Abstract
75-year-old male was admitted to the hospital because of general malaise. He had the abnormal liver function test due to alcohol consumption. The tests for anti-HBs, anti-HBc, anti-HCV were negative. Abdominal ultrasonography and the computed tomography scan showed a tumor that was about 20 mm in diameter in the segment 6 (S6) of the liver. The angiography and the CT during hepatic arteriography confirmed the presence of the S6 liver tumor and the tumor was diagnosed as combined hepatocellular and cholangiocarcinoma preoperatively. The operation was performed in August 2009. Grossly, there were two distinct parts in the resected tumor; hepatocellular carcinoma (HCC)-like lesion, which was yellowish and had the fibrous capsule, and cholangiocarcinoma (CC)-like lesion, which is whitish and infiltrated the surrounding tissues. Pathologically, HCC-like lesion showed moderately differentiated HCC with trabecular cell arrangement and CC-like lesion showed an anastomosing pattern of Hering's canal-like small glands with abundant fibrous stroma. Immunohistochemically, Cytokeratin (CK) 7, CK19 and EMA (Epithelial membrane antigen) were strongly positive in small glands and HePpar1 and AFP were also positive in small glands in part. Some glands were positive for both hepatocytic and cholangiocytic markers. This tumor was diagnosed as combined HCC and CC, in which CC area consisted solely of cholangiolocellular carcinoma (CLC). Primary liver cancer consisting of HCC and CLC components is rarely reported and this case provides useful information on the histogenesis of combined HCC-CC.
