Combined hepatocellular-cholangiocarcinoma: An update

Abstract

Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a tumour that exhibits both hepatocytic and biliary differentiation. Classical risk factors for hepatocellular carcinoma (HCC) seem to also predispose patients to the development of cHCC-CCA. The pathological definition of cHCC-CCA has significantly evolved over time. The last 2019 WHO classification highlighted that the diagnosis of cHCC-CCA should be primarily based on morphology using routine stainings, with additional immunostaining used to refine the identification of subtypes. Among them, "intermediate cell carcinoma" is recognised as a specific subtype, while "cholangiolocellular carcinoma" is now considered a subtype of iCCA. Increasing molecular evidence supports the clonal nature of cHCC-CCA and parallels its biphenotypic histological appearance, with genetic alterations that are classically observed in HCC and/or iCCA. That said, the morphological diagnosis of cHCC-CCA is still challenging for radiologists and pathologists, especially on biopsy specimens. Identification of cHCC-CCA's cell of origin remains an area of active research. Its prognosis is generally worse than that of HCC, and similar to that of iCCA. Resection with lymph node dissection is unfortunately the only curative option for patients with cHCC-CCA. Thus, there remains an urgent need to develop specific therapeutic strategies for this unique clinical entity.

Biopsy for advanced hepatocellular carcinoma: results of a multicentre UK audit

“…Our study serves to confirm these findings. Similarly, the overlap between imaging characteristics of cHCC-CC and HCC has recently been highlighted and biopsy has been recommended to improve diagnostic accuracy [12][13][14].…”

Prediction of Survival and Analysis of Prognostic Factors for Patients With Combined Hepatocellular Carcinoma and Cholangiocarcinoma: A Population-Based Study

“…The main treatments for CHC include liver resection (LR) and liver transplantation (LT). Complete LR is considered to be the first-line treatment strategy for resectable CHC; however, the median overall survival (OS) of patients with CHC who have undergone surgery was only approximately 25-35.4 months (12,13,(17)(18)(19). LT is another surgical option that may offer the only chance for long-term survival.…”

“…LT is another surgical option that may offer the only chance for long-term survival. Although LT has a survival advantage for patients with HCC, transplantation for CHC remains controversial (3,16,19).…”

Modulation of hepatic mRNA-miRNA panel linked to NAFLD/NASH Hippo signaling and gut microbiota after administration of kefir in Non-Alcoholic Steatohepatitis Rat Model

“…Hepatic stem/progenitor cells (HPCs or HpSCs, in humans) or oval cells (in rodents) are bipotential stem cells that can differentiate into mature hepatocytes and cholangiocytes [31]. They represent a reserve compartment that can be activated to reactive ductulus (Or ductular reaction: DR) only when the mature epithelial cells of the liver are continuously damaged or blocked in their replication or in cases of serious cell loss [32].…”