Journal of Liver Cancer

Case Report

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

Abstract 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.

Review Articles

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

Abstract 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

Abstract 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

Abstract 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 Report

A Case of Combined Hepatocellular-Cholangiocarcinoma: Kee Sup Song, Young Saeng Kim, Uk Sun Chang, Oh Sang Kwon, Yun Soo Kim, Duck Ju Choi, Ju Hyun Kim, Ha Na Kim, Jee Hee Kang, Jung Ho Kim, Jae Hong Park, Dong Hae Jung, Keon Kuk Kim; Journal of the Korean Liver Cancer Study Group. 2007;7(1):98-102. Published online June 30, 2007

Abstract PDF: Combined hepatocellular-cholangiocarcinoma (HCC-CC) is a rare form of primary liver cancer, featuring both hepatocellular and biliary epithelial differentiation. A 49-year-old man who was chronic HBV carrier complained of generalized weakness for 1 month. Abdominal CT scan and MRI showed a 3 cm-sized, hypodense mass in S6 of the liver with contrast enhancement. Percutaneous ultrasound-guided core needle biopsy of the liver yielded HCC-CC, and transarterial chemoembolization was done. Abdominal CT scan taken 2 weeks after TACE showed a partial uptake of lipiodol and then he underwent right posterior segmentectomy. The surgical specimen showed complete necrosis and no viable tumor cell. He was discharged without any complication.

Search