Double primary hepatic cancer (hepatocellular carcinoma and intrahepatic cholangiocarcinoma) originating from hepatic progenitor cell: a case report and review of the literature

Abstract

BackgroundSynchronous development of primary hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) in different sites of the liver have rarely been reported before. The purpose of this study is to investigate the clinicopathological characteristics of synchronous double cancer of HCC and ICC.Case presentationA 56-year-old Chinese man without obvious liver cirrhosis was preoperation diagnosed with multiple HCC in segments VI (SVI) and VII (SVII) by the abdominal computed tomography (CT) and contrast-enhanced ultrasonography (CEUS). We performed hepatic resection of both segments. The tumors in SVI and SVII were pathologically diagnosed as ICC and HCC, respectively. Immunohistochemically, the HCC in SVII was positive for HepPar-1 and negative for CK19, while the ICC in SVI tumor was positive for CK19 and negative for HepPar-1. Interestingly, the immunohistochemical results also showed that the classic hepatic progenitor cell (HPCs) markers CD34 and CD117 were both positive of the two tumors. The patient still survived and at a 1-year follow-up did not show evidence of metastasis or new recurrent lesions. We speculate that the two masses may have originated from HPCs based on the findings of this patient.ConclusionsSynchronous development of HCC and ICC is very rare with unique clinical and pathological features. The correct preoperative diagnosis of double hepatic cancer of HCC and ICC is difficult. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection were both the independent risk factor to the development of double liver cancer. Hepatic resection is the preferred and most effective treatment choice. The prognosis of synchronous occurrence of double hepatic cancer was poorer than for either HCC or ICC, and the origin of it needs further study.

Diagnosis of liver tumors by multimodal ultrasound imaging

“…Such efforts are currently a focus and challenge in clinical work on hepatobiliary surgery. [ 4 ] As the preferred examination method for liver tumor screening, conventional ultrasonography (US) can reveal the location, size, morphology, internal echo, boundary, presence of acoustic halo at the edge, and condition of the blood flow of tumors. [ 5 ] Contrast-enhanced ultrasonography (CEUS) is a noninvasive imaging technology that can continuously and dynamically observe blood perfusion in tumors in real-time through injection of a contrast agent to enhance the blood flow reflux signal in the human body.…”

Metabolic biomarkers in cancer

“…Liver Tumor is classified as hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and combined HCC cholangiocarcinoma (cHCC-CC), according to the histological type (95,96). Hepatocellular carcinoma (HCC) is the most frequent primary malignant liver tumor, with incidences of 75-85% (95).…”

Duplex Ultrasound in the Diagnosis of Liver Tumors

“…Chronic viral hepatitis B and C, which lead to liver cirrhosis, remain the most important risk factors for the development of hepatocellular hepatoma [6]. Early differential diagnosis of the benign and malignant nature of the liver tumor is important for choosing the tactics of treating patients [7]. Concomitant liver dysfunction at a later stage of the tumor further complicates therapeutic therapy.…”