Transcript Slide 1
Radiological Category: Abdominal Submitted by: Faculty: Date: Principal Modality (1): MRI Principal Modality (2): CT
Case Report Patient PP
Matthew Clower, MSIV Sandra Oldham, MD 29 August 2007 Presented during Radiology 4001.
80 year-old Caucasian woman presents to gastroenterologist complaining of burning epigastric pain, dysphagia, weight loss, and RLQ pain.
PMH of hemicolectomy secondary to diverticulitis, cholecystectomy, and “low grade hepatitis.” Denies EtOH/Tob/Drugs.
Family history of pancreatic and colon cancers.
Physical exam was unremarkable and laboratory studies were within normal limits.
Endoscopic Gastro-Duodenoscopy (EGD) and abdominal CT were ordered.
On EGD, the patient was found to have a small hiatal hernia. Biopsy of a gastric polyp showed benign histology.
The following was found on the abdominal CT:
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Focal Nodular Hyperplasia
Transient Hepatic Intensity Difference
Findings and Differentials Findings:
5.4 x 4.7 x 4.6 cm mass in the right lobe adjacent to the gallbladder fossa.
Associated satellite lesions.
Nodular liver with capsular retraction. No involvement of portal venous system or dilation of the bile ducts.
Arterial phase enhancement and marked delayed enhancement on CT and MRI.
Biopsy showed poorly differentiated carcinoma with occasional gland formation.
Focal Nodular Hyperplasia
Hepatocellular Carcinoma Associated with hepatitis, alcoholism, cirrhosis, and hemochromatosis.
Elevated LFTs and decreased synthetic function.
MRI: T1 hypointense, T2 hyperintense, intense arterial enhancement.
Histology: hepatocyte-like with pseudogland formation. May stain for bile or AFP Cholangiocarcinoma Associated with PSC, liver fluke infection, hepatitis C, cirrhosis, Thorotrast exposure.
May present with jaundice or may be asymptomatic.
MRI: Homogenous, T1 hypointense, T2 hyperintense, remains enhanced on delayed images.
Histology: Typically glandular and well-differentiated, may resemble biliary epithelium
Hemangioma Asymptomatic and found incidentally.
MRI: Nodular enhancement, T1 hypointense, T2 hyperintense.
Histology: Reveals vascular structures.
Adenoma May rarely cause hepatomegaly and RUQ pain but typically incidentally found. Associated with OCP use.
MRI: T1 hyperintense, T2 hyperintense due to fat content.
Histology: Uniform hepatocytes.
Focal Nodular Hyperplasia Clinically silent. Usually an incidental finding during imaging or autopsy.
MRI: Iso/hypointense on T1, iso/hyperintense on T2, central vessels visible, uniform arterial enhancement with delayed Histology: Resembles adenoma.
Findings most consistent with intrahepatic mass-forming cholangiocarcinoma.
Next step: staging to determine resectability, usually with ERCP to evaluate biliary structures and further body imaging to evaluate for metastasis.
Cholangiocarcinoma is a cancer arising from the biliary duct system.
Incidence is 1 in 100,000 persons per year in the US (approx 2500 cases/yr).
Associated with PSC, liver fluke infection, hepatitis C, cirrhosis, Thorotrast exposure.
Tumors are classified by location: intrahepatic (25%), hilar (AKA Klatskin tumor), or extrahepatic.
Further classified by morphology: mass-forming, periductal-infiltrating, or intraductal growing.
90% are adenomatous.
Treatment consists of surgical removal or palliative biliary decompression.
5-year survival is 9-18% overall and up to 22-36% for intrahepatic tumors.
Nature Clinical Practice
Gastroenterology & Hepatology 2006 AJR 2003
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