Rapid progression of combined hepatocellular carcinoma and cholangiocarcinoma

Abstract

Combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CC) is a rare entity comprising 1–14.2% of all primary liver carcinomas. In this report, we present a case of rapid progression of cHCC-CC, a rare tumor in a 77-year-old Caucasian male patient with hepatitis B-induced cirrhosis, moderately elevated alpha fetoprotein, and imaging and pathologic features of a mixed liver tumor. There was no evidence of metastatic disease in the chest, abdomen or pelvis by computed tomography (CT) scan at the time of diagnosis. Needle biopsy of the segment 8 lesion revealed two discrete histologic components to the tumor: well-differentiated HCC and poorly differentiated adenocarcinoma, consistent with intrahepatic CC.The patient rapidly developed metastatic disease after initial local therapy with hepatic arterial chemoembolization and percutaneous cryoablation, dying within 5 months of diagnosis. Radiofrequency ablation, cryoablation and radioembolization with yttrium-90 microspheres remain possible treatment strategies for patients with cHCC-CC unable to undergo surgical resection. The diagnosis and treatment of cHCC-CC can be challenging due to clinical, imaging and histological features that overlap with pure HCC and CC.

Differentiation combined hepatocellular and cholangiocarcinoma from intrahepatic cholangiocarcinoma based on radiomics machine learning

“…We found that intratumor necrosis was an independent predictor for CHC, not consistent with the published papers (14)(15)(16)(17)(18)(19)(20)(21), conclusions of which were also inconsistent. We suggest two explanations of why radiographic imaging of CHC varies among researches.…”

“…Additionally, radiographic imaging plays a vital role in the diagnosis and differential diagnosis of liver tumors. However, CHC can share some similar radiographic characteristics with ICC (15,16), so it is challenging to differentiate diagnosis preoperatively through those methods (17). For example, there have been some studies regarding CHC's radiographic characteristics (18)(19)(20)(21)(22)(23)(24)(25), but these studies' results are contradictory.…”

Radiology Estimates of Viable Tumor Percentage in Hepatocellular Carcinoma Ablation Cavities Correlate Poorly With Pathology Assessment

“…One published case report describes rapid progression of a confirmed hepatocholangiocarcinoma after ablation. 21 These tumors are less vascular and more fibrotic than pure HCC and it has been suggested that this renders them less likely to respond to TACE. 22…”

Combined Hepatocellular-Cholangiocarcinoma

“…Some authors had proposed that CHCC-C behaves like HCC, but in fact a biliary cell component is now thought to confer a poorer prognosis (Wu et al 1996), and CHCC-C can undergo rapid progression (Saboo et al 2011;Garancini et al 2014;Kim et al 2014) In a study on 25 patients, the overall median survival of CHCC-C patients was 38 weeks while that of HCC patients was 54 weeks (Chantajitr et al 2006). In 29 Korean patients with CHCC-C who underwent liver resection or liver transplantation, diseasefree survival rates at 6 months, 1 year, and 3 years were 51.1 %, 38.3 %, and 25.6 %, respectively.…”