Investig Magn Reson Imaging.  2015 Mar;19(1):47-51. 10.13104/imri.2015.19.1.47.

Image Findings of Sarcomatous Intrahepatic Cholangiocarcinoma Focused on Gd-EOB-DTPA Enhanced MRI: A Case Report

• Kim KB
• Kim SH

• KMID: 2175576
• DOI: http://doi.org/10.13104/imri.2015.19.1.47

Abstract

Sarcomatous Intrahepatic cholangiocarcinoma is a rare but an aggressive variant of cholangiocarcinoma with a very poor prognosis. A 79-year-old man was admitted to our hospital because of incidentally found liver mass. Magnetic resonance imaging (MRI) revealed well-defined hypointense mass on T1WI and heterogeneous hyperintense mass on T2WI. Gd-EOB-DTPA enhanced study shows peripheral rim-like enhancement in arterial phase and progressive concentric filling of contrast in delayed phase. And mass shows significant enhancement in hepatobiliary phase. The pathologic diagnosis was intrahepatic cholangiocarcinoma with sarcomatous change.

Keyword

Sarcomatous intrahepatic cholangiocarcinoma; Sarcomatous transformation; Cholangiocarcinoma; Computed tomography; Magnetic resonance imaging; Hepatobiliary phase

MeSH Terms

Aged
Cholangiocarcinoma*
Diagnosis
Humans
Liver
Magnetic Resonance Imaging*
Prognosis

Figure

• 

  Fig. 1 A hypoattenuating mass in right posterior segment of the liver is shown on abdominal dynamic computed tomography pre (a), arterial (b) and portal phase (c) images. The mass has thin peripheral enhancement in arterial phase and concentric filling of contrast media in portal phase.

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  Fig. 2 Magnetic resonance (MR) imaging. An axial T1-weighted image (WI) shows a well-defined hypointense mass (a) and T2WI shows heterogeneous hyperintense mass (b) in right posterior segment of the liver. Gd-EOB-DTPA enhanced MRI obtained during the arterial phase reveals peripheral rim-like enhancement (c). The mass demonstrates progressive concentric filling of contrast in delayed phase (d) and significant enhancement in hepatobiliary phase (20 min after injection) (e). The mass shows increased SI on high-b-value diffusion-weighted image (f).

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  Fig. 3 Positron emission tomography (PET)-CT scan shows intense fluorodeoxyglucose (FDG) uptake in the mass, indicating possibility of malignant lesion (a). Photomicrograph (original magnification, × 100; H&E stain) shows some parts of the tumor appeared sarcomatous and were composed of pleomorphic spindle cells with numerous mitoses, whereas other parts were composed of adenocarcinoma cells (b). An immunochemical examination of the sarcomatous components showed positive staining for vimentin (c) and low molecular cytokeratin (CK7) (d).

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