Mass-forming intrahepatic cholangiocarcinoma

Mass-forming intrahepatic cholangiocarcinomas (MF-ICC), also referred as peripheral cholangiocarcinomas, compromise one of the three recognized growth patterns of intrahepatic cholangiocarcinomas

On imaging, these tumors usually present as large and relatively well-defined hepatic masses with lobulated margins and showing peripheral rim enhancement. They are often associated with peripheral biliary dilatation. 

MF-ICCs are associated with chronic liver diseases, including viral hepatitis 5

These tumors tend to present as larger masses as they rarely cause symptoms early in their course 4

The mass-forming subtype is the most common among the intrahepatic cholangiocarcinomas 4.

Mass-forming tumors mostly originate from cholangiocarcinomas in the peripheral small bile ducts and, rarely, from a mixed presentation of large ducts cholangiocarcinomas with both periductal and mass-forming lesions 5

Peripheral cholangiocarcinomas are commonly large white tumors with dense fibrosis 4.

General morphological features that commonly guide radiologists to the diagnosis of MF-ICC are the associated capsular retraction and distal bile ducts dilatation. 

The enhancement pattern seen on the post-contrast dynamic images can be quite variable depending on tumor size and degree of differentiation. Be aware that the enhancement of MF-ICC and HCC overlaps when tumors are smaller than 3 cm and in cirrhotic livers 7

These tumors present as a homogeneous and well-delineated liver mass, which commonly have intermediate echogenicity and irregular contours. Other features may include: 

  • peripheral hypoechoic halo of compressed liver parenchyma
  • often associated with capsular retraction 1 
  • dilated bile ducts distal to the mass 

Mass-forming cholangiocarcinomas are relatively well-defined and markedly hypodense on the non-contrast studies. On dynamic post-contrast scans:

  • there is minor peripheral rim enhancement during both the arterial and portal venous phases
    • arterial enhancement has been associated with better prognosis 6
  • the central part of the tumor usually does not enhance during the early phases, but frequently show gradual centripetal prolonged enhancement at delayed-phases 1-2,4.
  • rate and extent of enhancement depend on the degree of central fibrosis 1 

The bile ducts distal to the mass are typically dilated.

Again, capsular retraction may be evident and is highly suggestive of this etiology. Lobar or segmental hepatic atrophy is usually associated with vascular invasion 3

Although narrowing of the portal veins - or less frequently, hepatic veins - is seen, unlike HCC, cholangiocarcinoma only rarely forms a tumor thrombus 1.

  • T1: low signal intensity 7
  • T2: high signal intensity 7
  • DWI: target-like diffusion restriction at high b values
    • central dark area on DWI may represent fibrosis and necrosis 7
    • this appearance, although not specific for and only seen in less than 50% of cases, helps in distinguishing the mass from an HCC
  • C+ (Primovist)
    • pattern and intensity of enhancement has been associated with tumor differentiation and, therefore, prognosis 6
      • hypoenhancement reflects poor differentiation 
      • rim enhancement reflects an intermediate differentiation 
      • diffuse enhancement reflects well-differentiated tumor

For a mass-forming intrahepatic cholangiocarcinoma consider:

  • hepatocellular carcinoma (HCC)
    • may appear very similar, particularly in tumors smaller than 3 cm and in cirrhotic liver 7
    • intralesional fat
    • diffuse hyperintensity on unenhanced T1 weighted imaging
    • nodule-in-nodule appearance
    • capsular enhancement on the portal and delayed phases 
    • tumor thrombus
    • capsular retraction is uncommon
  • liver metastases
    • central necrosis (high T2 signal) is more common
    • multiplicity is more common 
  • other primary liver tumors
Hepatobiliary pathology
Share article

Article information

rID: 70566
Section: Gamuts
Synonyms or Alternate Spellings:
  • Intrahepatic mass-forming cholangiocarcinoma
  • Peripheral cholangiocarcinomas

Support Radiopaedia and see fewer ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.