Detection of Combined Hepatocellular and Cholangiocarcinomas: Enhanced Computed Tomography
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Most primary liver cancers are grossly divided into two histologic categories: hepatocellular carcinoma (HCC), derived from hepatocytes, and cholangiocellular carcinoma (CC), arising from the intra-hepatic bile duct epithelium. Combined hepatocellular and cholangiocarcinoma (cHCC-CC) is a rare form of primary liver cancer presenting histologic evidence of both hepatocellular and biliary epithelial differentiation, and is seen in 1.0–3.3% of surgically treated patients with pri mary liver tumors (The liver cancer study group of Japan, 1990; Aoki et al., 1993). Comparing the clinicopathological fea tures of patients with cHCC-CC with those of HCC or CC patients has yielded somewhat conflicting results in several studies. In many studies, cHCC-CC was found to be more prevalent in males (Lee et al., 2002). The incidence of positive hepatitis B or C serological test results in the cHCC-CC group is reported to be intermediate between that in the HCC group and in the CC group (Liu et al., 2003; Koh et al., 2005), or to be similar to that in the HCC group (Yano et al., 2003). Furthermore, the incidence of underlying chronic liver disease in the cHCC-CC group is also intermediate between that in the HCC group and in the CC group (Yano et al., 2003; Liu et al., 2003), or similar to that in the HCC group (The liver cancer study group of Japan, 1990). On the other hand, Jarnagin et al. (2001) reported that the incidence of positive hepatitis B or C serology and liver cirrhosis in patients with cHCC-CC was similar to that in CC patients. The reasons for the difference in this clinicopathological feature may include the difference between Western and Asian societies in the cause of liver cancer or the difference in the selection criteria of patients for hepatic resection (Liu et al., 2003). The survival rate in patients with cHCC-CC has been reported to be worse than that in patients with HCC or CC (Jarnagin et al., 2001; Yano et al., 2003; Liu et al., 2003), while Koh et al. (2005) concluded that the cHCC-CC group had a prognosis that was better than the CC group but worse than the HCC group. We have not come to a conclusion about clinicopathological features of cHCC-CC at the present time, and more cases must be analyzed to elucidate them.
In our daily practice we tend to be distressed at the difficulty of making a preoperative diagnosis of this type of tumor because it is rarely encountered. In an examination performed by The liver cancer study group of Japan (1990), the frequency of lymph node metastases in patients with cHCC-CC was 76.2% and was as high as that in patients with CC, while that in patients with HCC is 30.3%. Some of the literature suggests that there was a need for a lymph node resection dur ing a hepatectomy for cHCC-CC (Uenishi et al., 2000; Sasaki et al., 2001; Eguchi et al., 2002). Therefore, it is important to make a diagnosis of cHCC-CC preopera-tively.
KeywordsCompute Tomography Finding Fine Needle Aspiration Biopsy Primary Liver Cancer Intermediate Cell Bile Duct Carcinoma
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