Abdominal Imaging

, Volume 39, Issue 6, pp 1228–1240 | Cite as

Mass-forming cholangiocarcinoma and adenocarcinoma of unknown primary: can they be distinguished on liver MRI?

  • Najwa Al Ansari
  • Bong Soo Kim
  • Saowanee Srirattanapong
  • Charles T. A. Semelka
  • Miguel Ramalho
  • Ersan Altun
  • John T. Woosley
  • Benjamin Calvo
  • Richard C. Semelka
Article

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.

Keywords

Cholangiocarcinoma Abdominal MRI Primary liver tumor Liver metastases Unknown primary site Adenocarcinoma 

References

  1. 1.
    Patel T (2001) Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology 33(6):1353–1357PubMedCrossRefGoogle Scholar
  2. 2.
    Shaib Y, El-Serag HB (2004) The epidemiology of cholangiocarcinoma. Semin Liver Dis 24:115–125PubMedCrossRefGoogle Scholar
  3. 3.
    Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD (2005) Cholangiocarcinoma. Lancet 366:1303–1314PubMedCrossRefGoogle Scholar
  4. 4.
    Burak K, Angulo P, Pasha TM, et al. (2004) Incidence and risk factors for cholangiocarcinoma in primary sclerosing cholangitis. Am J Gastroenterol 99:523–526PubMedCrossRefGoogle Scholar
  5. 5.
    Lim JH (2003) Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. Am J Roentgenol 181:819–827CrossRefGoogle Scholar
  6. 6.
    Kim SA, Lee JM, Lee KB, et al. (2011) Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern—correlation with clinicopathologic findings. Radiology 260:148–157PubMedCrossRefGoogle Scholar
  7. 7.
    Braga L, Semelka RC, Danet I-M, Venkataraman S, Woosley JT (2003) Liver metastases from unknown primary site: demonstration on MR images. Magn Reson Imaging 21:871–877PubMedCrossRefGoogle Scholar
  8. 8.
    Nystrom JSWJ, Heffelfinger-Juttner J, Irwin LE, Baterman JRWR (1977) Metastatic and histologic presentation in unknown primary cancer. Semin Oncol 4:53–58PubMedGoogle Scholar
  9. 9.
    Le Chevalier TCE, Caille P, Harvey J, et al. (1998) Early metastatic cancer of unknown primary origin at presentation. A clinical study of 302 consecutive autopsied patients. Arch Intern Med 148:2035–2039CrossRefGoogle Scholar
  10. 10.
    Tickoo SK, Zee SY, Obiekwe S, et al. (2002) Combined hepatocellular-cholangiocarcinoma: a histopathologic, Immunohistochemical, and in situ hybridization study. Am J Surg Pathol 26:989–997PubMedCrossRefGoogle Scholar
  11. 11.
    Pavlidis N, Pentheroudakis G (2012) Cancer of unknown primary site. Lancet 14(379):428–435Google Scholar
  12. 12.
    Lazaridis G, Pentheroudakis G, Fountzilas G, Pavlidis N (2008) Liver metastases from cancer of unknown primary (CUPL): a retrospective analysis of presentation, management and prognosis in 49 patients and systematic review of the literature. Cancer Treat Rev 34:693–700PubMedCrossRefGoogle Scholar
  13. 13.
    Saiura A, Yamamoto J, Kokudo N, et al. (2011) Intrahepatic cholangiocarcinoma: analysis of 44 consecutive resected cases including 5 cases with repeat resections. Am J Surg 201:203–208PubMedCrossRefGoogle Scholar
  14. 14.
    Morimoto Y, Tanaka Y, Ito T, et al. (2003) Long-term survival and prognostic factors in the surgical treatment for intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg 10:432–440PubMedCrossRefGoogle Scholar
  15. 15.
    Shimonishi T, Miyazaki K, Nakanuma Y (2000) Cytokeratin profile relates to histological subtypes and intrahepatic location of intrahepatic cholangiocarcinoma and primary sites of metastatic adenocarcinoma of liver. Histopathology 37:55–63PubMedCrossRefGoogle Scholar
  16. 16.
    El Rassi ZE, Partensky C, Scoazec JY, et al. (1999) Peripheral cholangiocarcinoma: presentation, diagnosis, pathology and management. Eur J Surg Oncol 25:375–380PubMedCrossRefGoogle Scholar
  17. 17.
    Maeda TKK, Adachi E, Takenaka K, Sugimachi K, Tsuneyoshi M (1996) The expression of cytokeratins 7, 19, and 20 in primary and metastatic carcinomas of the liver. Mod Pathol 9:901–909PubMedGoogle Scholar
  18. 18.
    Bugat R, Bataillard A, Lesimple T, et al. (2003) Summary of the standards, options and recommendations for the management of patients with carcinoma of unknown primary site. Br J Cancer 89:S59–S66PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Sasaki A, Kawano K, Aramaki M, et al. (1999) Immunohistochemical expression of cytokeratins in intrahepatic cholangiocarcinoma and metastatic adenocarcinoma of the liver. Journal of Surgical Oncology 70:103–108PubMedCrossRefGoogle Scholar
  20. 20.
    Alastair D, Burt BCP, Ferrell LD (2008) MacSween’s pathology of the liver, 5th edn. Philadelphia: Churchill LivingstonGoogle Scholar
  21. 21.
    Chung YE, Kim M-J, Park YN, et al. (2009) Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics 29:683–700PubMedCrossRefGoogle Scholar
  22. 22.
    Ros PR, Buck JL, Goodman ZD, Ros AM, Olmsted WW (1988) Intrahepatic cholangiocarcinoma: radiologic-pathologic correlation. Radiology 167:689–693PubMedCrossRefGoogle Scholar
  23. 23.
    Lim JH, Park CK (2004) Pathology of cholangiocarcinoma. Abdom Imaging 29:540–547PubMedGoogle Scholar
  24. 24.
    Lee WJ, Lim HK, Jang KM, et al. (2001) Radiologic spectrum of cholangiocarcinoma: emphasis on unusual manifestations and differential diagnoses. Radiographics 21:S97–S116PubMedCrossRefGoogle Scholar
  25. 25.
    Buc E, Lesurtel M, Belghiti J (2008) Is preoperative histological diagnosis necessary before referral to major surgery for cholangiocarcinoma? HPB 10:98–105PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Rullier A, Le Bail B, Fawaz R, et al. (2000) Cytokeratin 7 and 20 expression in cholangiocarcinomas varies along the biliary tract but still differs from that in colorectal carcinoma metastasis. Am J Surg Pathol 24:870–876PubMedCrossRefGoogle Scholar
  27. 27.
    Choi BI, Lee JM, Han JK (2004) Imaging of intrahepatic and hilar cholangiocarcinoma. Abdom Imaging 29:548–557PubMedGoogle Scholar
  28. 28.
    Khan SA, Davidson BR, Goldin R, et al. (2005) Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 51:VI1–9Google Scholar
  29. 29.
    Valls C, Gumà A, Puig I, et al. (2000) Intrahepatic peripheral cholangiocarcinoma: CT evaluation. Abdom Imaging 25:490–496PubMedCrossRefGoogle Scholar
  30. 30.
    Danet I-M, Semelka RC, Leonardou P, et al. (2003) Spectrum of MRI appearances of untreated metastases of the liver. Am J Roentgenol 181:809–817CrossRefGoogle Scholar
  31. 31.
    Nanashima A, Sumida Y, Abo T, et al. (2008) Relationship between pattern of tumor enhancement and clinicopathologic characteristics in intrahepatic cholangiocarcinoma. J Surg Oncol 98:535–539PubMedCrossRefGoogle Scholar
  32. 32.
    Chiu CT, Chiang JM, et al. (2008) Clinicopathological analysis of colorectal cancer liver metastasis and intrahepatic cholangiocarcinoma: are they just apples and oranges? Dig Liver Dis 40:749–754PubMedCrossRefGoogle Scholar
  33. 33.
    Maithel SK, Gamblin TC, Kamel I, et al. (2013) Multidisciplinary approaches to intrahepatic cholangiocarcinoma. Cancer 119:3929–3942PubMedCrossRefGoogle Scholar
  34. 34.
    Ishida H, Ishibashi K, Ohsawa T, et al. (2011) Significance of hepatic lymph node metastasis in patients with unresectable synchronous liver metastasis of colorectal cancer. Int Surg 96:291–299PubMedCrossRefGoogle Scholar
  35. 35.
    Soyer P, Bluemke DA, Vissuzaine C, et al. (1994) CT of hepatic tumors: prevalence and specificity of retraction of the adjacent liver capsule. Am J Roentgenol 162:1119–1122CrossRefGoogle Scholar
  36. 36.
    Jeong HT, Kim MJ, Chung YE, et al. (2013) Gadoxetate disodium-enhanced MRI of mass-forming intrahepatic cholangiocarcinomas: imaging-histologic correlation. Am J Roentgenol 201:W603–W611CrossRefGoogle Scholar
  37. 37.
    Jhaveri KS, Halankar J, Aguirre D, et al. (2009) Intrahepatic bile duct dilatation due to liver metastases from colorectal carcinoma. Am J Roentgenol 193:752–756CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Najwa Al Ansari
    • 1
  • Bong Soo Kim
    • 1
  • Saowanee Srirattanapong
    • 1
  • Charles T. A. Semelka
    • 2
  • Miguel Ramalho
    • 1
  • Ersan Altun
    • 1
  • John T. Woosley
    • 3
  • Benjamin Calvo
    • 4
  • Richard C. Semelka
    • 1
  1. 1.Department of RadiologyUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Biomedical EngineeringUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of Pathology and Laboratory MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillUSA

Personalised recommendations