P1-13-5 - Clinico-Pathological Analysis of Combined Hepatocellular Cholangiocarcinoma: a Single Center Experience

Abstract

Background: Combined hepatocellular cholangiocarcinoma (cHCC CC) is a rare variant of primary liver carcinoma. Although several reports presented clinical characteristics, incidences, treatment strategy and prognosis of cHCC CC, most of them were case reports or case series and much part still remains uncertain. This study was undertaken to investigate the clinicopathological characteristics of cHCC CC and effective treatment strategy based on a meticulous review of our cases and literature. From the result, we attempted to draw a systemized guideline of cHCC CC management from diagnosis to treatment.1: The clinical data from 8 patients who were pathologically confirmed as cHCC CC from 2008 to 2013 at YEOUIDO St Marys Hospital was analyzed retrospectively. We reviewed pathological characteristics including immunohistochemistry profile and clinical findings with radiologic features. Further, we reviewed the treatment modalities of 8 patients with response results. In addition to that, we searched studies about systemic treatment of cHCC CC and recent advances in treatment strategy via PUBMED. Based on that we made a systemized guideline of cHCC CC management.Conclusion: Atypical enhancement pattern and lymph node metastasis pattern were useful clues for the suspicion of cHCC CC. Enhancement pattern of liver dynamic CT was helpful to estimate relative portion of CC and HCC. However, in case of hypovascular mass or small sized mass, MRI was needed for further discrimination. Tumor vascularity was closely related with favorable prognosis and good response for TACE. However, hypovascularity and portal vein thrombosis hindered wide usage of TACE. Stem cell feature was closely related with poor prognosis with fatal clinical course. Sorafenib, tyrosine kinase inhibitor and combination chemotherapy with gemcitabine and cisplatin showed marginal response. Further studies about treatment for poorly vascularized tumor are warranted.