Ablative therapies for intrahepatic cholangiocarcinoma

Among the 3 sub-types of cholangiocarcinoma (CH), [intrahepatic CH, hylar (CH) and extrahepatic (CH)], intrahepatic cholangiocarcinoma (ICC) accounts for up 8–10% of cholangiocarcinomas and 10–20% of all primary liver tumors (1). Interestingly, the occurrence of ICC on cirrhosis is increasing in the last years (2). Diagnosis of ICC mainly relies on histologic findings obtained with imaging guided biopsy when a hepatic lesion, usually single (small or large), is occasionally discovered in a healthy liver or in a cirrhotic liver during surveillance for hepatocellular carcinoma (HCC). At imaging, the suspicion of ICC is based on the findings of a hypovascular lesion or a hepatic nodule with a hypervascular rim on dynamic CT and/or MRI. On contrast enhanced ultrasound (CEUS), that usually is the imaging tool that should be immediately performed after the recognition of a liver lesion on conventional US, the dynamic contrast pattern is the same. Concerns may arise in patients with cirrhosis and the appearance of a small (<3 cm), single nodule with arterial enhancement mimicking HCC. The differential diagnosis is based on the very rapid wash out that is present in the ICC lesions, while the wash out of HCC appears in the very late phase, when present (3)