Management of combined hepatocellular and cholangiocarcinoma

Abstract

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver malignancy composed of cells with histopathological features of both cholangiocarcinoma (CC) and hepatocellular carcinoma (HCC). It reportedly accounts for 0.4-14.2% of all primary liver carcinomas, with incidence varying in different regions. The clinical features are similar to those of either HCC or CC. Preoperative noninvasive diagnosis of cHCC-CC with conventional radiography is difficult. Because the origin of cHCC-CC is from two different tumour entities, despite intensive preoperative imaging studies, most studied patients were misdiagnosed either as HCC or CC. Accurate preoperative diagnosis is important because the most appropriate treatment depends on the major component of the tumour (HCC or CC). A high index of suspicion, imaging studies (ultrasound, computed tomography, positron emission tomography), levels of serum tumour markers (alpha-fetoprotein, carbohydrate antigen 19-9), and histology assist case detection and treatment choice. Patients who qualify for surgery should have a partial hepatectomy with hilar lymph node dissection, which can result in 5-year survival rates exceeding 50%. The role of liver transplantation is not yet known.

Mixed hepatocellular and cholangiocarcinoma: a rare tumor with a mix of parent phenotypic characteristics

“…Both HCC and ICC have characteristic imaging features. [16][17][18][19] The imaging features of cHCC-ICC are often only subtly different 9,20 from HCC and ICC, precluding reliable imaging diagnosis. Moreover, even percutaneous biopsy of cHCC-ICC may be misleading because only the dominant HCC or ICC component of cHCC-ICCC is confirmed pathologically, and the true histopathology of cHCC-ICC can only be confirmed after evaluation of the resected surgical specimen.…”

A Case of Curative Resection of Advanced Combined Hepatocellular-cholangiocarcinoma after Neoadjuvant Chemotherapy

“…Surgery is the only treatment offering the possibility of a cure at the present time (6). However, commonly combined liver cirrhosis has the potential for serious complications, so strict selection of patients is required, taking into consideration any pre-existing cirrhosis, general physical condition, tumor extent as examples (6,11,12).…”

“…Because of its low incidence, information on the prognosis of patients with cHCC-CC is very limited and the reported clinical outcomes vary and may not accurately represent the actual prognosis of patients with cHCC-CC (3,5,6).…”

“…However, commonly combined liver cirrhosis has the potential for serious complications, so strict selection of patients is required, taking into consideration any pre-existing cirrhosis, general physical condition, tumor extent as examples (6,11,12). Currently, aggressive treatments including liver transplantation have been attempted on cHCC-CC patient (13).…”

Double primary hepatic cancer (hepatocellular carcinoma and intrahepatic cholangiocarcinoma) in a single patient: A case report

“…The majority of PLCs are hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC); however, combined HCC and cholangiocarcinoma (CC) in a single liver (cHCC-CC) is reported to account for 0.4-14.2% of cases (3)(4)(5)(6)(7). Allen and Lisa (8) classified cHCC-CC into three subtypes: Type A, separate nodules of HCC and CC; type B, contiguous masses of HCC and CC; and type C, individual masses intermingling, with components of HCC and CC.…”