Unit 7 Intrahepatic Biliary Neoplasms

A Cystadenoma & Cystadenocarcinoma are:

Rare

Cystadenoma & Cystadenocarcinoma are most common in who?

Middle-aged women

What are the symptoms of Cystadenoma & Cystadenocarcinomas?

• Abdominal pain, mass, or jaundice (if mass is near porta hepatis)

Cystadenoma & Cystadenocarcinoma US Findings: What do cystic mass have?

Multiple septa & papillary excrescences (lump)

Cystadenoma & Cystadenocarcinoma US Findings: Mass can show variations and can appear as what?

• unilocular,

• calcified,

• or multiple

Cystadenoma & Cystadenocarcinoma US Findings: What can a lesion be associated with?

Dilation of intrahepatic ducts

What are the differential diagnosis for Cystadenoma & Cystadenocarcinomas?

• Hemorrhagic cyst or infection

• Echinococcal cyst

• Abscess

• Cystic metastasis

What are the 3 classifications of a Cholangiocarcinoma?

• Intrahepatic

• Hilar (Klatskin’s)

• Distal

What is the second most common primary malignancy in liver?

Intrahepatic Cholangiocarcinoma

In a Intrahepatic Cholangiocarcinoma, incidence has risen and there is an increasing number patients with what diseases?

Cirrhosis and Hepatitis C

Intrahepatic Cholangiocarcinomas are often resectable or unresectable?

Unresectable

What is the outcome for a Intrahepatic Cholangiocarcinoma?

Poor prognosis

Intrahepatic Cholangiocarcinoma US findings: What is the size?

Large hepatic mass

Intrahepatic Cholangiocarcinoma US findings: What is the echogenicity?

Hypoechoic to hyperechoic

Intrahepatic Cholangiocarcinoma US findings: What is the texture?

•Heterogeneous texture or hypo vascular solid mass

Intrahepatic Cholangiocarcinoma US findings: What do 1/3 of the cases also have?

Biliary ductal dilation

What is being shown in the image above?

Intrahepatic Cholangiocarcinoma

A Hilar Cholangiocarcinoma is also known as:

Klatskin’s tumor

Is Hilar Cholangiocarcinoma intrahepatic or extrahepatic?

Intrahepatic

Where is the Hilar Cholangiocarcinoma located?

At bifurcation of common hepatic duct

Hilar Cholangiocarcinomas are _____ _________

Slow growing

Hilar Cholangiocarcinoma can be _____ ____________

Late metastases

Clinically, what are the symptoms of a Hilar Cholangiocarcinoma?

• Jaundice

• Pruritus

• Elevated cholestatic liver parameters

Klatskin’s Tumor US assessment: Where should the sonographer scan?

• Porta hepatis

• At level of obstruction

Klatskin’s Tumor US assessment: What should the sonographer assess?

• Presence of a mass, lobar atrophy

• Patency of MPV, RPV, LPV

• Encasement of HA

• Local or distant adenopathy & metastases

In a Klatskin’s Tumor if the ducts are dilated what should the sonographer do?

Follow course toward hilum to determine involved branches

What is the arrow pointing to in the image above?

Hilar Cholangiocarcinoma/Klatskin’s Tumor

What are these images showing?

Klatskin’s Tumor

A distal cholangiocarcinoma is difficult to distinguish from what?

hilar cholangiocarcinoma

A main symptom of a distal cholangiocarcinoma is:

Progressive jaundice

A Distal Cholangiocarcinoma tumor can be either _____ or _______

Sclerosing or polypoid

With a Distal Cholangiocarcinoma what must be evaluated?

Tumor spread in superior ductal system; extrahepatic area; extension into adjacent lymph nodes

Distal Cholangiocarcinoma US findings: A sclerosing tumor is:

Nodular

Distal Cholangiocarcinoma US findings: What is shown with focal irregularities?

Ductal constriction & wall thickening

Distal Cholangiocarcinoma US findings: What is the echogenicity?

Hypoechoic & hypo vascular appearance
with poorly defined margins

With Distal Cholangiocarcinoma, a sclerosing tumor around the CBD is classified as what type of obstruction?

Extrinsic

With Distal Cholangiocarcinoma, a sclerosing tumor presents with what?

• Nodular with focal irregular ductal constriction &
  wall thickening

• Hypoechoic & hypovascular appearance with poorly
  defined margins

With Distal Cholangiocarcinoma, a polypoid tumor within the CBD is classified as what type of obstruction?

Instrinsic

With Distal Cholangiocarcinoma, a polypoid tumor looks like what on ultrasound?

Hypovascular, well-defined mass

A sclerosing and polypoid tumor both dilate:

The entire biliary tree

What is this image showing?

Distal Cholangiocarcinoma
Sclerosing Tumor

What are the most common tumor sites for metastases to the biliary tree?

• Breast

• Colon

• Melanoma

What does metastases to the biliary tree affect?

Affects intrahepatic & extrahepatic ductal systems

What are the ultrasound findings for metastases to the biliary tree?

• Similar to cholangiocarcinoma

• Hyperechoic or hypoechoic

• Hypovascular

• Poorly defined margins

What is being shown in this image above?

Metastases to Biliary Tree 

What is being shown in this image above?

Biliary Tree metastases