75 year old lady with features of obstructive jaundice
Unenhanced CT abdomen:
Enhanced CT abdomen:
Findings:
Marked intrahepatic biliary dilatation. A small area of calficiation and surrouding small area of low attenuation in the liver close to the caudate lobe. No extrahepatic biliary dilatation. No other abnormality. Unenhanced CT showed the findings better than the enhanced CT
ERCP:
Findings:
Marked intrahepatic biliary dilataion. A focal area of irregular filling defect in the distal intrahepatic biliary segment
AXR: post percutaneous stenting
Diagnosis:
Intrahepatic cholangiocarcinoma
Discussion:
Calcification in intrahepatic cholangiocarcinoma is usally illdefined, mostly occurs in the periphery of the tumour and is seen in about 20% of patients. Calcifications may also be seen in in biliary cystadenocarcinomas. However, the most common cause of calcified hepatic lesions is inflammatory lesion like granulomatous diseases (TB). Hydatid cysts produce curvilinear or ring calcification. Large hemangiomas may show large central coarse calcffications. Hepatic adenoma may show solitary or multiple calcifications usually eccentric in location. Fibrolamellar carcinoma show calcifications in approximately 20% of cases . Calcfied hepatic metastases are most commonly due to mucin-producing neoplasms (colon carcinoma).
The likely causes for the calcifications in intrahepatic cholangiocarcinomas include central necrosis, mucinous type of cholangiocarcinoma. it is not known if the calcification can predict the prognosis of the disease.
Most of the cholangiocarcinomas are inoperable at the time of presentation and are treated with either ERCP or percutaneous stenting.
References:
1. Lee WJ et al. Radiologic Spectrum of Cholangiocarcinoma: Emphasis on Unusual Manifestations and Differential Diagnoses. RadioGraphics 2001; 21: 97
2. Stoupis C et al. The Rocky liver: radiologic-pathologic correlation of calcified hepatic masses.
RadioGraphics 1998; 18: 675
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