A clinical study of 11 cases of combined hepatocellular–cholangiocarcinomaAssessment of enhancement patterns on dynamics computed tomography before resection

Abstract

: The aim of this study was to identify computed tomography features that contribute to clinical diagnosis of hepatocellular-cholangiocarcinoma. : We retrospectively reviewed the clinicopathologic features of 11 patients who underwent hepatectomy for hepatocellular-cholangiocarcinoma between January 1994 and December 2003 at Hiroshima City Hospital and investigated correlation of histopathologic features of surgical specimens with preoperative enhanced computed tomography findings. : Three computed tomography enhancement patterns were observed: an area of hyperenhancement in the early phase and hypoenhancement due to washout of contrast medium in the late phase, resembling hepatocellular carcinoma (Type I, n=4); peripheral enhancement in the early and late phases (Type II, n=2); an area of hyperenhancement in the early phase and an area of slight delayed enhancement in the late phase (Type III, n=4). Histopathologically, all tumors were of mixed morphology (Allen's Type C) comprising hepatocellular carcinoma and cholangiocarcinoma components with transitional features. Computed tomography findings conformed well to pathologic findings. The hepatocellular carcinoma component was predominant in Type I masses. Type II masses showed central necrosis. In Type III masses, the hepatocellular carcinoma-predominant component corresponded to the area of early-phase enhancement and the cholangiocarcinoma-predominant component to the area of late-phase enhancement. : In Type III tumors, hepatocellular and cholangiocellular components can be identified on the basis of dynamic computed tomography enhancement pattern.