal invasion, and absence of intrahepatic metastasis of ICC to be significant independent prognostic factors for overall survival in patients with MF type ICC. CONCLUSIONS MF type ICC with marked enhancement within the tumor on arterial CT scans showed a favorable surgical outcome due to its less invasive histopathologic characteristics in patients with MF type ICC.
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Affiliation(s)
- Shun-Ichi Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
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Nanashima A, Tobinaga S, Abo T, Kunizaki M, Takeshita H, Hidaka S, Taura N, Ichikawa T, Sawai T, Nakao K, Nagayasu T. Usefulness of sonazoid-ultrasonography during hepatectomy in patients with liver tumors: A preliminary study. J Surg Oncol 2010; 103:152-7. [DOI: 10.1002/jso.21782] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 09/20/2010] [Indexed: 01/11/2023]
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Andrašina T, Válek V, Pánek J, Kala Z, Kiss I, Tuček S, Slampa P. Multimodal oncological therapy comprising stents, brachytherapy, and regional chemotherapy for cholangiocarcinoma. Gut Liver 2010; 4 Suppl 1:S82-8. [PMID: 21103300 DOI: 10.5009/gnl.2010.4.s1.s82] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/AIMS To prospectively evaluate our palliative management of unresectable cholangiocarcinoma (CC) treated with tailored multimodal oncological therapy. METHODS Between January 2005 and January 2010, 50 consecutive patients with unresectable CC and jaundice were palliated with percutaneous drainage. Forty-three patients underwent metallic-stent implantation followed by brachytherapy. Patients were divided into two arms: the intra-arterial chemotherapy arm (IA arm, n=17) consisted of patients treated with locoregional treatment (IA admission of Cisplatin and 5-fluorouracil, or chemoembolization with Lipiodol) and/or systemic chemotherapy, while the systemic chemotherapy arm (IV arm, n=23) included all the other patients, who were treated only with systemic chemotherapy. RESULTS In total, 78 metal self-expandable stents were placed. Hilar involvement with mass-forming and periductal infiltrating types of CC (84%) was predominant. The average number of percutaneous interventional procedures was 11.61 per patient (range, 4-35). The median overall survival from diagnosis of disease for all patients was 13.5 months (range, 11.0-18.8 months). The median overall survival times were 25.2 months (range, 15.2-31.3 months) and 11.5 months (range, 8.5-12.6 months) in the IA and IV arms, respectively (p<0.05). The 1-, 2-, and 3-year survival rates in the IA and IV arms were 88.2%, 52.9%, and 10.1% and 43.5%, 25.4, and 0%, respectively. There were no major complications (WHO III/IV) due to interventional procedures. CONCLUSIONS We could reach acceptable prognosis in patients with unresectable CC using complex tailored oncological therapy. However, the main limitations of prolonging survival are performance status, patient compliance and the maintaining of biliary tract patency.
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Affiliation(s)
- Tomáš Andrašina
- Department of Radiology, University Hospital Brno, Masaryk University, Brno, Czech Republic
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Zhang L, Cai JQ, Zhao JJ, Bi XY, Tan XG, Yan T, Li C, Zhao P. Impact of hepatitis B virus infection on outcome following resection for intrahepatic cholangiocarcinoma. J Surg Oncol 2010; 101:233-8. [PMID: 20169539 DOI: 10.1002/jso.21488] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about the prognosis of intrahepatic cholangiocarcinoma (ICC) patients with hepatitis B virus (HBV) infection following surgical resection. METHODS The clinico-pathological data of 40 consecutive ICC patients including 29 patients with HBV infection were analyzed after surgical resection. RESULTS Of all 40 ICC patients, the overall 1-, 3-, 5-year survival rates and a median survival for 29 (74.4%) patients with current or previous HBV infection were 78.9%, 42.8%, 35.7%, and 32.0 months, respectively. Twenty-nine (74.4%) patients with HBV infection, represented by HBsAg(+) or anti-HBc(+), had a better prognosis than 10(25%) patients without HBV infection represented by all markers-negative. Compared with 10 (25%) patients without HBV infection, 11 (27.5%) ICC patients with HBsAg(+) had a better prognosis as well. Additionally, lymph node metastasis were identified as an independent predictors of poor overall survival on multivariate analysis in the study of all the 40 patients and 29 patients with HBV infection. CONCLUSIONS Patients with current or previous HBV infection, represented by HBsAg+ or anti-HBc+, had significantly better prognosis than patients without HBV infection. Patients with HBV infection should be distinguished from other ICC patients, because of their favorable outcome after surgery.
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Affiliation(s)
- Lei Zhang
- Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
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Zhang C, Tu Z, Du S, Wang Y, Wang Q. Expression of matrix metalloproteinase 2 and extracellular matrix metalloproteinase inducer are unfavorable postoperative prognostic factors in intrahepatic cholangiocarcinoma. Pathol Oncol Res 2009; 16:47-53. [PMID: 19629755 DOI: 10.1007/s12253-009-9186-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 07/06/2009] [Indexed: 11/27/2022]
Abstract
Many investigators have indicated that overexpression and amplification of matrix metalloproteinase 2 (MMP-2) and extracellular matrix metalloproteinase inducer (EMMPRIN) are independent prognostic factors for primary tumors. We studied expression of them in tissues from intrahepatic cholangiocarcinoma (IHCCA) and normal bile ducts, and discussed the occurrence and development of IHCCA. Another goal was to explore possible association of MMP-2 and EMMPRIN with clinicopathologic parameters and prognosis of IHCCA. MMP-2 and EMMPRIN expression in 106 cases of IHCCA tissues and 15 cases of normal bile ducts were examined by immunohistochemical staining. Then, the association of MMP-2 and EMMPRIN expression with clinicopathologic parameters and patients' prognosis was analyzed. The positive expression levels of MMP-2 and EMMPRIN associated significantly with various clinicopathologic risk factors, such as poor histologic differentiation (p = 0.03, 0.02), higher TNM stages (p = 0.02, 0.01) and decreased tumor-specific survival. In particular, the tumor-specific survival rate of the patients with MMP-2+/ EMMPRIN+expression was the lowest (p < 0.01). Using Cox regression analysis of the 89 patients, the conjoined expressions of MMP-2-/ EMMPRIN-, MMP-2+/ EMMPRIN +, histologic differentiation, and the clinical TNM stages of tumorous tissues were independent prognostic indicators of IHCCA (p < 0.01, p < 0.01, p = 0.02, p = 0.01 and p = 0.01, respectively). MMP-2 and EMMPRIN expression in primary tumor predicts an unfavorable prognosis in IHCCA, suggesting a crucial role of the two markers in progression of human IHCCA.
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Affiliation(s)
- Che Zhang
- Taihe Hospital, Yunyang Medical College, Shiyan, Hubei, 442000, China
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Nanashima A, Shibata K, Nakayama T, Tobinaga S, Araki M, Kunizaki M, Takeshita H, Hidaka S, Sawai T, Nagayasu T, Tagawa T. Relationship Between Microvessel Count and Postoperative Survival in Patients with Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 2009; 16:2123-9. [DOI: 10.1245/s10434-009-0494-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 04/07/2009] [Accepted: 04/08/2009] [Indexed: 12/15/2022]
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