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18 "Cholangiocarcinoma"
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Case Report
Rare Clinical and Radiologic Case of Cholangiocarcinoma Mimicking Pyogenic Abscess, Hepatic Echinococcal Cysts, and Metastases
Si Hyeong Lee, Soo Hyung Ryu, Dong Hoon Lee, Won Eui Yoon, Tae Young Park, Hye Kyung Lee, Jeong Seop Moon
J Liver Cancer. 2020;20(2):173-176.   Published online September 30, 2020
DOI: https://doi.org/10.17998/jlc.20.2.173
  • 2,836 Views
  • 73 Downloads
AbstractAbstract PDF
Cholangiocarcinoma is a biliary carcinoma with a wide spectrum of imaging, histological, and clinical features. In immunocompromised patients, pyogenic abscesses are relatively common and an echinococcal hepatic cysts are very rare. The authors experienced a very rare case of cholangiocarcinoma showing multiple hypodense masses with wall enhancement mimicking pyogenic liver abscess, echinococcal hepatic cyst, and cystic metastases. An 83-year-old man, complaining of fatigue and poor oral intake, presented to our outpatient clinic. Abdominal computed tomography (CT) revealed multiple, variable-sized hypodense masses with peripheral rim enhancement throughout the liver. Dynamic liver magnetic resonance images also showed findings similar to those of a CT scan. We performed ultrasound-guided biopsy of the mass which revealed cholangiocarcinoma.
Original Article
Postoperative Chemoradiotherapy for R1 Resected Intrahepatic Cholangiocarcinoma
Kim, Kyung Su , Kim, Hwi Young , Kim, Kyubo , Yi, Nam Joon , Suh, Kyung Suk , Chie, Eui Kyu
J Liver Cancer. 2018;18(2):115-120.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.115
  • 2,267 Views
  • 77 Downloads
  • 2 Citations
AbstractAbstract PDF
Background/Aim
s: To investigative the potential role of postoperative chemoradiotherapy (CCRT) after R1 resection of intrahepatic cholangiocarcinoma (IHCC).
Methods
Between January 2000 and December 2012, medical records of 18 patients who underwent curative surgery with R1 resection for IHCC were retrospectively reviewed.
Results
Median age was 68 years and 12 patients (66.7%) were male. Median tumor size was 5.0 cm (range, 2.2-11.0) and 12 patients (66.7%) had T3 or higher disease. Lymph nodes were involved in four patients (22.2%). Vascular invasion and perineural invasion were present in 10 (55.6%) and 12 patients (66.7%), respectively. Postoperative CCRT given with 5-fluorouracil or gemcitabine were delivered to 7 patients (38.9%). Median radiation dose was 50.4 Gy (range, 45-54). Univariate analysis showed that median loco-regional recurrence-free survival (LRRFS), progression-free survival (PFS) and overall survival (OS) were prolonged for patients treated with CCRT (median LRRFS; 5.6 months vs. not reached, P<0.001, median PFS; 5.6 vs. 8.3 months, P=0.047, median OS; 15.0 vs. 26.6 months, P=0.064).
Conclusions
Postoperative CCRT improved the loco-regional control and PFS in IHCC patients with R1 resection. Further study is warranted to validate the role of postoperative CCRT for these patients.

Citations

Citations to this article as recorded by  
  • Precision therapy for intrahepatic cholangiocarcinoma: A case report on adjuvant treatment in a recurrent patient after surgery and literature review
    Bao Ying, Tao Tang, Li-Xing Zhang, Jian-Wei Xiong, Kai-Feng Zhao, Jia-Wei Li, Guo Wu
    Oncology Letters.2023;[Epub]     CrossRef
  • Stereotactic radiotherapy for intrahepatic cholangiocarcinoma
    Aditya Borakati, Farid Froghi, Ricky H Bhogal, Vasileios K Mavroeidis
    World Journal of Gastrointestinal Oncology.2022; 14(8): 1478.     CrossRef
Case Reports
A Case of Combined Hepatocellular-cholangiocarcinoma Mimicking Pyogenic Liver Abscess
Seung Suk Baek, Eileen L. Yoon, Hyun-Jung Kim, Kyung Eun Bae, Kyeongmee Park, Won-choong Choi
J Liver Cancer. 2017;17(2):174-181.   Published online September 30, 2017
DOI: https://doi.org/10.17998/jlc.17.2.174
  • 2,547 Views
  • 26 Downloads
AbstractAbstract PDF
Heterogeneous features of liver cancer can mimic liver abscess. Therefore it is essential to doublecheck tumor markers in the diagnosis of liver abscess. Herein, we report a case of combined hepatocellular-cholangiocarcinoma (cHC) occurred in an unrecognized chronic hepatitis B patient initially misdiagnosed as liver abscess. A 49-year old male initially presented with chill, right upper quadrant pain, and a liver mass. Mass showed peripheral enhancement in arterial phase of computed tomography, which was not typical for hepatocellular carcinoma (HCC). Strikingly elevated alpha-fetoprotein and fine needle aspirated pathology revealed HCC. Despite discordant image findings he was treated with transarterial chemoembolization. He was treated with sorafenib due to metastatic retrocaval lymphadenopathy afterwards. The mass presumed to be HCC progressed with sorafenib. It was surgically resected and he was finally confirmed as cHC. Discordant tumor markers with presumptive image findings should prompt the suspicion of rare type of primary liver cancer, the cHC.
A Case of Sarcomatoid Cholangiocarcinoma Which Developed at the Site Previously Treated by Transarterial Chemoembolization
Changkun Lee, Kyung Min Kang, Hae Lim Lee, Sung Won Lee, Heejeong Lee, Nam Ik Han
J Liver Cancer. 2017;17(1):100-104.   Published online March 31, 2017
DOI: https://doi.org/10.17998/jlc.17.1.100
  • 1,725 Views
  • 13 Downloads
AbstractAbstract PDF
Intrahepatic sarcomatoid carcinoma is a rare tumor with poor prognosis due to its highly invasive and metastatic nature and difficulty for early detection. The most common form of intrahepatic sarcomatoid carcinoma is the sarcomatoid hepatocellular carcinoma, the development of which is usually associated with previous treatment for hepatocellular carcinoma. In contrast, sarcomatoid cholangiocarcinoma is extremely rare and results from spontaneous sarcomatoid transformation during the development of tumor. Here, we report a case of sarcomatoid cholangiocarcinoma, in a 58-year-old male, which developed at the site of previous treatment for hepatocellular carcinoma. A 9 × 7 cm sized tumor which had not been detected in the computed tomography exam 3 months before diagnosis was newly observed. The tumor rapidly progressed and the patient died only 31 days after the diagnosis.
Sarcomatoid Intrahepatic Cholangiocarcinoma: A Rare Case of Primary Liver Cancer
Doo Hyuck Lee, Kyu Hyung Han, Sun Young Ahn, Sang Sun Kim, Hyun Sung Shin, Ki Bae Bang, Jun Ho Choi, Suk Bae Kim, Won Ae Lee, il Han Song
J Liver Cancer. 2016;16(2):139-144.   Published online September 30, 2016
DOI: https://doi.org/10.17998/jlc.16.2.139
  • 1,249 Views
  • 17 Downloads
  • 3 Citations
AbstractAbstract PDF
Sarcomatoid carcinoma arising from intrahepatic cholangiocyte, an extremely rare primary liver cancer, has highly invasive and metastatic potential. The pathogenesis of this tumor is unclear, although histogenetic mechanisms, such as transdifferentiation/dedifferentiation (epithelialmesenchymal transition or metaplastic transformation), biphasic differentiation (combination and collision), and redifferentiation, might be suggested to explain the simultaneous coexistence of carcinoma and sarcoma components in the same tumor. Immunohistochemical staining might be necessary to differentiate whether sarcomatous component is originated from hepatocyte or cholangiocyte. We report a case of sarcomatoid intrahepatic cholangiocarcinoma in a 58 year-old man presenting as an incidentally detected liver mass on regular health examination, which was diagnosed by an application of immunohistochemical methods after surgical resection, with a review of the literature based on 9 cases reported in Korea.

Citations

Citations to this article as recorded by  
  • Pathologic features and clinical treatment of sarcomatoid intrahepatic cholangiocarcinoma
    Xiaoli Xie, Nannan Lai, Yuanyuan Yang, Jinwei Zhang, Jianmin Qin, Xia Sheng
    Intractable & Rare Diseases Research.2023; 12(4): 267.     CrossRef
  • Clinical diagnosis and treatment strategies for sarcomatoid intrahepatic cholangiocarcinoma
    Xia Sheng, Jian-Min Qin
    World Chinese Journal of Digestology.2022; 30(14): 614.     CrossRef
  • Analysis of intrahepatic sarcomatoid cholangiocarcinoma: Experience from 11 cases within 17 years
    Dong Kyun Kim, Bo Ra Kim, Jin Sook Jeong, Yang Hyun Baek
    World Journal of Gastroenterology.2019; 25(5): 608.     CrossRef
Review Article
Genomic Heterogeneity of Hepatocellular Carcinomas
Hyun Goo Woo
Journal of the Korean Liver Cancer Study Group. 2013;13(1):48-50.   Published online February 28, 2013
DOI: https://doi.org/10.17998/jlc.13.1.48
  • 858 Views
  • 5 Downloads
AbstractAbstract PDF
Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) are major primary liver cancers in adults, comprising liver cancer spectrum. The existence of combined hepatocellular-cholangiocarcinoma (CHC), a histopathologic intermediate form between HCC and CC, suggests phenotypic overlap between these tumors. By applying an integrative oncogenomic approach, we identified a novel HCC subtype, i.e., cholangiocarcinoma-like HCC (CLHCC), which expressed cholangiocarcinoma-like traits (CC signature). In addition, we found that CLHCC coexpressed embryonic stem cell–like expression traits (ES signature) suggesting its derivation from bipotent hepatic progenitor cells. Further histopathological evaluation revealed a variant HCC with fibrous stromal component, i.e. scirrhous HCC, has CC-like genomic features, suggesting that the fibrous stromal component in HCC may contribute to the acquisition of CC-like gene expression trait in HCC. Our integrative analysis combining histopathological and genomic data would be a powerful approach to delineate the tumor heterogeneity.
Case Report
A One cm Sized Intrahepatic Cholangiocarcinoma in a Patient with Chronic Hepatiits B Misdiagnosed as Hepatocellular Carcinoma
Gene Hyun Bok, Soung Won Jeong, Jae Young Jang, Kwang Yeun Shim, Sae Hwan Lee, Sang Gyune Kim, Young Seok Kim, Hong Soo Kim, Boo Sung Kim, So Young Jin, Sung Sook Hong, Yong Jae Kim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):23-27.   Published online February 28, 2012
  • 492 Views
  • 2 Downloads
AbstractAbstract PDF
Morphologically, intrahepatic cholangiocarcinoma (ICC) presents as a parenchymal mass, and it is occasionally resectable and potentially curable. In some cases, differentiation from other hepatic neoplasms such as metastatic lesions and hepatocellular carcinoma (HCC) can be extremely difficult, both clinically and histologically, and definitive diagnosis often needs correlation with clinical and radiologic finding.Contrasted computed tomography (CT) is useful in the diagnosis of ICC and in determining the extent of tumor involvement. Although the majority of liver tumors can be diagnosed by modern imaging modalities such as contrast CT, some cases of ICC show tumor enhancement in the arterial phase the same as that in HCC, or a biliary dilatation without stenosis by intraductal tumor growth. Differences in these patterns of tumor enhancement and status of the bile ducts in ICC may also reflect differences in cellular characteristics, clinical features, and prognosis after treatment. We present a case of a small ICC showing similar clinical and radiologic characteristics to HCC.
Review Articles
Clonorchis sinensis and Biliary Stones as Etiological Factors of Cholangiocarcinoma
Dongil Choi, Jae Hoon Lim
Journal of the Korean Liver Cancer Study Group. 2010;10(1):22-28.   Published online June 30, 2010
  • 474 Views
  • 1 Download
AbstractAbstract PDF
C. sinensis induces adenomatous hyperplasia of the epithelium of the bile ducts, and the epithelium of the bile duct persistently exposed to biochemically altered bile may undergo the sequence, hyperplasia-metaplaisa-dysplasia-carcinoma. Cholangiocarcinomas were developed in most hamsters treated with an N-nitroso compound and then infected with C. sinensis. In the patients with intrahepatic duct stones, bile usually infected with bacteria. Mechanical stimuli due to stones, long-lasting bile stasis, and bacterial infection are considered to be the other significant causative factors in cholangiocarcinogenesis. Radiological examinations are essential in the diagnosis and treatment of biliary tree diseases including clonorchiasis, biliary stone disease, and cholangiocarcinoma. As both C. sinensis and intrahepatic duct stones are common, radiological and clinical findings should be attentively investigated for the possible presence of cholangiocarcinoma in patients with clonorchiasis or intrahepatic duct stones.
Tumorigenesis of Combined hepatocellular and cholangiocarcinoma
Si Hyun Bae
Journal of the Korean Liver Cancer Study Group. 2007;7(1):8-12.   Published online June 30, 2007
  • 483 Views
  • 0 Download
AbstractAbstract PDF
Combined hepatocellular-cholangiocarcinoma (CHC) is an extremely rare form of primary liver cancer having features of both hepatocellular and biliary epithelial differentiation. The incidence of CHC was 1.0-6.3% of all primary liver cancers. Since Allen and LIsa first described the features of this tumor in 1949, Allen’s classification has been widely used. This classification includes: type A, double cancer of HCC and CC, with HCC and CC present at different sites without contact; type B, HCC and CC are present at adjacent sites and mingle with continued growth; and type C, HCC and CC are mixed, growing within the same tumor. CHC are often confused with pseudoglandular growth pattern in HCC, but this has led to the mistaken impression that CHC are common. Histologically, only type C displays the characteristic of genuine mixture of both HCC and CC elements, and only Allen’s type C was included and regarded as true CHC in many published studies of CHC. With regard to the tumorigensis of CHC, the following possibilities have been proposed: 1st, the CC component arises from the main HCC tumor, and 2nd, the entire cancer arises from a stem cell potentially differentiating into hepatocytes and bile duct epithelium. In this review, I will describe the tumorigenesis of CHC and introduce the hepatic stem cell, such as hepatic progenitor cells.
Radiology of the Combined HCC and CC
Jin-Young Choi
Journal of the Korean Liver Cancer Study Group. 2007;7(1):16-21.   Published online June 30, 2007
  • 576 Views
  • 8 Downloads
AbstractAbstract PDF
Combined hepatocellular-cholangiocarcinoma (HCC-CC) is a rare tumor showing histological evidence of both hepatocellular and biliary epithelial differentiation. Because of its rarity, there have been few reports about the imaging findings of this tumor. The CT findings of the combined HCC-CC include well-defined tumor with signs of malignancy such as hepatic hypervascularity, biliary obstruction, satellite nodules, and lymphadenopathy. Some portions may show hypoattenuation on arterial phase, whereas other portions show delayed persistent enhancement. The signal intensity of this tumor on magnetic resonance (MR) imaging is not specific. However, when the tumor resembles cholangiocarcinoma on gross pathologic exam, it shows peripheral rim-like enhancement, infiltrative margin, and portal vein invasion in patients with liver cirrhosis. On the other hand, when the tumor has gross appearance of HCC, imaging findings are not helpful for diagnosis. Cross-sectional imagings are helpful for predicting the predominant component of the combined HCC-CC and determining the treatment strategy.
Surgical treatment of combined hepatocellular and cholangiocarcinoma
Chul Soo Ahn
Journal of the Korean Liver Cancer Study Group. 2007;7(1):22-27.   Published online June 30, 2007
  • 430 Views
  • 3 Downloads
AbstractAbstract PDF
Combined hepatocellular and cholangiocarcinoma (HCC-CC) is an uncommon form of primary liver cancer (PLC) with features of hepatocellular and biliary epithelial differentiation. According to publishing records HCC-CC accounts for 0.4% to 14.2% of all PLC cases. Large number of HCC-CC is associated with chronic viral hepatitis or cirrhosis, especially in asian countries. The tumor markers of HCC-CC (AFP, CA19-9) shows the intermediate level between hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). The clinical features of HCC-CC resembled with HCC but its post operative result and metastatic pattens are similar to that of CC. Surgical results of this tumor can yield results that are intermediate between HCC and CC in characteristics. But complete resection is the only effective therapy and can result in long term survival. And there are hot debates for the additional hilar lymph node dissection. The survival rate of HCC-CC is higher than CC but lower than HCC. The recurrence after resection has been frequently reported. Most of them are intrahepatic recurrences as HCCs but extrahepatic recurrences are much more frequent like CC. The CC component of HCC-CC seem to determine the prognosis. So more effective approaches for treating recurrent disease, such as local ablation therapy and or combination systemic chemotherapy and neoadjuvant chemoradiation, should be applied for long term and better results.
Case Reports
Combined hepatocellular and cholangiocarcinoma
Jung Hyun Kwon, Si Hyun Bae, Jung Pil Suh, Ho Sung Park, Chan Ran You, Jong Young Choi, Seung Kew Yoon, Dong Hoon Lee, Ho Jong Chun, Byung Gil Choi, Chan Kwon Chung, Eun Sun Jung, Mi Ryung Ryu
Journal of the Korean Liver Cancer Study Group. 2007;7(1):49-54.   Published online June 30, 2007
  • 537 Views
  • 1 Download
AbstractAbstract PDF
A 43 year-old-women patient was admitted for one month of jaundice. She was diagnosed hepatitis B carrier 17 years ago and has not done a routine check. Abdominal CT showed a large ill defined mass in left hepatic lobe with inhomogenous enhancement in arterial and delayed phase. The result of biopsy including the immunohistochemical stains showed the combined hepatocellular and cholangiocarcinoma (stage IVa, type C by Allen and Lisa). With the radiation therapy (3,910 cGy), six times of transarterial chemo-lipiodolization and two times of percutaneous ethanol injection, huge mass was markedly decreased in size and no stain in hepatic angiogram. She underwent left lobectomy.
A Case of Combined Hepatocellular-Cholangiocarcinoma Mimicking Focal Nodular Hyperplasia
Dong Hyun Shin, Kwang Cheol Koh, Geum Youn Gwak, Dong Il Choi, Cheol Keun Park, Moon Seok Choi, Joon Hyoek Lee, Seung Woon Paik, Byung Chul Yoo
Journal of the Korean Liver Cancer Study Group. 2007;7(1):55-58.   Published online June 30, 2007
  • 509 Views
  • 2 Downloads
AbstractAbstract PDF
Combined hepatocellular and cholangiocarcinoma (cHCC-CC) is an uncommon form of primary liver cancer having features of both hepatocellular and billiary epithelial differentiation. We report a case of cHCC-CC in a patient who was serologically positive for hepatitis B virus. A 39-year-old male was diagnosed by ultrasonography with an asymptomatic tumor in the left lobe of the liver. Based on radiologic and serologic findings of elevated serum alpha-fetoprotein level, a preoperative diagnosis of hepatocellular carcinoma was made, but differential diagnosis included focal nodular hyperplasia, because tumor was enhanced in delayed phase in Godolinium MRI scan. A final diagnosis of cHCC-CC was made after operation.
A Case of Combined Hepatocellular and Cholangiocarcinoma
Woo Jin Chung, Sang Hun Jeon, Dong Choon Kim, Ju Yup Lee, Kyung In Lee, Hye Jin Seo, Byung Kuk Jang, Kyung Sik Park, Kwang Bum Cho, Jae Seok Hwang, Sung Hoon Ahn, Ku Jeong Kang, Young Hoon Kim, Jung Hyeok Kweon, Young Hwan Kim, Yu Na Kang
Journal of the Korean Liver Cancer Study Group. 2007;7(1):59-61.   Published online June 30, 2007
  • 452 Views
  • 1 Download
AbstractAbstract PDF
A 51 years-old man who had postnecrotic liver cirrhosis due to chronic hepatitis B had elevated serum alpha fetoprotein level. According to computed tomographic findings, about 2.4cm sized mass was noted at segment 7 and he underwent segmentectomy. After 9 months later, multicentric recurrence was detected at segment 5-6, So, he underwent transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection therapy. After 22 months later, marginal recurrence was noted again at segment 6. So, he underwent 2nd TACE and he was following up over 30 months until now.
A Case of Combined hepatocellular carcinoma and cholangiocarcinoma (CHC) without underlying liver disease.
Jae Hoon Jung, Jung Il Kim, Sun Hyung Kang, Seok Hee Moon, Seok Hyun Kim, Byung Seok Lee, Heon Young Lee, Joon Sik Cho, Kyung Sook Shin, Dae Young Kang, Hyun Mo Kang
Journal of the Korean Liver Cancer Study Group. 2007;7(1):62-65.   Published online June 30, 2007
  • 550 Views
  • 1 Download
AbstractAbstract PDF
Combined hepatocellular carcinoma and cholangiocarcinoma (CHC) is a rare form of primary liver cancer having features of both hepatocelluar and biliary epithelial differentiation and is related to cirrhosis. Recently, a 64-oldmale who was admitted to our hospital for evaulation of hepatic mass which was detected on ultrasonography. He had no underlying cirrhosis. Based on serologic findings of high alpha-fetoprotein(AFP) level, a preoperative diagnosis of hepatocellular carcinoma was made. A right lobectomy was done. On histologic examination, the resected tumor was shown to consist of two different tissues. On immunohistochemistry, the tumor is postitive for both anti-hepatocyte, CK-7 and CK-19. Finally we confirm combined hepatocellular carcinoma and cholangiocarcinoma (CHC).

JLC : Journal of Liver Cancer