Cargando…

The MR Imaging of Primary Intrahepatic Lymphoepithelioma-like Cholangiocarcinoma: A Diagnostic Challenge

Purpose: To characterize the magnetic resonance imaging features of primary intrahepatic lymphoepithelioma-like cholangiocarcinoma (LELCC). Materials and Methods: Thirty-four patients with 38 histologically confirmed LELCCs were enrolled retrospectively from January 2014 to August 2022. We evaluated...

Descripción completa

Detalles Bibliográficos
Autores principales: Liu, Yangyang, Guo, Dajing, He, Xiaojing, Liu, Xi, Chen, Weijie, Chen, Lingli, Ji, Yuan, Zeng, Mengsu, Wang, Mingliang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10528328/
https://www.ncbi.nlm.nih.gov/pubmed/37761365
http://dx.doi.org/10.3390/diagnostics13182998
_version_ 1785111252040679424
author Liu, Yangyang
Guo, Dajing
He, Xiaojing
Liu, Xi
Chen, Weijie
Chen, Lingli
Ji, Yuan
Zeng, Mengsu
Wang, Mingliang
author_facet Liu, Yangyang
Guo, Dajing
He, Xiaojing
Liu, Xi
Chen, Weijie
Chen, Lingli
Ji, Yuan
Zeng, Mengsu
Wang, Mingliang
author_sort Liu, Yangyang
collection PubMed
description Purpose: To characterize the magnetic resonance imaging features of primary intrahepatic lymphoepithelioma-like cholangiocarcinoma (LELCC). Materials and Methods: Thirty-four patients with 38 histologically confirmed LELCCs were enrolled retrospectively from January 2014 to August 2022. We evaluated the clinical features, histologic findings, and imaging manifestations on dynamic enhanced MRI. Results: 74% (25/34) of the cases were associated with EBV infection. Moreover, patients infected with EBV exhibited a lower level of Ki-67 proliferation. The serum CA199 level was elevated in 10 patients. The median tumor diameter was 2.8 cm (range, 1.1–8.7 cm). Most tumors were well-defined with a smooth or lobulated margin and showed peripheral hyperintensity and central hypointensity on T2-weighted imaging (T2WI). T2 hyperintense foci were recognized in 8 patients. In the dynamic enhanced MRI, 21 tumors demonstrated Type A enhancement pattern (rim enhancement), 10 demonstrated Type B (rapid wash-in and wash-out), and seven demonstrated Type C (rapid wash-in without wash-out). Capsular enhancement in PVP or DP was found in 22 tumors. A few patients had satellite lesions, portal vein thrombosis, bile duct dilatation, and distal metastasis. Lymph node metastases were discovered pathologically in 11 patients. Conclusions: MRI findings of LELCC vary and are non-specific. While a majority of LELCCs exhibit typical features of intrahepatic cholangiocarcinoma (iCCA), unique findings like T2 hyperintense foci or capsular enhancement could suggest LELCC. EBV infection and elevated tumor markers can aid in differentiation. However, given the mimics of some cases of liver hypervascular lesions, histological examination remains essential for definitive diagnosis.
format Online
Article
Text
id pubmed-10528328
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-105283282023-09-28 The MR Imaging of Primary Intrahepatic Lymphoepithelioma-like Cholangiocarcinoma: A Diagnostic Challenge Liu, Yangyang Guo, Dajing He, Xiaojing Liu, Xi Chen, Weijie Chen, Lingli Ji, Yuan Zeng, Mengsu Wang, Mingliang Diagnostics (Basel) Article Purpose: To characterize the magnetic resonance imaging features of primary intrahepatic lymphoepithelioma-like cholangiocarcinoma (LELCC). Materials and Methods: Thirty-four patients with 38 histologically confirmed LELCCs were enrolled retrospectively from January 2014 to August 2022. We evaluated the clinical features, histologic findings, and imaging manifestations on dynamic enhanced MRI. Results: 74% (25/34) of the cases were associated with EBV infection. Moreover, patients infected with EBV exhibited a lower level of Ki-67 proliferation. The serum CA199 level was elevated in 10 patients. The median tumor diameter was 2.8 cm (range, 1.1–8.7 cm). Most tumors were well-defined with a smooth or lobulated margin and showed peripheral hyperintensity and central hypointensity on T2-weighted imaging (T2WI). T2 hyperintense foci were recognized in 8 patients. In the dynamic enhanced MRI, 21 tumors demonstrated Type A enhancement pattern (rim enhancement), 10 demonstrated Type B (rapid wash-in and wash-out), and seven demonstrated Type C (rapid wash-in without wash-out). Capsular enhancement in PVP or DP was found in 22 tumors. A few patients had satellite lesions, portal vein thrombosis, bile duct dilatation, and distal metastasis. Lymph node metastases were discovered pathologically in 11 patients. Conclusions: MRI findings of LELCC vary and are non-specific. While a majority of LELCCs exhibit typical features of intrahepatic cholangiocarcinoma (iCCA), unique findings like T2 hyperintense foci or capsular enhancement could suggest LELCC. EBV infection and elevated tumor markers can aid in differentiation. However, given the mimics of some cases of liver hypervascular lesions, histological examination remains essential for definitive diagnosis. MDPI 2023-09-20 /pmc/articles/PMC10528328/ /pubmed/37761365 http://dx.doi.org/10.3390/diagnostics13182998 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Liu, Yangyang
Guo, Dajing
He, Xiaojing
Liu, Xi
Chen, Weijie
Chen, Lingli
Ji, Yuan
Zeng, Mengsu
Wang, Mingliang
The MR Imaging of Primary Intrahepatic Lymphoepithelioma-like Cholangiocarcinoma: A Diagnostic Challenge
title The MR Imaging of Primary Intrahepatic Lymphoepithelioma-like Cholangiocarcinoma: A Diagnostic Challenge
title_full The MR Imaging of Primary Intrahepatic Lymphoepithelioma-like Cholangiocarcinoma: A Diagnostic Challenge
title_fullStr The MR Imaging of Primary Intrahepatic Lymphoepithelioma-like Cholangiocarcinoma: A Diagnostic Challenge
title_full_unstemmed The MR Imaging of Primary Intrahepatic Lymphoepithelioma-like Cholangiocarcinoma: A Diagnostic Challenge
title_short The MR Imaging of Primary Intrahepatic Lymphoepithelioma-like Cholangiocarcinoma: A Diagnostic Challenge
title_sort mr imaging of primary intrahepatic lymphoepithelioma-like cholangiocarcinoma: a diagnostic challenge
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10528328/
https://www.ncbi.nlm.nih.gov/pubmed/37761365
http://dx.doi.org/10.3390/diagnostics13182998
work_keys_str_mv AT liuyangyang themrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT guodajing themrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT hexiaojing themrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT liuxi themrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT chenweijie themrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT chenlingli themrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT jiyuan themrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT zengmengsu themrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT wangmingliang themrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT liuyangyang mrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT guodajing mrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT hexiaojing mrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT liuxi mrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT chenweijie mrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT chenlingli mrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT jiyuan mrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT zengmengsu mrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge
AT wangmingliang mrimagingofprimaryintrahepaticlymphoepitheliomalikecholangiocarcinomaadiagnosticchallenge