无周围胆管扩张的肝内周围型胆管细胞癌MRI表现及病理分析

Intrahepatic Peripheral Cholangiocarcinoma Without Peripheral Bile Duct Dilatation: MRI Findings and Pathological Features

目的探讨不伴有局灶胆管受侵扩张的肝内周围型胆管细胞癌(IPCC)的MRI表现及病理,提高其MRI诊断水平。方法回顾性分析10例经术后病理确诊为IPCC、MRI图像未见周围胆管扩张患者的病理及MRI资料。结果 10例均为腺癌,1例为胆管细胞癌和肝细胞癌混合,1例合并肝脓肿;以高、中分化癌多见(9/10);大体分型均为肿块型,具有肿块型IPCC影像病理特征:不规则肿块(外缘浅分叶状8例),肿块内有大量的纤维或黏液成分(7例以纤维为主,T2WI上呈稍高混杂等低信号;3例以黏液为主,T2WI上呈较高信号),邻近肝包膜牵拉皱缩凹陷征(4/10),渐进性延迟强化(10/10);与典型IPCC不同表现:病灶周围无胆管扩张,卫星灶及淋巴转移相对少见(1/10)。术前误诊为感染性病变4例。结论不伴有周围胆管扩张IPCC病理以高、中分化为主,侵袭扩散相对少见,具有肿块型IPCC的影像特征,但无特征性周围胆管扩张,易误诊为感染。

Objective To investigate MRI findings and pathological features of the intrahepatic peripheral cholangiocarcinoma （IPCC） without peripheral bile duct dilatation. Methods This study involved 10 patients with IPCC diagnosed by postoperative pathological data. All MRI data were retrospectively analyzed and no peripheral bile duct dilatation found on MR imagings. Results Ten cases were adenocarcima, 1 case was mixed cholangiocarcinoma and hepatocellular carcinoma, and 1 case was combinded with liver abscess. 9 cases were well or medium differentiated staging on pathology. The macroscopic type of 10 cases were mass forming type（ MF type）, which had general features of mass-forming cholangiocarcinoma, such as：irregular mass （8 cases with shallow lobulated edge）, a large number of fibers or mucus in the center of the lesion（7 case were slightly higher or equal density on T2WI with a large number of fibers, 3 case were high density on T2WI with a large number of mucus）, and 10 cases with delayed enhancement feature. However, there were some features different from the typical mass forming cholangiocarcinoma, included no peripheral bile duct dilatation, relative rare rate of the satellite lesions and lymph metastasis（ only 1 case respectively）. 4 cases were misdiagnosed as inflammation preoperatively. Conclusion The IPCC without peripheral bile duct dilatation mostly was well or medium differentiated carcinoma and showed MF type features without feature of peripheral bile duct dilatation on MR imagings.