An association of hepatolithiasis and cholangiocarcinoma is thought to be rare, with a rate reported to be 2.36%-10%. Most of the cholangiocarcinomas concurrent with intrahepatic stones are found in the vicinity of the hepatolithiasis, and the diagnosis of intrahepatic cholangiocarcinoma in cases with hepatolithiasis is very difficult to detect preoperatively in spite of recent developments in techniques of imaging studies. Recently, the development of cholangiocarcinoma was reportd even after the complete removal of the hepatic stones. Thus, bile stasis and bacterial infecton appear to be important causative factors causing cholangiocarcinoma rather than the stone itself. A rare case is reported on intrahepatic cholangiocarcinoma developed in a remote region from the site of the hepatolithiasis. Therefore, the possible presence of cholangiocarcinoma should always be considered and sought during the diagnosis and treatment of hepatolithiasis.
Bile ; Cholangiocarcinoma* ; Diagnosis ; Cholangiocarcinoma

Nodular hepatic involvement of multiple myeloma is very rare. We report here on a case of nodular hepatic involvement of multiple myeloma that mimicked intrahepatic cholangiocarcinoma. In patients with multiple myeloma, hepatic involvement of the multiple myeloma might be included in the differential diagnosis of hepatic mass.
Cholangiocarcinoma* ; Diagnosis, Differential ; Humans ; Liver* ; Multiple Myeloma*

Nodular hepatic involvement of multiple myeloma is very rare. We report here on a case of nodular hepatic involvement of multiple myeloma that mimicked intrahepatic cholangiocarcinoma. In patients with multiple myeloma, hepatic involvement of the multiple myeloma might be included in the differential diagnosis of hepatic mass.
Cholangiocarcinoma* ; Diagnosis, Differential ; Humans ; Liver* ; Multiple Myeloma*

PURPOSE: To evaluate the characteristics of contrast enhancement of peripheral cholangiocarcinoma, as seen on spiral CT. MATERIALS AND METHODS: Spiral CT was used to examine twelve patients with peripheral cholangiocarcinoma of the liver. All underwent conventional CT before contrast enhancement. After the administration of contrast material, two-phased spiral CT was used to investigate seven patients, and three-phased spiral CT, to investigate five. In each phase, we analysed the patterns of contrast enhancement at the central and peripheral portions of the lesion, and compared these with the patterns of normal liver parenchyma. We evaluated changes, according to time lapse, in the central low-density area, and obtained the phase-density curve with the cursor placed at the central portion of the lesion. For three-phased spiral CT examinations, we also tried to determine the phase dvring which the margin of the lesion was most clearly demonstrated. RESULTS: During the arterial phase, eight of twelve patients (67%) showed hyperdensity in the peripheral portion of the lesion; during the portal phase, four of five patients (80%) showed hypodensity in both the central and peripheral portions. During the delayed phase, six of twelve patients (50%) showed isodensity and five showed high density in the peripheral portion. Compared to those in the arterial phase, central hypodense areas relative to normal liver parenchyma in the delayed phase decreased in eleven of twelve patients (92%). On phase-density curves, the density of the central portion of the lesion increased progressively in nine of twelve patients (75%). On three-phased CT, the margin of lesion was-in all five patients - most clearly demonstrated in the portal phase. CONCLUSION: On spiral CT, the central portion of peripheral cholangiocarcinoma always showed low density and the peripheral portion showed high, low, or iso or high density, depending on the phase. In addition, spiral CT clearly demonstrated a minimal centripetal pattern of contrast enhancement. We therefore conclude that in the diagnosis of peripheral cholangiocarcinoma, the characteristics of contrast enhancement are helpful.
Cholangiocarcinoma* ; Diagnosis ; Humans ; Liver ; Tomography, Spiral Computed*

Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory condition of which IgG4-related sclerosing cholangitis (IgG4-SC) is the biliary manifestation. In this review, we provide an overview of IgG4-RD, with a focus on the biliary manifestations. In particular, we describe the important differential diagnoses of IgG4-SC, namely, primary sclerosing cholangitis and cholangiocarcinoma, outline diagnostic criteria for IgG4-SC, provide insight into possible pathophysiological mechanisms underlying the disease and discuss short and long-term management options of this recently described disease.
Cholangiocarcinoma ; Cholangitis, Sclerosing* ; Diagnosis, Differential ; Immunoglobulins*

Background : Differential diagnoses of intrahepatic adenocarcinomas (IHAC) play an important role in the detecting primary sites and the determining type of treatment and overall prognosis of the patient. However, histopathologic findings alone have limitations of differential diagnoses of IHAC. Methods : To clarify which tumor related proteins (TRP) are useful for differential diagnoses of IHAC, TRP expression were investigated immunohistochemically, using MUC5AC, MUC2, mAb 91.9H, MUC1, and pS2, and by high iron diamine (HID) staining in 61 clinically confirmed IHACs. Results : MUC5AC (9/18, p<0.05) and MUC1 (17/18, p>0.05) displayed the most frequent expression in cholangiocarcinomas, and MUC2 (11/18, p<0.05), mAb 91.9H (16/18, p<0.05), and HID (16/18, p<0.05) in colorectal adenocarcinomas. pS2 (3/11, p>0.05) was expressed more often in pancreatic adenocarcinomas than other IHAC, while MUC2 and 91.9H were not expressed at all in pancreatic adenocarcinomas. The positivity of several TRP did not correlate with tumor differentiation. Conclusions : MUC5AC, MUC2, mAb 91.9H, and HID may be useful in differentiating cholangiocarcinomas from colorectal adenocarcinomas.
Adenocarcinoma* ; Cholangiocarcinoma ; Diagnosis ; Diagnosis, Differential* ; Humans ; Iron ; Prognosis

Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is very uncommon even in countries with high prevalence of TB. The clinical manifestation of primary hepatic TB is atypical and imaging modalities are unhelpful for differential diagnosis of the liver mass. Image-guided needle biopsy is the best diagnostic method for primary hepatic TB. In the cases presented here, we did not perform liver biopsy because we believed the liver masses were cholangiocarcinoma, but primary hepatic TB was ultimately confirmed by postoperative pathology. Here we report two cases of patients who were diagnosed with primary hepatic TB mimicking mass-forming intrahepatic cholangiocarcinoma.
Biopsy ; Biopsy, Needle ; Cholangiocarcinoma* ; Diagnosis, Differential ; Hepatectomy ; Humans ; Liver ; Pathology ; Prevalence ; Tuberculosis ; Tuberculosis, Hepatic* ; Cholangiocarcinoma

BACKGROUND: Chronic biliary-tract infection and long-standing hepatolithiasis are considered as important etiologic factors of a cholangiocarcinoma. PURPOSE: We reviewed cases of hepatolithiasis-associated cholangiocarcinomas to determine their clinical and pathologic characteristics. RESULTS: Nineteen patients with heptolithiasis-associated cholangiocarcinomas admitted during the last 6 years. The incidence of cholangiocarcinomas among the patients with hepatholithiasis was 8.5% (19/224). Their mean age was 59.4 years, which was older than that of the hepatolithiasis patients (53 years). The dominant location of the stones was the left lobe, followed by both lobes and the right lobe. In two cases, the stones were found in different locations from the cancer. The interval between the diagnosis of stones and the diagnosis of cancer was five months to 12 years. A hepatic resection was performed in 8 cases of them. A follow-up study was performed in sixteen cases. Two of seven patients with a curative resection died:one at eight months and the other at thirty-one months post operatively. Five patients are still surviing without recurrence. All nine patients in the non-resected group died during the follow-up period. The overall median survival was 9 month. CONCLUSION:Hepatolithiasis is one of the important causative factors of cholangiocarcinomas, The possibility of an associated cholangiocarcinoma should be considered in the patients with hepatolithiasis before and after the surgery, and even after the stones have been eradicated. Hence, life long close observation is essential for hepatolithiasis patients.
Cholangiocarcinoma* ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Recurrence

Cholangiocarcinomas have several histologic types, but intrahepatic cholangiocarcinoma with sarcomatous change is rare. A 71-year-old man was admitted to our hospital because of fever which had lasted two months. Ultrasonography (US) of the upper abdomen demonstrated a huge hepatic mass with central solid and peripheral cystic portions, and computed tomography (CT) revealed a heterogeneous hepatic mass with a central area in which enhancedment was delayed. Magnetic resonance imaging (MRI) disclosed a huge mass of predominantly low signal intensity at T1WI, and peripheral portions of high signal intensity and a central portion of intermediate signal intensity at T2WI. The pathologic diagnosis was cholangiocarcinoma with sarcomatous change.
Abdomen ; Aged ; Cholangiocarcinoma* ; Diagnosis ; Fever ; Humans ; Magnetic Resonance Imaging ; Ultrasonography

PURPOSE: To determine the diagnositic value of multi-shot echo-planar MR imaging (EPI) in focal hepaticlesions by quantitatively comparing this with other standard MR sequences such as FSE(fast spin echo) T2WI,SE(spin echo) T1WI with and without Gd enhancement, FMPSPGR(fast multiplanar spoiled GRASS) with and without Gdenhancement. MATERIALS AND METHODS: Seventeen patients with 18 focal hepatic lesions were retrospectivelyreviewed by two abdominal radiologists. The pathological or clinical results of hepatic lesions were nine cases ofhemangioma, four of hepatocellular carcinoma, one of peripheral cholangiocarcinoma, one of simple cyst, and ofhemangioma. By dividing the data acquisition period into eight interleaved segments, multi-shot EPI images wereobtained. This T2W spin echo eight-shot EPIs of the liver in one 18 second breath hold was compared with otherpulse sequences. The foci of review were lesion detectablity and characterization. For the former, SNR(signal tonoise ratio) of the liver and CNR(contrast to noise ratio) of the lesion to the liver were calculated ;to evaluatethe latter, a separate calculation of lesion to liver CNR for each solid and nonsolid lesion group was performed. RESULTS: Among six pulse sequences, multi-shot EPI provided the poorest liver SNR (p<.01). With regard to lesionto liver CNR, EPI was superior to FMPSPGR, SE, and Gd SE, but inferior to FSE, Gd FMPSPGR(p<.01). For nonsolidlesions(hemangioma, cyst), EPI provided higher liver CNR than FMPSPGR, SE, or Gd-SE, but one that was poorer thanthat provided by FSE and Gd-FMPSPGR(p<.05). Among six pulse sequences, there was no statistically significantdifference in lesion to liver CNR in solid lesions. In the evaluation of liver to lesion CNR, multi-shot EPI wasalways inferior to FSE. CONCLUSION: We concluded that with regard to sensitivity and suseptibility, multi-shotEPI is inferior to T2W FSE. For SNR, EPI was the least satisfactory, though with the exception of FSE, EPIprovided a higher or comparable CNR than other pulse sequences, and this made lesion depiction easy, especially innonsolid lesions. It was, however, difficult to characterize lesions by using EPI alone to determine whether alesion was solid or nonsolid.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Diagnosis* ; Humans ; Liver ; Magnetic Resonance Imaging* ; Noise