Unresectable cholangiocarcinoma - Yttrium-90 microsphere radioembolization

Case contributed by Azza Elgendy
Diagnosis certain

Presentation

Pathologically proven cholangiocarcinoma.

Patient Data

Age: 65 years
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 cholangiocarcinoma. 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 areas that filled with contrast on delayed images).

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Case Discussion

The case represents targeted radiotherapy of inoperable liver cancer (pathologically proven cholangiocarcinoma) 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 in 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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