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Cancer stem cells in primary liver cancers: pathological concepts and imaging findings.

Joo I, Kim H, Lee JM - Korean J Radiol (2015)

Bottom Line: There is accumulating evidence that cancer stem cells (CSCs) play an integral role in the initiation of hepatocarcinogenesis and the maintaining of tumor growth.Liver CSCs derived from hepatic stem/progenitor cells have the potential to differentiate into either hepatocytes or cholangiocytes.Primary liver cancers originating from CSCs constitute a heterogeneous histopathologic spectrum, including hepatocellular carcinoma, combined hepatocellular-cholangiocarcinoma, and intrahepatic cholangiocarcinoma with various radiologic manifestations.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea.

ABSTRACT
There is accumulating evidence that cancer stem cells (CSCs) play an integral role in the initiation of hepatocarcinogenesis and the maintaining of tumor growth. Liver CSCs derived from hepatic stem/progenitor cells have the potential to differentiate into either hepatocytes or cholangiocytes. Primary liver cancers originating from CSCs constitute a heterogeneous histopathologic spectrum, including hepatocellular carcinoma, combined hepatocellular-cholangiocarcinoma, and intrahepatic cholangiocarcinoma with various radiologic manifestations. In this article, we reviewed the recent concepts of CSCs in the development of primary liver cancers, focusing on their pathological and radiological findings. Awareness of the pathological concepts and imaging findings of primary liver cancers with features of CSCs is critical for accurate diagnosis, prediction of outcome, and appropriate treatment options for patients.

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Related in: MedlinePlus

Schematic representation of imaging features of HCC, cHCC-CC, and CC.A, C, E. Arterial phase images. B, D, F. Portal and delayed phase images. A, B. HCC in cirrhotic liver shows arterial enhancement and delayed washout. Pseudocapsule shows delayed enhancement. C, D. cHCC-CC in cirrhotic liver shows strong arterial enhancement in peripheral portion of tumor and concentric filling on delayed phase. Note tumor thrombus in portal vein. E, F. CC in noncirrhotic liver shows weak arterial enhancement in peripheral portion of tumor and concentric filling on delayed phase. Note bile duct dilation and hepatic surface retraction. CC = cholangiocarcinoma, cHCC-CC = combined hepatocellular-cholangiocarcinoma, HCC = hepatocellular carcinoma
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Figure 6: Schematic representation of imaging features of HCC, cHCC-CC, and CC.A, C, E. Arterial phase images. B, D, F. Portal and delayed phase images. A, B. HCC in cirrhotic liver shows arterial enhancement and delayed washout. Pseudocapsule shows delayed enhancement. C, D. cHCC-CC in cirrhotic liver shows strong arterial enhancement in peripheral portion of tumor and concentric filling on delayed phase. Note tumor thrombus in portal vein. E, F. CC in noncirrhotic liver shows weak arterial enhancement in peripheral portion of tumor and concentric filling on delayed phase. Note bile duct dilation and hepatic surface retraction. CC = cholangiocarcinoma, cHCC-CC = combined hepatocellular-cholangiocarcinoma, HCC = hepatocellular carcinoma

Mentions: Combined hepatocellular-cholangiocarcinomas contain histological elements of both HCCs and CCs. Imaging findings of cHCC-CCs are also a coexistence or mixture of HCC and CC imaging features. Therefore, cHCC-CCs can mimic either HCCs or CCs on imaging (Fig. 6) (36). In addition, both HCCs and CCs can show a variety of radiologic features according to the tumor size, cellular differentiation, and underlying liver disease (37, 38, 39, 40), differential diagnosis between cHCC-CCs from HCCs or CCs through imaging is often difficult. cHCC-CCs have been frequently misdiagnosed as HCCs or CCs in preoperative settings. Fowler et al. (7) have reported that preoperative imaging diagnoses of cHCC-CCs showed 33-34% sensitivity with 81-100% specificity. In addition, Nishie et al. (41) reported a diagnostic accuracy of only 33% for cHCC-CCs through analysis of enhancement patterns within and around the tumor on contrast-enhanced CT.


Cancer stem cells in primary liver cancers: pathological concepts and imaging findings.

Joo I, Kim H, Lee JM - Korean J Radiol (2015)

Schematic representation of imaging features of HCC, cHCC-CC, and CC.A, C, E. Arterial phase images. B, D, F. Portal and delayed phase images. A, B. HCC in cirrhotic liver shows arterial enhancement and delayed washout. Pseudocapsule shows delayed enhancement. C, D. cHCC-CC in cirrhotic liver shows strong arterial enhancement in peripheral portion of tumor and concentric filling on delayed phase. Note tumor thrombus in portal vein. E, F. CC in noncirrhotic liver shows weak arterial enhancement in peripheral portion of tumor and concentric filling on delayed phase. Note bile duct dilation and hepatic surface retraction. CC = cholangiocarcinoma, cHCC-CC = combined hepatocellular-cholangiocarcinoma, HCC = hepatocellular carcinoma
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296278&req=5

Figure 6: Schematic representation of imaging features of HCC, cHCC-CC, and CC.A, C, E. Arterial phase images. B, D, F. Portal and delayed phase images. A, B. HCC in cirrhotic liver shows arterial enhancement and delayed washout. Pseudocapsule shows delayed enhancement. C, D. cHCC-CC in cirrhotic liver shows strong arterial enhancement in peripheral portion of tumor and concentric filling on delayed phase. Note tumor thrombus in portal vein. E, F. CC in noncirrhotic liver shows weak arterial enhancement in peripheral portion of tumor and concentric filling on delayed phase. Note bile duct dilation and hepatic surface retraction. CC = cholangiocarcinoma, cHCC-CC = combined hepatocellular-cholangiocarcinoma, HCC = hepatocellular carcinoma
Mentions: Combined hepatocellular-cholangiocarcinomas contain histological elements of both HCCs and CCs. Imaging findings of cHCC-CCs are also a coexistence or mixture of HCC and CC imaging features. Therefore, cHCC-CCs can mimic either HCCs or CCs on imaging (Fig. 6) (36). In addition, both HCCs and CCs can show a variety of radiologic features according to the tumor size, cellular differentiation, and underlying liver disease (37, 38, 39, 40), differential diagnosis between cHCC-CCs from HCCs or CCs through imaging is often difficult. cHCC-CCs have been frequently misdiagnosed as HCCs or CCs in preoperative settings. Fowler et al. (7) have reported that preoperative imaging diagnoses of cHCC-CCs showed 33-34% sensitivity with 81-100% specificity. In addition, Nishie et al. (41) reported a diagnostic accuracy of only 33% for cHCC-CCs through analysis of enhancement patterns within and around the tumor on contrast-enhanced CT.

Bottom Line: There is accumulating evidence that cancer stem cells (CSCs) play an integral role in the initiation of hepatocarcinogenesis and the maintaining of tumor growth.Liver CSCs derived from hepatic stem/progenitor cells have the potential to differentiate into either hepatocytes or cholangiocytes.Primary liver cancers originating from CSCs constitute a heterogeneous histopathologic spectrum, including hepatocellular carcinoma, combined hepatocellular-cholangiocarcinoma, and intrahepatic cholangiocarcinoma with various radiologic manifestations.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea.

ABSTRACT
There is accumulating evidence that cancer stem cells (CSCs) play an integral role in the initiation of hepatocarcinogenesis and the maintaining of tumor growth. Liver CSCs derived from hepatic stem/progenitor cells have the potential to differentiate into either hepatocytes or cholangiocytes. Primary liver cancers originating from CSCs constitute a heterogeneous histopathologic spectrum, including hepatocellular carcinoma, combined hepatocellular-cholangiocarcinoma, and intrahepatic cholangiocarcinoma with various radiologic manifestations. In this article, we reviewed the recent concepts of CSCs in the development of primary liver cancers, focusing on their pathological and radiological findings. Awareness of the pathological concepts and imaging findings of primary liver cancers with features of CSCs is critical for accurate diagnosis, prediction of outcome, and appropriate treatment options for patients.

Show MeSH
Related in: MedlinePlus