A case of combined hepatocellular-cholangiocarcinoma with underlying schistosomiasis

Abstract

Combined hepatocellular-cholangiocarcinoma is a rare form of primary liver cancer showing features of both hepatocellular and biliary epithelial differentiation. We report here on a case with collision tumor, which apparently was the coincidental occurrence of both hepatocellular carcinoma and cholangiocarcinoma underlying schistosomiasis. A 39-year-old-Philippine female was transferred to our hospital for evaluation of a liver mass that was found on ultrasonography at a local hospital. HBsAg and Anti-HCV were negative and serum alpha-fetoprotein (AFP) level was normal. The tumor mass was histologically diagnosed as adenocarcinoma by sono-guided biopsy before the operation. Partial lobectomy was performed and we histologically identified the concurrent occurrence of hepatocellular carcinoma and cholangiocarcinoma, (a "collision type carcinoma").

Figure 1

Abdominal enhanced CT scan. (A) A 3.6×4.8 cm sized ill-defined enhancing mass is shown in segment 6 of the liver on the arterial phase (arrow). (B) Another 3.3×2.6 cm sized ill-defined enhancing mass is seen at the porta hepatis (arrowhead) and a part of the mass at segment 6 of the liver is seen during the portal phase (arrow).

Figure 2

The microscopic findings of the mass in segment 6 show an adenocarcinoma with moderate differentiation by ultrasonography-guided needle biopsy (H&E stain, ×40).

Figure 3

Microscopic findings. (A) Surgical specimen of the liver shows the histologically identified concurrent occurrence of hepatocellular carcinoma (left upper) and cholangiocarcinoma (right lower) (H&E stain, ×40). Several calcified schistosome eggs (arrowheads) with fibrosis are noted between the two components. (B) Hepatocellular carcinoma and (C) cholangiocarcinoma, respectively (H&E stain, ×100). (D) The lymph node biopsy was positive for metastasis, and the node contained hepatocellular carcinoma (H&E stain, ×400).

Figure 4

Gross findings after partial right lobectomy. Cut-section examination shows several nodular shaped components of hepatocellular carcinoma (arrowheads) and homogenous sclerotic components of cholangiocarcinoma (arrow) with a whitish central scar.