Unresectable cholangiocarcinoma: with Yttrium-90 microsphere radioembolisation

Case contributed by Dr Azza Elgendy

Presentation

63 years old male with pathologically proven cholangiocarcinoma

Patient Data

Age: 63 years male
Gender: Male

The liver is notable for an infiltrative mass associated with capsular retraction. 

Portal phase axial images: a large infiltrative mass involving both hepatic lobes with capsular retraction suggestive of cholangiocarcinoma. The case is pathologically proven cholangiocharcinoma. The post procedural CT is limited as compared to PET/CT in diagnosing tumor response to therapy. Here the portal venous phase shows larger tumor size which either tumor necrosis or viable tumor tissues (tumor tissue didn't respond to microspheres targeted therapy). All the filled in areas on delayed images represent viable tumor tissues. 

Delayed phase axial images: the size of the tumor has decreased on the delayed images consistent with viable tumor tissue ( the ares that filled with contrast on delayed images) . 

 

Case Discussion

The case represents targeted radiotherapy of inoperable liver cancer (pathologically proven cholangiocharcinoma) with no evidence of metastases, portal vein thrombosis or lung shunting using transhepatic arterial embolization with biocompatible Y-90 microspheres. Based on the fact that primary cancer liver is supplied by arterial blood supply meanwhile normal liver tissues supplied by portal blood. 

The post procedural CT is limited as compared to PET/CT is diagnosing tumor response to therapy. Here the portal venous phase shows larger tumor size which is either tumor necrosis or viable tumor tissues (tumor tissue didn't respond to microspheres targeted therapy). All the filled in areas on delayed images represent viable tumor tissues.

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Case Information

rID: 38865
Case created: 8th Aug 2015
Last edited: 9th Sep 2015
Inclusion in quiz mode: Included

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