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Cholangiocarcinoma: Morphologic Classification According to Growth Pattern and Imaging Findings

¹ Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, South Korea.

View larger version (6K): [in a new window]   Fig. 1A. —Morphologic classification of intrahepatic and extrahepatic cholangiocarcinoma. Tubule represents bile duct. Drawings show mass-forming (A), periductal-infiltrating (B), and intraductal-growing (C) cholangiocarcinomas.

View larger version (4K): [in a new window]   Fig. 1B. —Morphologic classification of intrahepatic and extrahepatic cholangiocarcinoma. Tubule represents bile duct. Drawings show mass-forming (A), periductal-infiltrating (B), and intraductal-growing (C) cholangiocarcinomas.

View larger version (5K): [in a new window]   Fig. 1C. —Morphologic classification of intrahepatic and extrahepatic cholangiocarcinoma. Tubule represents bile duct. Drawings show mass-forming (A), periductal-infiltrating (B), and intraductal-growing (C) cholangiocarcinomas.

View larger version (95K): [in a new window]   Fig. 2. —Mass-forming intrahepatic cholangiocarcinoma. Photograph of gross pathologic specimen shows whitish mass with extensive desmoplastic change. Margin is irregular but sharply circumscribed. Note peritumoral satellite masses (arrows). Also note small central hemorrhagic necrosis.

View larger version (132K): [in a new window]   Fig. 3. —58-year-old woman with mass-forming intrahepatic cholangiocarcinoma. CT scan shows lobulated tumor with sharp but irregularly rolled margin in right hepatic lobe.

View larger version (124K): [in a new window]   Fig. 4. —57-year-old man with mass-forming intrahepatic cholangiocarcinomas. CT scan shows irregularly shaped mass with peripheral enhancement. Note three small peritumoral satellite nodules (arrow).

View larger version (116K): [in a new window]   Fig. 5. —Periductal-infiltrating hilar cholangiocarcinoma. Photograph of resected left hepatic lobe shows infiltrating cancer along left hepatic duct (arrows). Scale increments are 5 mm.

View larger version (141K): [in a new window]   Fig. 6A. —55-year-old man with periductal-infiltrating intrahepatic and extrahepatic cholangiocarcinoma. Endoscopic retrograde cholangiogram shows diffuse narrowing (arrows) of right and left hepatic ducts and extrahepatic duct. Note complete obstruction of posterior segmental bile ducts of right lobe.

View larger version (135K): [in a new window]   Fig. 6B. —55-year-old man with periductal-infiltrating intrahepatic and extrahepatic cholangiocarcinoma. CT scan obtained at portal venous phase shows left intrahepatic bile duct dilatation (curved arrow) and obliteration of bile ducts in right hepatic lobe and hepatic hilum. Ill-defined, branchlike, low-attenuating mass (straight arrows) represents periductal infiltrating intrahepatic cholangiocarcinoma.

View larger version (121K): [in a new window]   Fig. 7A. —53-year-old man with intraductal growing intrahepatic cholangiocarcinoma. Contrast-enhanced CT scan shows aneurysmally dilated left hepatic bile ducts containing multiple fungating tumors and fluid in between. Peripheral bile ducts (arrow) are dilated.

View larger version (153K): [in a new window]   Fig. 7B. —53-year-old man with intraductal growing intrahepatic cholangiocarcinoma. Endoscopic retrograde cholangiogram shows diffuse dilatation of intraand extrahepatic bile ducts. Elongated filling defect in extrahepatic duct represents mucin (solid arrows). Note irregular filling defect in disproportionately dilated left intrahepatic duct representing fungating papillary tumor (open arrow).

View larger version (66K): [in a new window]   Fig. 7C. —53-year-old man with intraductal growing intrahepatic cholangiocarcinoma. Photograph of gross pathologic specimen shows large fungating papillary tumors (arrow) in aneurysmally dilated intrahepatic bile duct. Bile duct wall has been thickened but not invaded by tumor. There was excessive mucin in bile ducts at surgery.

View larger version (132K): [in a new window]   Fig. 8A. —71-year-old man with mass-forming extrahepatic cholangiocarcinoma. Endoscopic retrograde cholangiogram shows short segmental asymmetric narrowing due to mass (arrow) at common hepatic duct.

View larger version (137K): [in a new window]   Fig. 8B. —71-year-old man with mass-forming extrahepatic cholangiocarcinoma. Tube cholangiogram via drainage catheter obtained 7 months after A shows amputation of common hepatic duct representing obstruction by tumor.

View larger version (151K): [in a new window]   Fig. 8C. —71-year-old man with mass-forming extrahepatic cholangiocarcinoma. Sonogram of common hepatic duct shows nodular mass measuring 1.5 cm. Note obliteration of echogenic wall of common hepatic duct indicating periductal invasion.

View larger version (52K): [in a new window]   Fig. 9. —Photomicrograph of histopathologic specimen from resected common hepatic duct shows well-differentiated adenocarcinoma replacing mucosa, submucosa, muscle layer (solid arrows), and serosa. Tumor spreads longitudinally along extrahepatic duct via lymphatics and perineural tissue, resulting in concentric layering of cellular stroma, neoplastic glands, and split muscle layers. Open arrows represent mucosal side. (H and E, x1)

View larger version (136K): [in a new window]   Fig. 10A. —61-year-old woman with periductal-infiltrating extrahepatic cholangiocarcinoma. Tube cholangiogram shows diffuse severe narrowing of extrahepatic duct.

View larger version (159K): [in a new window]   Fig. 10B. —61-year-old woman with periductal-infiltrating extrahepatic cholangiocarcinoma. CT scan shows severe dilatation of extrahepatic duct and asymmetric thickening of wall (arrow).

View larger version (138K): [in a new window]   Fig. 10C. —61-year-old woman with periductal-infiltrating extrahepatic cholangiocarcinoma. CT scan obtained through extrahepatic duct shows encircling wall-thickening with enhancement (arrow) and obliteration of lumen.

View larger version (116K): [in a new window]   Fig. 11A. —72-year-old man with intraductal-growing intra- and extrahepatic papillary cholangiocarcinomatosis. Contrast-enhanced CT scan shows asymmetric thickening of bile duct wall (arrow) and intraluminal mass representing tumor.

View larger version (109K): [in a new window]   Fig. 11B. —72-year-old man with intraductal-growing intra- and extrahepatic papillary cholangiocarcinomatosis. Tube cholangiogram shows severe irregularity and tiny filling defects in right and left hepatic ducts as well as extrahepatic ducts representing papillary carcinomatosis (arrows).

View larger version (143K): [in a new window]   Fig. 11C. —72-year-old man with intraductal-growing intra- and extrahepatic papillary cholangiocarcinomatosis. Photograph of cholangioscopic finding shows tiny, innumerable masses in lumen of bile ducts.

View larger version (6K): [in a new window]   Fig. 12A. —Growing patterns of intrahepatic mass-forming cholangiocarcinoma. Drawings show main tumor and peritumoral satellite nodules caused by portal vein tumor thrombosis (A) and growth of tumor caused by fusion of growing satellite nodules (B).

View larger version (34K): [in a new window]   Fig. 12B. —Growing patterns of intrahepatic mass-forming cholangiocarcinoma. Drawings show main tumor and peritumoral satellite nodules caused by portal vein tumor thrombosis (A) and growth of tumor caused by fusion of growing satellite nodules (B).

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