Case 255:   Cholangiocarcinoma

Diagnostic Category:

Clinical Presentation:

57 year old man with abdominal pain.

MR: Nodular type, with hypervascularity and fibrotic stroma, in steatosis

Imaging Findings:

MR shows strong arterial and portal venous ring enhancement of biopsy proven moderately differentiated cholangiocarcinoma in segment 2.

Note strong central enhancement on equilibrium phase representing the classic desmoplastic stroma reaction within this tumor. The peripheral ring enhancement of the earlier contrast phases corresponds to a rim of washout on equilibrium phase, representing the most viable tumor components containing mainly tumor cells and neoangiogenesis.

Note the T2w signal is more intense within the fibrotic tumor components than it is in its more cellular periphery.