PMC6612990_01
(a) Portal phase CT scan shows large, hypoattenuating mass (arrows) in the right hepatic lobe, consistent with mass-forming peripheral cholangiocarcinoma (arrow). (b) Maximum intensity projection reconstruction of axial CT scan of the chest demonstrates multiple bilateral lung nodules consistent with metastasis. (c) Sagittal CT reconstruction of the spine showed no bony lesions.
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Whole body multidetector computed tomography (MDCT) scan showed a large hypoattenuating hepatic mass in the right lobe (maximum axial dimension 13 cm) characterized by heterogeneous peripheral enhancement, associated with secondary lesions located in the spleen and lung (more than 30 nodules); no evidence of bone metastasis was found (Figure 1).
(a) Axial T2-weighted magnetic resonance (MR) image shows a hyperintense mass located in the right hepatic lobe (arrow). There is mild parenchymal atrophy with minimal capsular retraction peripheral to the posterior aspect of the lesion (arrowhead). T1-weighted MR images show irregular, ragged rim enhancement (arrow in (b)) with gradual centripetal enhancement in the portal phase (c). (d) Diffusion weighted image demonstrates high cellularity.
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The following magnetic resonance imaging, performed to confirm the diagnostic hypothesis from the previous CT study, showed typical findings of peripheral CHCC (Figure 2).
(a) Needle biopsy of the neoplasia showing t solid nests of hepatocarcinoma on the right side with strong cytoplasmic PAS stain and cholangiocarcinoma on the left, with ill formed glands (PAS stain, 1.4x original magnification). (b) Immunoperoxidase staining showed strong CK7 expression on the glandular neoplasia (left side) and negative stain on the hepatocellular carcinoma (right side). (c) Hep-Par1 staining showed a counter-opposite staining pattern (immunoperoxidase stains B and C, 1.4x original magnification).
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Nests and trabeculae showed strong immunohistochemical staining for cytokeratin 8/18 and HepPar1 while pseudoglandular structures stained selectively for cytokeratin 7 and cytokeratin 19 (Figure 3).