Peripheral Intrahepatic Cholangiocarcinoma Research Articles

The impact of tumor location on the value of lymphadenectomy for intrahepatic cholangiocarcinoma

BackgroundThe therapeutic role of lymphadenectomy (LND) for intrahepatic cholangiocarcinoma (ICC) patients remains ill-defined. We sought to analyze the therapeutic value of LND relative to tumor location and preoperative lymph node metastasis (LNM) risk. MethodsPatients who underwent curative-intent hepatic resection of ICC between 1990 and 2020 were included from a multi-institutional database. Therapeutic LND (tLND) was defined as LND that harvested ≥3 lymph nodes. ResultsAmong 662 patients, 178 (26.9%) individuals received tLND. Patients were categorized into central type ICC (n = 156, 23.6%) and peripheral type ICC (n = 506, 76.4%). Central type harbored multiple adverse clinicopathologic factors and worse overall survival (OS) compared with peripheral type (5-year OS, central: 27.0% vs. peripheral: 47.2%, p < 0.001). After consideration of preoperative LNM risk, patients with central type and high-risk LNM who underwent tLND survived longer than individuals who did not (5-year OS, tLND: 27.9% vs. non-tLND: 9.0%, p = 0.001), whereas tLND was not associated with better survival among patients with peripheral type ICC or low-risk LNM. The therapeutic index of hepatoduodenal ligament (HDL) and other regions was higher in central type than in peripheral type, which was more pronounced among high-risk LNM patients. ConclusionsCentral type ICC with high-risk LNM should undergo LND involving regions beyond the HDL.

CT and MRI Diagnosis and Clinical Analysis of Intrahepatic Peripheral Cholangiocarcinoma

CT and MRI Diagnosis and Clinical Analysis of Intrahepatic Peripheral Cholangiocarcinoma

Predicting prognosis and evaluating the benefits of adjuvant chemotherapy depending on the tumor location in intrahepatic cholangiocarcinoma: focusing on the involvement of below 2nd bile duct confluence.

PurposeIntrahepatic cholangiocarcinoma (ICC) has various characteristics according to anatomical, histologic classifications, and its prognoses are different. This study aimed to compare oncologic outcomes according to tumor location (second bile duct confluence) and evaluate the effect of adjuvant chemotherapy.MethodsClinical data of 318 patients who underwent curative resection for ICC was reviewed. Central type ICC (C-ICC) and peripheral type ICC (P-ICC) were defined when the tumor invades the intrahepatic secondary biliary confluence and when located more peripherally, respectively.ResultsA larger tumor size, higher rate of elevated CA 19-9 level, vascular invasion, R1 resection, advanced T stage, and lymph node metastasis were found in C-ICC. C-ICC had poorer overall survival (median, 33 months vs. 58 months; P = 0.001), and the difference was more prominent in the early stage. C-ICC had a higher recurrence rate (68.7% vs. 55.1%, P = 0.014); otherwise, there was no difference in the recurrence patterns. There were no survival benefits of adjuvant chemotherapy in the entire cohort, but there were benefits in advanced stages (T3–4, N1 stage), especially in C-ICC.ConclusionC-ICC has more aggressive tumor characteristics and poor survival compared to P-ICC. Adjuvant chemotherapy seems to have survival benefits in the advanced stages, especially in the central type.

Impact of lymph node dissection on clinical outcomes of intrahepatic cholangiocarcinoma: Inverse probability of treatment weighting with survival analysis.

BackgroundLymph node metastasis (LNM) has been established as a critical risk factor for prognosis in intrahepatic cholangiocarcinoma (ICC). The clinical implications of lymph node dissection (LND) have been debated. This study aimed to clarify the prognostic impact of LND by multicenter retrospective analysis.MethodsA total of 310 ICC patients who had undergone curative resection between 2000 and 2016 were retrospectively analyzed. The prognostic impact of LND was estimated under an inverse probability of treatment weighting (IPTW) approach using propensity scores.ResultsLND was performed for 224 patients (72%), with LNM pathologically confirmed in 90 patients (40%). Prognosis was poorer for patients with LNM (median survival, 16.9 months) than for those without (57.2 months; P < .0001). One‐, 3‐, and 5‐year overall survival rates (OS) were comparable among LND+ (81.6%, 48.0%, and 37.5%, respectively) and LND– groups (81.6%, 55.4%, and 44.6%, respectively). However, advanced tumor, as characterized by larger tumor, multinodular lesions, and serosal invasion, was significantly more frequent in the LND+ group than in the LND– group. After IPTW adjusting for imbalances, 1‐, 3‐, and 5‐year OS were better in the LND+ group (83.5%, 52.2%, and 42.8%, respectively) than in the LND– group (71.9%, 32.4%, and 23.4%, respectively; P = .046). LND thus showed significant prognostic impact (hazard ratio = 0.58, 95%CI = |0.39|–|0.84|, P = .005), especially in hilar ICC. However, peripheral ICC displayed no therapeutic benefit from LND.ConclusionsLND could have a significant role to play in improving oncologic outcomes. Therapeutic LND should be implemented on the basis of tumor location and tumor advancement.

Clinical implication of tumor location in intrahepatic cholangiocarcinoma and assessment of the current staging system

Intrahepatic cholangiocarcinoma (ICC) exhibits a variety of morphologic and histologic growth pattern, and its treatment and prognosis are known to vary depending on the location and extent of tumor. This study aims to compare the clinical data according to the tumor location in ICC and to verify the current staging system used in ICC. 302 patients who underwent curative resection were reviewed. Central type ICC (C-ICC) was defined when the tumor had an invasion of intrahepatic secondary confluence or segmental branches of the bile duct and peripheral type ICC (P-ICC) when the tumor was located more peripherally. Clinicopathologic characteristics, oncological outcomes, and prognostic stratification of the AJCC 8th staging system were assessed. Among 302 patients, 123 were classified as C-ICC and 179 as P-ICC. Bigger tumor size, higher rate of elevated CA19-9 level, vascular invasion, periductal invasion type, R1 rate, and advanced T stage was found in C-ICC. Five-year overall survival rates were 34.0% for C-ICC and 47.5% for P-ICC (p = 0.005). A significant difference in disease-free survival was seen as well (p = 0.036). The prognostic utility of ICC T stage was assessed in N0 C-ICC but failed to stratify T2, T3, and T4 tumors (median survival; T2: 37 m. T3: 34 m. T4: 33 m. p = 0.591). When applying the perihilar cholangiocarcinoma staging system (p < 0.001), stratification was improved and similar results were also seen in the overall staging. C-ICC has a worse aggressive clinical course compared to P-ICC. The perihilar cholangiocarcinoma cancer staging system is better than ICC staging to stratify the prognosis of C-ICC.

Investigation of a Tumor Location-Specific Therapeutic Strategy for Intrahepatic Cholangiocarcinoma.

Objective:An optimal therapeutic strategy for intrahepatic cholangiocarcinoma (ICC) has not yet been determined. Herein we focused on intrahepatic tumor location and retrospectively analyzed tumor characteristics depending on location to elucidate a location-specific therapeutic strategy for ICC. Methods:Sixty-five ICC patients were divided into three groups based on the distance between the innermost portion of the tumor and portal vein branches observed on preoperative imaging: peripheral, intermediate and central ICC. Results:Median disease-specific survival (DSS) of the peripheral ICC was not reached, whereas median DSS was 32.9 months in intermediate ICC and 25.2 months in central ICC (p <0.05). Vascular invasion was observed in all groups (56-92%). Bile duct invasion to the first branch of the hepatic duct was more commonly observed in central ICC (43%) compared with the peripheral and intermediate ICC (0-8%). Lymph node metastasis was not observed in peripheral ICC, whereas it was frequently observed in intermediate and central ICC (39-44%). A Cox regression analysis revealed sufficient RDI (≥58.3%) of adjuvant chemotherapy (AC) significantly increased the length of DSS (HR: 0.205). Based on these data, we have proposed a location-specific therapeutic strategy as follows: peripheral ICC requires anatomical resection without lymphadenectomy; intermediate ICC requires anatomical resection with lymphadenectomy and sufficient doses of AC; and central ICC requires anatomical resection with extrahepatic bile duct resection, caudate lobectomy, lymphadenectomy, and sufficient doses of AC. Conclusion:We propose an intrahepatic tumor location-specific therapeutic strategy for ICC. This information could contribute to the appropriate therapeutic management of patients with ICC.

Invasion category-oriented lymph node metastases of cholangiocarcinoma and the prognostic impact.

It was speculated that intrahepatic cholangiocarcinoma (ICC) invasion would influence cancer progression, such as lymph node (LN) metastasis, and the efficacy of LN dissection (LND). The purpose of this study is to evaluate the LN metastatic pattern of intrahepatic cholangiocarcinoma, including the invasion category and prognosis after surgical resection, in order to explore effective LND. We analyzed a prospectively collected cohort for ICC with a previously reported invasion category: hilar type, showing invasion to the main or first branch of Glisson; peripheral type, showing no invasion to less than the third branch; and intermediate type, for all others. Data from a total of 180 patients who underwent surgical resection were analyzed (LN dissection in 142 (79%)). In single ICC, hilar type had a higher LN metastatic rate than the others (hilar; 23/45 (51%), intermediate; 7/25 (28%), peripheral; 1/34 (3%)). Although the survival with LN metastasis (LN+) was worse, single and hilar/intermediate ICC LN+ had a better survival than peripheral type LN+ (3-year OS: hilar/intermediate 30-37%, peripheral 0%). The most frequent LN metastatic region was the hepatico-duodenal ligament for all invasion categories, and the LN metastatic region was not related to the survival. In peripheral ICC, LND did not affect the survival. By contrast, hilar/intermediate ICC LN+ had a better survival than did peripheral ICC LN+, and the 3-year OS was ≥ 20%. LN metastasis depended on the ICC invasion category in addition to the tumor number, which affected patients' survival and the need for LND. In hilar-type disease, LN dissection may contribute to the survival.

Difference in driver gene expression patterns between perihilar and peripheral intrahepatic cholangiocarcinoma in an experimental mouse model.

The prognosis of intrahepatic cholangiocarcinoma (ICC) is based on tumor localization; however, the mechanism remains unknown. Therefore, we investigated the biological characteristics of perihilar and peripheral ICC in a mouse model. The model was established by the administration of three oncogenic plasmids harboring myristoylated AKT, mutated human YAP, and pCMV-Sleeping Beauty into the mice. The perihilar and peripheral ICC tumors that developed in the same mouse were assessed for the expression of cell adhesion factors and driver genes with immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR). The perihilar ICC tumors were irregularly shaped, whereas the peripheral tumors were mostly circular, similar to the differences found in patients. Alpha-smooth muscle actin was strongly expressed in the perihilar tumors at 10weeks, and vimentin expression was significantly up-regulated in the perihilar ICC at 14weeks. Fgfr2 level significantly increased in peripheral ICC at 10weeks, whereas Idh2 expression was up-regulated in perihilar ICC. Despite diffuse injection of oncogenic plasmid, expression of driver genes and oncogenes in ICC tumor cells differs depending on the tumor localization, resulting in changes in epithelial-mesenchymal transition, which may explain the different outcomes of patients with peripheral and perihilar ICC.

Comparison of the Clinicopathological Features and Survival in Small Bile Duct Type and Bile Ductular Type Intrahepatic Cholangiocarcinoma

Background: Intrahepatic cholangiocarcinoma (ICC) is anatomically divided into the perihilar subtype and the peripheral subtype. Peripheral ICC can be further classified into the small bile duct type and bile ductular type based on the pathological findings.The small bile duct type was considered to have the nature of conventional ICC, such as tubular and micropapillary carcinoma with desmoplastic variation and this may have different features from the bile ductular type characterized by bile ductular features with slit-like lumen. However, the differentiation of the clinicopathological features between small bile duct and bile ductular type ICC, which were anatomically categorized as the same peripheral type, has not been well defined.

Cystic Degeneration of Peripheral Intrahepatic Cholangiocarcinoma: An Atypical Presentation

Cholangiocarcinomas are primary malignant tumors of the liver that arises from the epithelium lining the small intra and extrahepatic bile ducts, and has numerous histologic types and growth patterns. At computed tomography (CT) and magnetic ressonance (MR), it has various appearences which motivated the present study; we present a case within an atypical presentation. The objective is to show the variety of differential diagnoses before an atypical aspect and the importance of the imaging methods for the diagnosis. Cholangiocarcinoma is still an uncommon neoplasm, and CT and MR are crucial for accurate diagnosis and for differentiation from other hepatic tumorous and nontumorous lesions.

Contrast-enhanced ultrasonography appearances of intrahepatic peripheral cholangiocarcinoma

Objective To investigate the contrast-enhanced ultrasonography appearances characteristics of intrahepatic peripheral cholangiocarcinoma(ICC) and to improve the diagnosis level of ICC on contrast-enhanced ultrasonography. Methods Thirty cases with ICC confirmed by pathological examinations of surgeries were retrospectively analyzed for findings of ultrasonography, clinic and pathology, to explore the typical contrast-enhanced ultrasonography appearances and the correlation with pathological differentiation. Results On contrast-enhanced ultrasonography, 30 lesions showed enhancement on the arterial phase and appeared hypo-echoic enhancement on the portal phase, which displayed fast-in and fast-out enhancement pattern. During the hepatic arterial phase of contrast-enhanced ultrasonography, 10 lesions showed peripheral enhancement, 10 lesions showed relatively homogeneous hyper-enhancement, 6 lesions showed heterogeneous enhancement, 2 lesions showed iso-enhancement, and 2 lesions showed hypo-enhancement. To the 30 lesions, the average initial time of enhancement was (18.81±4.66)s (12-28 s), the average time of washing-out was (36.00±12.30)s (18-60 s). There was no significant difference in time of washing-in and washing-out among different pathological differentiation groups(P>0.05). Conclusions ICC often shows fast-in and fast-out enhancement pattern on contrast-enhanced ultrasonography, and the time of washing-out is generally in late arterial phase or early portal phase, but there is no significant difference in time of washing-in and washing-out among different pathological differentiation groups. Key words: Contrast-enhanced ultrasonography; Intrahepatic peripheral cholangiocarcinoma

Locoregional Therapy With Transarterial Chemoembolization (TACE) for Stage 1A Intrahepatic Cholangiocarcinoma (ICC) Before Surgical Resection: A Case Report

Intrahepatic cholangiocarcinoma is usually treated by hepatic resection to achieve negative resection margins but only minority of patients present with early stage disease. Hepatic artery based therapies such as radioembolization (TACE) is used for locally advanced unresectable disease. We present a case of stage 1A localized ICC treated with TACE followed by radiotherapy with possible liver resection in the future. A 42 year old male with history of alcohol use disorder, diabetes mellitus and hypertension came in with right upper quadrant abdominal pain. Abdominal examination was significant for distended abdomen with epigastric tenderness. Labs revealed alanine transaminase (ALT) 72 U/L, aspartate transaminase (AST) 79 U/L, platelet count 132 k/uL, and INR of 1.0. He had a sonogram of the liver which revealed a complex left hepatic lobe lesion with peripheral vascularity, so magnetic resonance imaging (MRI) of abdomen was done which showed cirrhosis with portal hypertension and 2.6 x 2.3 cm lesion involving segment II and III (Figure 1). His viral hepatitis panel was negative, and CA 19-9 was 36.8 U/ml. He underwent EGD and colonoscopy which revealed no mass. Interventional radiology (IR) guided liver biopsy of mass ICC. Patient underwent IR guided TACE with 75 mg of Doxorubicin beads administered into segmental branch of right hepatic artery the tumor (Figure 2) followed by split beam radiation therapy (SBRT). Repeat CT scan of abdomen done 7 months post TACE has not shown recurrent disease (Figure 3).2328_A Figure 1. MRI abdomen showing 2.6 x 2.3 cm lesion involving segment II and III of liver (red arrow) before TACE procedure2328_B Figure 2. Cone beam CT imaging (right) during TACE procedure showing chemotherapy beads being administered near tumor site by catheter (red arrow) & contrast enhancement of tumor site (left) on digital subtraction angiography (DSA) imaging.2328_C Figure 3. CT abdomen showing post treatment tumor with surrounding peripheral region of hyper density representing post TACE changes (red arrow).Intrahepatic tumors derive blood supply from hepatic artery rather than portal vein. This has led to development of TACE which involves elimination of tumor's blood supply by particle embolization and/or cytotoxic chemotherapy infusion into the branch of hepatic artery that feeds the tumor. Such therapies, particularly radioembolization, appear promising for patients with locally advanced unresectable ICC. Partial hepatectomy is the treatment of choice for small peripheral ICC. In our case due to patient's current heavy alcohol use and compensated cirrhosis, partial hepatectomy was thought to confer a very high risk for hepatic decompensation postoperatively. So, he was successfully treated with TACE followed by radiotherapy, with plan of left hepatic resection once he is abstinent from alcohol. Our case demonstrates the effectiveness of TACE for ICC which cannot undergo partial liver resection due to his alcoholic cirrhosis.

Laparoscopic Hilar Lymph Node Sampling in Patients With Biliary Tract Cancers That are Rarely Associated With Nodal Metastasis

Among the various types of biliary tract cancer, patients with single, small (<5 cm), peripheral intrahepatic cholangiocarcinoma (ICC), or small (<2 cm) gallbladder tumors (GBTs) rarely develop lymph node (LN) metastasis. We investigated a laparoscopic approach for hilar LN sampling in such cases. Among the 176 patients with biliary tract cancer who were treated from January 2012 to March 2017, 21 (ICC, n=4; GBT, n=17) met the above indications. All patients were treated by a laparoscopic approach with R0 resection. After determining the pathologic diagnosis, 9 patients with GBT and all 4 patients with ICC underwent laparoscopic LN sampling; the mean numbers of sampled LNs were 2.6 and 7.3, respectively; no patients had metastasis. The mean operating times for GBT and ICC were 223 and 379 minutes, respectively; the mean blood loss was 23 mL and 171 mL. With the exception of 1 patient who developed intrahepatic metastasis of ICC at the opposite liver lobe, all of the patients were recurrence free. A laparoscopic approach could be safely applied under our indications.

Perioperative and long-term outcome of intrahepatic cholangiocarcinoma involving the hepatic hilus after curative-intent resection: comparison with peripheral intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma

BackgroundIntrahepatic cholangiocarcinoma with hepatic hilus involvement has been either classified as intrahepatic cholangiocarcinoma or hilar cholangiocarcinoma. The present study aimed to investigate the clinicopathologic characteristics and short- and long-term outcomes after curative resection for hilar type intrahepatic cholangiocarcinoma in comparison with peripheral intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma. MethodsA total of 912 patients with mass-forming peripheral intrahepatic cholangiocarcinoma, 101 patients with hilar type intrahepatic cholangiocarcinoma, and 159 patients with hilar cholangiocarcinoma undergoing curative resection from 2000 to 2015 were included from two multi-institutional databases. Clinicopathologic characteristics and short- and long-term outcomes were compared among the 3 groups. ResultsPatients with hilar type intrahepatic cholangiocarcinoma had more aggressive tumor characteristics (eg, higher frequency of vascular invasion and lymph nodes metastasis) and experienced more extensive resections in comparison with either peripheral intrahepatic cholangiocarcinoma or hilar cholangiocarcinoma patients. The odds of lymphadenectomy and R0 resection rate among patients with hilar type intrahepatic cholangiocarcinoma were comparable with hilar cholangiocarcinoma patients, but higher than peripheral intrahepatic cholangiocarcinoma patients (lymphadenectomy incidence, 85.1% vs 42.5%, P < .001; R0 rate, 75.2% vs 88.8%, P < .001). After curative surgery, patients with hilar type intrahepatic cholangiocarcinoma experienced a higher rate of technical-related complications compared with peripheral intrahepatic cholangiocarcinoma patients. Of note, hilar type intrahepatic cholangiocarcinoma was associated with worse disease-specific survival and recurrence-free survival after curative resection versus peripheral intrahepatic cholangiocarcinoma (median disease-specific survival, 26.0 vs 54.0 months, P < .001; median recurrence-free survival, 13.0 vs 18.0 months, P = .021) and hilar cholangiocarcinoma (median disease-specific survival, 26.0 vs 49.0 months, P = .003; median recurrence-free survival, 13.0 vs 33.4 months, P < .001). ConclusionMass-forming intrahepatic cholangiocarcinoma with hepatic hilus involvement is a more aggressive type of cholangiocarcinoma, which showed distinct clinicopathologic characteristics, worse long-term outcomes after curative resection, in comparison with peripheral intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma.

Intrahepatic peripheral cholangiocarcinoma misdiagnosised by imaging: a case report

Intrahepatic peripheral cholangiocarcinoma misdiagnosised by imaging: a case report

ROLE OF MULTIPHASE STUDY OF LIVER LESIONS ON 128 SLICE DUAL SOURCE COMPUTED TOMOGRAPHY WITH CYTOLOGY OR HISTOPATHOLOGICAL CORRELATION

Introduction: Dual source Multidetector Computed Tomography (MDCT) provides multiphase study of various liver lesions for better detection and characterization. This study aims to detect and characterize the liver lesions in multiphase Computed Tomography (CT) with cytological and histopathological correlation to confirm the diagnosis. Material and Methods: This cross-sectional study included 65 patients who were referred to the Radiology Department of Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India with clinical features jaundice, pain in abdomen, nausea and vomiting. All patients were evaluated by five phase CT (unenhanced, early and late arterial, portal venous and delayed scan)of liver with Siemens128 slice dual source spiral CT. Protocols with a scan delay of 06 seconds, 09 seconds, 45 seconds and 180-300 secondsfrom contrast bolus was preselected for early and late arterial, portovenous and delayed scans. Results: Sixty five (age 10yrs- 90yrs) patients were included in the study. Most common neoplasm was metastases 33(51%).Hepatocellular carcinoma (HCC) were 18(28%), hemangioma 10(15%), peripheral intrahepatic cholangiocarcinoma 1and 3 were nonneoplastic which included hepatic abscesses and hydatid cyst.Most common pattern of enhancement of metastasis in arterial phase was hypodense with peripheral enhancement and most were hypodense in portal venous phase. Portal venous phase had highest grade for hypovascular metastases and arterial phase had high grade to detect hypervascular metastasis. Delayed scan was better for smaller lesions less than 1cm.The sensitivity to detect metastases was 94%. Most common pattern of enhancement in HCC (variegated or heterogeneous enhancementin arterial phase with rapid washout in the portal venous phase. Total sensitivity to detect HCC was 83.3%. Hemangioma showed peripheral globular enhancement in arterial phase. In portal venous and delayed phase showed progressive enhancement with more centripetal filling. Sensitivity was 90% in case of hemangiomas. Conclusion: Multiphasic CT scan is a good non-invasive tool and can be used as first line imaging modality for differentiating benign and malignant liver lesions.

Clinical Significances of Preoperative Classification of Intrahepatic Cholangiocarcinoma: Different Characteristics of Perihilar vs. Peripheral ICC.

The aim of this study was to evaluate the clinical significance of preoperative classification of intrahepatic cholangiocarcinoma (ICC) into perihilar and peripheral types using dynamic computed tomography (CT). A retrospective cohort study was performed to analyze the differences in clinical characteristics between perihilar and peripheral ICC samples from patients between 1990-2014. A total of 87 patients were divided into three ICC subtypes; perihilar (n=34), peripheral (n=44), and unclassifiable ICC (n=9). The positive rates of pathological lymphatic infiltration (ly) (p=0.02) and perineural invasion (pn) (p<0.0001) were significantly higher in perihilar ICC. There was no significant difference in the disease-free survival rate (p=0.2268); however, the overall survival rate of perihilar ICC was significantly worse (p=0.0031). The rate of systemic recurrence (>3 nodules) was significantly higher in perihilar ICC (p=0.0135). In perihilar ICC, the local tumor invasions such as ly and pn were more frequent. Therefore, it is important in such cases to attempt to achieve a sufficient tumor margin. Systemic recurrences were more frequent in perihilar ICC, so perioperative chemotherapy should be conducted as well.

Role of 18F-FDG PET/CT Imaging in Intrahepatic Cholangiocarcinoma.

Although intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy after hepatocellular carcinoma, there are limited data available on PET/CT imaging in ICC. This retrospective study analyzed the role of PET/CT imaging in the evaluation of ICC. FDG PET/CT findings were reviewed in 65 patients with histologically confirmed ICC. PET/CT was evaluated based on visual interpretation and the semiquantitative index of SUVmax and tumor-to-normal liver tissue ratio (TNR), which were consequently further analyzed and correlated with tumor localization, differentiation, size, and serum levels of tumor markers. Forty-five cases also underwent abdominal MRI examinations. Nineteen patients had hilar ICC, whereas 46 patients had peripheral ICC. Sixty cases of ICC showed elevated FDG uptake with an average SUVmax of 8.3 ± 4.7 and TNR of 3.1 ± 1.7. Five cases located in the hilum were false negative on PET/CT imaging. Compared with hilar ICC, SUVmax and TNR of peripheral ICC were significantly higher (P < 0.05). FDG accumulation correlated with the degree of ICC differentiation. SUVmax and TNR correlated with tumor size, whereas there was no correlation observed with serum levels of carbohydrate antigen 19-9. The sensitivity, specificity, and accuracy of PET/CT and MRI in the diagnosis of regional lymph node metastases were 70.0% versus 50%, 91.7% versus 83.3%, and 81.8% versus 68.2%, respectively. PET/CT upstaged 12.3% and downstaged 3.1% of cases and had no impact on patient management in the remaining 84.6% of cases. Combination of FDG PET/CT and abdominal MRI might improve the diagnostic accuracy for ICC.

MRI characteristics and pathological correlation regarding the intrahepatic cholangiocarcinoma without cholangiectasis

Objective To studying the MR findings and pathology of peripheral small intrahepatic cholangiocarcinoma and improving the understanding of peripheral small cholangiocarcinoma with no-bile duct dilatation. Methods A retrospective analysis of 12 patients with intrahepatic peripheral cholangiocarcinoma which were confirmed by surgery and pathology, all patients were examined by abdominal MRI without and with contrast. Correlation was made with gross pathology and surgical pathological specimen. Results On T1WI, there were 4 cases of complex low signal intensity and 8 cases of low signal intensity. On T2WI, there were 8 cases of high signal intensity and 4 cases of complex high signal intensity. Enhanced MRI showed: marked nidus enhancement on arterial phase in 1 case, and the pathological diagnosis was poorly differentiated adenocarcinoma. Inhomogeneous enhancement or annular enhancement were seen in 10 cases on arterial phase, 3 of these cases showed thin annular enhancement on arterial phase, low signalintensity on portal venous phase and isointensity on delayed phase. One case showed delayed enhancement. Thick circular enhancement correlated with pathological changes of survival of tumor cells, center areas correlated with fibrous connective tissue, and a small amount of necrotic tissue. Island-like enhancement or inhomogeneous enhancement were seen in 3 cases. Corresponding pathological changes consisted of tumor tissue and a small amount of fibrous connective tissue, as well as somenecrotic tissue. In 1 case, no enhancement was seen on all three phases and pathological changes showed cystic changes, hemorrhage, necrosis, with survival tumor cells seen between cyst and normal liver tissue. Conclusions MRI scanning of peripheral small cholangiocarcinoma lacked characteristic features, but dynamic contrast-enhanced MR had certain specific findings. Due to different pathology, the fibrous tissue, necrotic tissue and survival tumor tissue components were exhibited different imaging findings. Key words: Bile duct neoplasms; Magnetic resonance imaging; Pathology

Tubulin β-III: a novel immunohistochemical marker for intrahepatic peripheral cholangiocarcinoma.

Our recent proteomic study identified tubulin β-III (TUBB3) as a potential tissue marker for intrahepatic cholangiocarcinomas (CCs). This validation study was conducted to see whether or not TUBB3 can serve as a novel immunohistochemical marker for peripheral CCs, using a large cohort (n=197) covering various liver tumours and premalignant conditions. Immunostaining using a monoclonal antibody demonstrated TUBB3 expression in 14/28 cases of peripheral CCs (50%), while its expression was significantly less common in perihilar CCs (6/40, 15%) (P=0.002). No significant difference was identified in clinicopathological features between TUBB3-positive and -negative cases. TUBB3 expression was entirely negative in hepatocellular carcinomas, biliary premalignant lesions (i.e., biliary intraepithelial neoplasias, intraductal papillary neoplasms), peribiliary gland hamartomas (bile duct adenomas), and non-neoplastic biliary epithelium. TUBB3 expression was only focally noted in 2/12 cases of mixed hepatocellular and cholangiocarcinomas (<10% of cancer cells). Compared with other biliary (CK7 and CK19) and malignant markers (p53 and MUC1), TUBB3 was less sensitive but more specific for peripheral CCs. TUBB3 was also expressed in 40% of metastatic colorectal or breast cancers. This study revealed that TUBB3 is a moderately sensitive and highly specific tissue marker for discriminating peripheral CCs from other primary liver tumours.