无周围胆管扩张的肝内肿块型胆管细胞癌CT表现

The CT Findings of Mass-forming Type Intrahepatic Cholangiocarcinoma without Peripheral Bile Duct Dilatation

目的:探讨无周围胆管扩张的肿块型肝内胆管细胞癌(ICC)的CT表现及病理基础,以提高其CT诊断水平。方法:回顾性分析22例经病理证实为ICC且CT扫描未见周围胆管扩张患者的CT及病理资料。结果:22例均为腺癌,3例为混合型胆管细胞癌-肝细胞癌;以高、中分化癌多见(16/22);大体分型均为肿块型,具有肿块型ICC的CT及病理特征:不规则肿块(外缘浅分叶状)14例,类圆形8例;肿块内含有大量的纤维或者粘液成分(硬癌型15例,髓质型7例);钙化(3/22);包膜皱缩征(10/22);渐进性延迟强化(19/22),渐进性-快进快出混合型强化(3/22);与典型ICC不同表现:病灶周围无胆管扩张,未见卫星灶及淋巴结转移。结论:不伴有周围胆管扩张ICC病理以高、中分化为主,侵袭扩散相对少见,具有肿块型ICC的影像特征,但无特征性周围胆管扩张,易误诊为不典型肝癌或感染性病变。

Objective： To investigate CT findings and pathological features of the mass-forming type（MF type） intrahepatic cholangiocarcinoma（ICC） without peripheral bile duct dilatation. Methods： This study involved 22 patients with ICC diagnosed by pathological data. All CT data were retrospectively analyzed and no peripheral bile duct dilatation found on CT imagings. Results： 22 cases were adenocarcima, 3 cases was mixed cholangiocarcinoma and hepatocellular carcinoma. 16 cases were well or medium differentiated staging on pathology. The macroscopic type of 22 cases were MF type, which had general features of MF type cholangiocarcinoma, such as： irregular mass 14 cases（with shallow lobulated edge）, like-round mass 8 cases; a large number of fibers or mucus in the center of the lesion（15case were with a large number of fibers, 3 case were with a large number of mucus）; calcification（3/22）; the capsular retraction sign（10/22）; 19 cases with delayed enhancement feature. However, there were some features different from the typical mass forming cholangiocarcinoma, included no peripheral bile duct dilatation, there were no relative satellite lesions and lymph metastasis. Conclusion： The ICC 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 imagines, easily misdiagnosed as atypical hepatocellular carcinoma or infectious disease.