Kazuto Kozaka MD, Presenter: Nothing to Disclose

Osamu Matsui MD, Abstract Co-Author: Nothing to Disclose

Toshifumi Gabata MD, Abstract Co-Author: Nothing to Disclose

Fumiaki Ueda MD, Abstract Co-Author: Nothing to Disclose

Satoshi Kobayashi MD, Abstract Co-Author: Nothing to Disclose

Wataru Koda, Abstract Co-Author: Nothing to Disclose

Tetsuya Minami MD, Abstract Co-Author: Nothing to Disclose

Yasuji Ryu MD, Abstract Co-Author: Nothing to Disclose

Azusa Kitao, Abstract Co-Author: Nothing to Disclose

To analyze the hemodynamic features of bile ductular carcinoma (BDC; pure type of cholangiolocellular carcinoma without internal hepatocellular and cholangiocellular carcinoma; CCC) with special references to hemodynamics evaluated by angiography-assisted CT with histopathologic correlation.

Total of 8 BDC and 7 mixed BDC (consisted of both pure BDC components and ordinary cholangiocellular carcinoma components). Dynamic CT was obtained all patients and angiography-assisted CT was obtained thirteen of 15 patients. Enhancement pattern of the tumor and peritumoral area, and interface pathology with special attention to tumor growth pattern and tumoral capillaries communication were assessed.

Seven of 8 BDCs showed inhomogeneous stain and remaining one showed homogeneous stain on early phase. Six of 7 mixed BDCs showed rim-like and the remaining one inhomogeneous stain in early phase. Peritumoral staining on early phase was evident in seven of 8 BDCs and six of 7 mixed BDCs. Penetrating or terminal branches of portal tracts were seen in all BDCs and mixed BDCs, though all 13 nodules which were underwent CT during arterio-portography showed portal defect. Histopathologically, BDC showed nest of carcinoma cells with fibrous stroma which was denser in central portion than in peripheral portion. On the other hand mixed BDC showed BDC components in peripheral potion and CCC components in central portion with various proportions. Seven of 8 BDCs and six of 7 mixed BDCs showed replacing infiltration growth and remained BDC and mixed BDC showed compressive growth. The tumor cells directly connected to surrounding hepatocytes. There were the continuities between the tumor blood sinusoids and peritumoral hepatic sinusoids. The immunohistochemical staining showed there were many tumor blood sinusoids which continued to intra-tumoral intermingled portal veins.

Peritumoral early enhancement may reflect possible early drainage of contrast medium from the tumor blood sinusoids through the abundant communications between surrounding hepatic sinusoids and intermingled portal venules due to replacing growth manner of BDCs.

Though peritumoral early enhancement is not specific but we believe this is one of BDC’s characteristic findings different from HCC.

Kozaka, K, Matsui, O, Gabata, T, Ueda, F, Kobayashi, S, Koda, W, Minami, T, Ryu, Y, Kitao, A, Early Peritumoral Enhancement of Bile Ductular Carcinoma: Radiologic Pathologic Correlation.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043463.html