Radiology 1985 Jul;156(1):43-6

Cholangiocarcinoma complicating primary sclerosing cholangitis: cholangiographi
appearances

MacCarty RL, LaRusso NF, May GR, Bender CE, Wiesner RH, King JE, Coffey RJ

Abstract
Cholangiograms from 104 patients (and serial cholangiograms in 66 patients) with
primary sclerosing cholangitis (PSC) were reviewed. In 13 patients the
additional diagnosis of cholangiocarcinoma was made at biopsy or autopsy.
Cholangiograms from patients with both PSC and carcinoma were compared with
cholangiograms from patients with PSC alone. Marked dilatation of ducts or
ductal segments (100% vs. 24%) and the appearance of a polypoid mass (46% vs.
7%) were common findings in the group of patients whose disease was complicated
by malignancy. In the malignant group, polypoid masses were larger, measuring 1
cm or greater in diameter. On serial cholangiograms, four of 15 patients with
progressive stricture formation and four of five with progressive ductal
dilatation proved to have carcinomas. The frequent occurrence of bile duct
carcinoma as a complication of PSC in this group of patients indicates that PSC
has a strong tendency to undergo malignant degeneration. Cholangiographic
findings which suggest malignant degeneration include markedly dilated ducts or
ductal segments, presence of a polypoid mass 1 cm or greater in diameter, and
progressive stricture formation or ductal dilatation