Combined hepatocellular carcinoma and cholangiocarcinoma: Clinical features and computed tomographic findings

Abstract

Clinicoradiological features were studied in 20 patients with 22 mass lesions of combined hepatocellular carcinoma and cholangiocarcinomas and findings of computed tomography in 12 of these patients with 14 hepatocellular carcinoma-cholangiocarcinomas. Five of these patients also had single overt hepatocellular carcinomas. The incidence of hepatocellular carcinoma-cholangiocarcinoma was 3.3% among the patients with primary liver cancer treated in our hospital. HBsAg was present in 25%, and increased levels of serum alpha-fetoprotein (> 200 ng/ml) and carcinoembryonic antigen (> 5 ng/ml) were found in 25% and in 47%, respectively. Associated cirrhosis was present in 60%. Analysis of 14 hepatocellular carcinoma-cholangiocarcinomas in 12 patients in whom the enhancement pattern on dynamic computed tomography and pathological findings could be studied and compared suggested three tumor types. Nine lesions (type A) were demonstrated only as areas with high-density peripheries in the early phase of enhancement that evolved into a pattern of peripheral low density and central high density in the late phase. Four masses (type B) were shown as hyperdense tumors (early phase) that changed to low density in the late phase. One mass (type C) was seen as a low-density lesion that did not change. Histopathologically, type A comprised hepatocellular carcinoma-predominant components in the peripheral area, cholangiocarcinoma-predominant components with abundant fibrous stroma in the central area and a tissue transitional between the two in the midzone. By contrast, two of four type B masses comprised hepatocellular carcinoma with scattered cholangiocarcinoma components throughout the tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy

“…26 CT and angiographic findings showing features of both HCC (early enhancement) and CCC (delayed enhancement) in contrast-enhanced images, tumor markers, and patient history proved in our experience adequate for diagnosis and previous experiences seem to confirm our findings. 27,28 Concerning the diagnosis of benign hepatic masses, the 100% specificity achieved in our series (Table 2) has to be addressed in relation to the correct definition of hemangiomas visualized by diagnostic imaging. The accuracy of FNB for diagnosing liver hemangiomas is poor, a fact that has been confirmed by Weimann et al, 16 who reported diagnostic accuracies of 69.4% and 43.9%, respectively, using cytological and microhistological techniques.…”

Combined hepatocellular and cholangiocarcinoma with sarcomatoid transformation: radiologic–pathologic correlation of a case

“…Similarly, preoperative diagnosis of cHCC-CC based on the identification of the enhancement characteristics of the individual tumor components is possible [10][11][12]. The HCC component typically with avid hepatic arterial supply often shows early phase (arterial) enhancement and low attenuation (''washout'') in the later venous and equilibrium phases.…”

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

“…The evolving pathologic definition of this tumor type and the inconsistent use of radiologic terminology to describe it limits the conclusions that can be drawn. A majority of cases report rim APHE with washout appearance in the periphery (86,110,120,(124)(125)(126)(127)(128)(129)(130).…”