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Mimics of Cholangiocarcinoma: Spectrum of Disease¹

¹ From the Department of Radiology, Mallinckrodt Institute of Radiology, St Louis, Mo (C.O.M., V.R.N.); the Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.R.S., S.R.P., K.N.C.); and the Department of Pathology, Washington University, St Louis, Mo (H.L.W.). Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received June 28, 2007; revision requested August 2 and received September 14; accepted October 9. V.R.N. is on the medical advisory boards of Vital Images and Imaging Advantage and is cofounder of Tesla9; all other authors have no financial relationships to disclose. Address correspondence to S.R.P. (e-mail: prasads{at}uthscsa.edu).

Cholangiocarcinoma is the second most common primary malignant hepatobiliary neoplasm, accounting for approximately 15% of liver cancers. Diagnosis of cholangiocarcinoma is challenging and the prognosis is uniformly poor, with recurrence rates of 60%–90% after surgical resection. A wide spectrum of neoplastic and nonneoplastic conditions of the biliary tract may masquerade as cholangiocarcinoma, adding to the complexity of management in patients suspected to have cholangiocarcinoma. Mimics of cholangiocarcinoma constitute a heterogeneous group of entities that includes primary sclerosing cholangitis, recurrent pyogenic cholangitis, acquired immunodeficiency syndrome cholangiopathy, autoimmune pancreatitis, inflammatory pseudotumor, Mirizzi syndrome, xanthogranulomatous cholangitis, sarcoidosis, chemotherapy-induced sclerosis, hepatocellular carcinoma, metastases, melanoma, lymphoma, leukemia, and carcinoid tumors. These entities demonstrate characteristic histomorphology and variable clinicobiologic behaviors. The imaging findings of these disparate entities are protean and may be indistinguishable from those of cholangiocarcinoma. In most cases, a definitive diagnosis can be established only with histopathologic examination of a biopsy specimen.

© RSNA, 2008