There is accumulating evidence that cancer stem cells (CSCs) play an integral role in the initiation of hepatocarcinogenesis and the maintaining of tumor growth. Liver CSCs derived from hepatic stem/progenitor cells have the potential to differentiate into either hepatocytes or cholangiocytes. Primary liver cancers originating from CSCs constitute a heterogeneous histopathologic spectrum, including hepatocellular carcinoma, combined hepatocellular-cholangiocarcinoma, and intrahepatic cholangiocarcinoma with various radiologic manifestations. In this article, we reviewed the recent concepts of CSCs in the development of primary liver cancers, focusing on their pathological and radiological findings. Awareness of the pathological concepts and imaging findings of primary liver cancers with features of CSCs is critical for accurate diagnosis, prediction of outcome, and appropriate treatment options for patients.
Bile Duct Neoplasms/pathology/radiography ; Bile Ducts, Intrahepatic/pathology/radiography ; Carcinoma, Hepatocellular/pathology/radiography ; Cholangiocarcinoma/pathology/radiography ; Humans ; Liver Neoplasms/*pathology/radiography ; Magnetic Resonance Imaging ; Neoplastic Stem Cells/*pathology/radiography ; Tomography, X-Ray Computed

No abstract available.
Carcinoma, Hepatocellular/*diagnosis/pathology ; Cholangiocarcinoma/*diagnosis/pathology ; Humans ; Liver Neoplasms/*diagnosis/pathology/radiography ; Male ; Middle Aged ; Neoplasms, Multiple Primary/*diagnosis/pathology/radiography ; Tomography, X-Ray Computed

No abstract available.
Aged ; Antigens, CD/metabolism ; Antigens, Differentiation, Myelomonocytic/metabolism ; Cadherins/metabolism ; Cholangiocarcinoma/*pathology/radiography ; Female ; Giant Cells/metabolism/*pathology/radiography ; Humans ; Osteoclasts/pathology ; Tomography, X-Ray Computed

Hilar cholangiocarcinoma is an adenocarcinoma arising from the bile duct epithelium, at the confluence of the right and left intrahepatic bile ducts, within the porta hepatis. In most cases, hilar cholangiocarcinomas are locally invasive tumors which have dismal prognosis if left untreated, with mean survival of approximately three months after the initial presentation. Recently, preoperative assessment of resectability and staging of hilar cholangiocarcinoma has gained importance in better management of the patients. Non-invasive cross-sectional radiological imaging has made considerable advances, and staging of hilar cholangiocarcinomas using radiological examination became more accurate in recent years. In this review, staging of hilar cholangiocarcinoma using computed tomography, magnetic resonance imaging, magnetic resonance cholangiopancreatography, and magnetic resonance angiography is described.
Bile Duct Neoplasms/*diagnosis/radiography ; *Bile Ducts, Intrahepatic/pathology/radiography ; Cholangiocarcinoma/*diagnosis/radiography ; Cholangiopancreatography, Magnetic Resonance ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed

No abstract available.
Adult ; Bile Duct Neoplasms/*pathology ; Bile Ducts, Intrahepatic/*pathology/radiography ; Caroli Disease/*pathology ; Cholangiocarcinoma/*pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Tomography, X-Ray Computed

Bi-phenotypic neoplasm refers to tumors derived from a common cancer stem cell with unique capability to differentiate histologically into two distinct tumor types. Bi-phenotypic hepatocellular carcinoma-cholangiocarcinoma (HCC-CC), although a rare tumor, is important for clinicians to recognize, since treatment options targeting both elements of the tumor are crucial. Imaging findings of bi-phenotypic HCC-CC are not specific and include features of both HCC and CC. A combination of imaging and immuno-histochemical analysis is usually needed to make the diagnosis.
CA-19-9 Antigen/metabolism ; Carcinoma, Hepatocellular/mortality/pathology/radiography ; Cholangiocarcinoma/mortality/pathology/radiography ; Humans ; Liver Neoplasms/mortality/pathology/*radiography ; Magnetic Resonance Imaging ; Phenotype ; Risk Factors ; Survival Analysis ; Tomography, X-Ray Computed ; alpha-Fetoproteins/analysis

Xanthogranulomatous cholecystitis (XGC) is an unusual and destructive inflammatory process that is characterized by thickening of the gallbladder (GB) wall with a tendency to adhere to neighboring organs. XGC is often mistaken for GB carcinoma, and the frequency of the coexistence of these two lesions is approximately 10%. Therefore, in case of severe XGC, there is chance of either overlooking the carcinoma or other significant lesions. CA 19-9 is commonly measured in the serum of patients with hepatobiliary malignancies. Although CA 19-9 can be elevated in benign conditions such as cholestasis, pancreatitis, tuberculosis, thyroid disease etc., malignancy should be considered at first in setting of its significant and persistent elevation. We report a case of a 62-year-old man who showed continuously rising level of CA19-9 over 2000 U/mL after cholecystectomy for xanthogranulomatous cholecystitis and finally was diagnosed as cholangiocarcinoma by short-term follow up.
Bile Duct Neoplasms/*diagnosis/pathology/radiography ; *Bile Ducts, Intrahepatic ; CA-19-9 Antigen/*blood ; Cholangiocarcinoma/*diagnosis/pathology/radiography ; Cholecystitis/pathology/*surgery ; Granuloma/pathology/*surgery ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography ; Tomography, X-Ray Computed ; Xanthomatosis/pathology/*surgery

Percutaneous access to the surgical bed after pancreaticoduodenectomy can be a challenge, due to the post-operative anatomy alteration. However, immediate complications, such as surgical bed abscess or suspected tumor recurrence, are often best accessed percutaneously, as open surgical or endoscopic approaches are often difficult, if not impossible. We, hereby, describe a safe approach that is highly replicable, in accessing the surgical bed for percutaneous intervention, following pancreaticoduodenectomy.
Abscess/radiography/therapy ; Bile Duct Neoplasms/pathology/radiography ; Biopsy/methods ; Catheterization/*methods ; Cholangiocarcinoma/pathology/radiography ; Drainage/instrumentation/*methods ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology/radiography ; Pancreatic Diseases/radiography/therapy ; *Pancreaticoduodenectomy ; Postoperative Complications/radiography/*therapy ; Radiography, Interventional/methods ; Retroperitoneal Space

No abstract available.
Bile Duct Neoplasms/*diagnosis/pathology/radiography ; Carcinoma, Hepatocellular/*diagnosis/radiography/therapy ; Chemoembolization, Therapeutic ; Cholangiocarcinoma/*diagnosis/pathology/radiography ; Humans ; Immunohistochemistry ; Keratin-7/metabolism ; Liver Neoplasms/*diagnosis/pathology/radiography/therapy ; Male ; Middle Aged ; Neoplasms, Multiple Primary/*diagnosis/pathology/radiography ; Positron-Emission Tomography ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Biliary drainage is performed in many patients with cholangiocarcinoma (CCA) to relieve obstructive jaundice. For those who have undergone biliary drainage, bile cytology can be easily performed since the access is already achieved. This study aims to determine the clinical usefulness of bile cytology for the diagnosis of CCA and to evaluate factors affecting its diagnostic yield. METHODS: A total of 766 consecutive patients with CCA underwent bile cytology via endoscopic nasobiliary drainage or percutaneous transhepatic biliary drainage from January 2000 to June 2012. Data were collected by retrospectively reviewing the medical records. We evaluated the diagnostic yield of bile cytology with/without other sampling methods including brush cytology and endobiliary forcep biopsy, and the optimal number of repeated bile sampling. Several factors affecting diagnostic yield were then analyzed. RESULTS: The sensitivity of bile cytology, endobiliary forceps biopsy, and a combination of both sampling methods were 24.7% (189/766), 74.4% (259/348), and 77.9% (271/348), respectively. The cumulative positive rate of bile sampling increased from 40.7% (77/189) at first sampling to 93.1% (176/189) at third sampling. On multivariate analysis, factors associated with positive bile cytology were perihilar tumor location, intraductal growing tumor type, tumor extent > or =20 mm, poorly differentiated grade tumor, and three or more samplings. CONCLUSIONS: Although bile cytology itself has a low sensitivity in diagnosing CCA, it has an additive role when combined with endobiliary forceps biopsy. Due to the relative ease and low cost, bile cytology can be considered a reasonable complementary diagnostic tool for diagnosing CCA.
Aged ; Bile/*cytology ; Bile Duct Neoplasms/*diagnosis/pathology/radiography ; CA-19-9 Antigen/metabolism ; Cholangiocarcinoma/*diagnosis/pathology/radiography ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Retrospective Studies