Combined Hepatocellular-Cholangiocarcinoma Associated With Radiofrequency Ablation for Hepatocellular Carcinoma

Abstract

The patient was a 70-year-old male with liver cirrhosis associated with viral hepatitis C. He underwent radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) four times of in the 3 years prior to this reported event. Although he was closely followed after RFA by imaging every 3 - 4 months, a hypovascular and ill-defined tumor was revealed in segment IV of the liver by enhanced CT. The tumor expanded from the necrotic area associated with RFA performed 2 years prior. Because the tumor rapidly enlarged and was accompanied by a progressive tumor thrombus that filled the left portal vein, left hepatectomy was urgently performed. Histopathological examination of the resected specimen demonstrated that the tumor was mostly composed of moderately differentiated HCC. However, it also included obvious glandular structures with mucin production, which were immunohistochemically positive for both cytokeratin 7 and 19. These features are characteristic of cholangiocarcinoma; therefore the tumor was diagnosed as an uncommon combined hepatocellular-cholangiocarcinoma (cHCC-CC). From both pathological investigation and retrospective review of imaging results, the present cHCC-CC was presumed to derive from a locally recurring tumor with morphologic changes to the biliary phenotype induced by RFA for HCC. Both distant and intrahepatic metastases appeared 4 months after surgery and the patient died of cancer 15 months after surgery in spite of anti-cancer treatments. J Med Cases. 2016;7(1):28-32 doi: http://dx.doi.org/10.14740/jmc2387w