GI Radiology > Biliary > Bile Ducts > Neoplastic > Primary

Biliary Tract Neoplasms

Primary Neoplasms: Cholangiocarcinoma
  1. Pathogenesis:
  • The most common primary malignancy of the biliary system.
     
  • Cholangiocarcinoma is usually extrahepatic rather than intrahepatic with the extrahepatic distal common biliary duct being affected in 50%-70% of cases.
     
  • By the time lesions are found, they are often advanced, commonly extending along the duct and spreading to regional lymph nodes.
     
  • Predisposing conditions include primary sclerosing cholangitis, choledochal cyst, congenital hepatic fibrosis, Clonorchis infection, and exposure to Thorotrast.
     
  • Klatskin's tumor refers to cholangiocarcinoma that arises at the bifurcation of the left and right hepatic ducts.
     
  1. Radiographic findings:
  • Cholangiography (often requiring opacification of duct above and below mass) is needed to fully evaluate the tumor.
     
  • An abrupt transition between normal and narrowed biliary duct is suggestive of a tumor.


    • Typical appearance of cholangio-
    carcinoma on ERCP.

  • CT: Most sensitive modality for detecting the low density mass, which may have a variable enhancement pattern.
     
  • CT below demonstrates a peripheral cholangiocarcinoma with central scarring shown during arterial phase.

  • Cholangiographs: Cholangiocarcinoma of common bile duct in 61 y.o. female. T-tube cholangiogram shows focal mural mass in wall of common bile duct (arrow).

    •           

  • Cholangiocarcinoma. PTHC shows filling defect from polypoid luminal mass in distal common bile duct in 72 y.o. male.