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.