A clinical study of 11 cases of combined hepatocellular-cholangiocarcinoma - Assessment of enhancement patterns on dynamics computed tomography before resection

Background and aim: The aim of this study was to identify computed tomography features that contribute to clinical diagnosis of hepatocellular-cholanglocarcinoma. Methods: We retrospectively reviewed the clinicopathologic features of 11 patients who underwent hepatectomy for hepatocellular-cholangiocarcinorna between January 1994 and December 2003 at Hiroshima City Hospital and investigated correlation of histopathologic features of surgical specimens with preoperative enhanced computed tomography findings. Results: Three computed tomography enhancement patterns were observed: an area of hyperenhancement in the early phase and hypoenhancement due to washout of contrast medium in the late phase, resembling hepatocellular carcinoma (Type 1, n = 4); peripheral enhancement in the early and late phases (Type 11, n = 2); an area of hyperenhancement in the early phase and an area of slight delayed enhancement in the late phase (Type III, n = 4). Histopathologically, all tumors were of mixed morphology (Allen's Type Q comprising hepatocellular carcinoma and cholangiocarcinoma components with transitional features. Computed tomography findings conformed well to pathologic findings. The hepatocellular carcinoma component was predominant in Type I masses. Type 11 masses showed central necrosis. In Type III masses, the hepatocellular carcinoma-predominant component corresponded to the area of early-phase enhancement and the cholangiocarcinoma-predominant component to the area of late-phase enhancement. Conclusions: In Type III tumors, hepatocellular and cholangiocellular components can be identified on the basis of dynamic computed tomography enhancement pattern. (c) 2005 Elsevier B.V. All rights reserved.