Synchronous development of HCC and CCC in the same subsegment of the liver in a patient with type C liver cirrhosis

Abstract

As a result of having undergone computed tomography (CT), a 75-year-old woman with type-C liver cirrhosiswas shown to have two tumors on the ventral and dorsal sides of subsegment 3 (S3). The tumor on the ventral side was diagnosed as a classic hepatocellular carcinoma (HCC), while that on the dorsal side was considered atypical for a HCC. Although the indocyanine green (ICG) findings indicated poor hepatic reserve, the prothrombin time (PT) was relatively good. An operation was performed in February 2007; however, this resulted in exploratory laparotomy. Dynamic CT performed 12 mo after the operation revealed that the tumor on the dorsal side of S3 had apparently increased. The marginal portion of the tumor was shown to be in the early and parenchymal phases, while the internal portion was found to have grown only slightly in the delayed phase. We diagnosed this tumor as a cholangiocellular carcinoma (CCC). S3 subsegmentectomy was performed in April 2008. The tumor on the ventral side was pathologically diagnosed as a moderately differentiated HCC, and that on the dorsal side was diagnosed as a CCC. We can therefore report a rare case of synchronous development of HCC and CCC in the same subsegment of the liver in a patient with type-C liver cirrhosis. We also add a literature review for all the reported cases published in Japan and around the world, and summarize the features of double cancer exhibiting both HCC and CCC.

Synchronous double cancers of primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma: a case report and review of the literature

“…In contrast, the other mass in SV was highly enhanced and its density gradually decreased in the portal venous and delayed phases (Figure 1 b). We also reviewed four additional studies of double primary liver cancer (HCC and ICC), and the imaging findings were approximately the same as those in our patient [ 1 , 6 – 8 ]. Therefore, we speculate that the imaging findings of double primary hepatic cancer conform to the pathologic findings.…”

“…The occurrence of synchronous double cancers comprising different primary hepatic tumors is very low. Only 33 cases of ICC with HCC have been reported [ 1 ], and a survey of previous reports produced only 18 cases of double primary liver cancers that were synchronously resected [ 2 ]. We herein report a patient who underwent hepatectomy for double primary liver cancer (HCC and ICC) without a background of obvious liver cirrhosis.…”

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

“…Double hepatic cancer of HCC and ICC is rarely encountered in clinical practice, and according to the retrospective analysis of Watanable [ 27 ], the incidence of double primary liver cancer was 0.54–0.70 % of PLCs, and the male to female ratio of double cancer was 10:1. The average age of double cancer patients was 67, the rates of HBV and HCV infection were 9.1 and 72.7 %, respectively, and cirrhosis was observed in 36.4 % of patients.…”

Combined hepatocellular-cholangiocarcinoma containing the cells of hepatocellular cancer and bile duct cancer

“…It occurs more frequently in men than in women: 14:1 [3], usually in the seventh decade of life [2,4]. The factors which might affect the development of this type of cancer comprise an infection with HCV, HBV and liver cirrhosis [3,5,7]. On the basis of clinical data and diagnostic imaging, a preoperative diagnosis is difficult [6].…”