Imaging findings and diagnostic challenges in intrahepatic cholangiocarcinoma during pregnancy: a case report

Cynthia N. Gonzalez-Ramirez, Magnetic Resonance Service, Hospital Angeles Pedregal; Mexican Faculty of Medicine, Universidad La Salle. Mexico City, Mexico;
Anamari Perochena-Gonzalez, Magnetic Resonance Service, Hospital Angeles Pedregal, Mexico City, Mexico;
M. Guadalupe Gomez-Perez, Magnetic Resonance Service, Hospital Angeles Pedregal, Mexico City, Mexico;

Intrahepatic cholangiocarcinoma (ICC) is exceptionally rare during pregnancy and requires balancing maternal oncologic evaluation with fetal safety. This case report describes non-contrast magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) findings in a woman at 23 weeks’ gestation who presented with abdominal pain and jaundice and was diagnosed with moderately differentiated ICC. Abdominal MRI and MRCP showed an intrahepatic lesion measuring 9 × 9.4 × 8.3 cm, predominantly located in the hepatic hilum. The T2-weighted coronal MRI sequence showed a lobulated, heterogeneously hyperintense intrahepatic tumor. Axial diffusion-weighted imaging (DWI) showed predominantly peripheral diffusion restriction (target-like appearance) with an apparent diffusion coefficient (ADC) of 0.7 × 10-3 mm2/s. The T1-weighted MRI sequence showed a hypointense lesion. The in-phase and out-of-phase sequences revealed central areas of fatty signal. On axial T2-weighted fat-saturation (FS) MRI, the tumor caused subtle liver capsular retraction and obstruction, with dilatation of the left intrahepatic biliary duct to 15.2 mm, corroborated on MRCP. Percutaneous biopsy and histopathologic examination showed moderately differentiated ICC with positive CK7 immunostaining. After biliary drainage, jaundice improved, and the decision was made to continue the pregnancy. This case report highlights the value of non-contrast MRI and MRCP in evaluating intrahepatic lesions during pregnancy, emphasizing their diagnostic utility in this rare clinical context.

Keywords: Pregnancy. Intrahepatic cholangiocarcinoma. Magnetic resonance imaging. Magnetic resonance cholangiopancreatography.