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Synchronous double cancers of primary hepatocellular carcinoma and cholangiolocellular carcinoma: a case report

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ABSTRACT

Synchronous double cancers consisting of hepatocellular carcinoma (HCC) and cholangiolocellular carcinoma (CoCC) are extremely rare. We herein report a surgical case of synchronous double cancers in a patient with primary HCC and CoCC. A 45-year-old man with hepatitis B was admitted to our hospital with hepatic tumors. The level of protein induced by vitamin K antagonist (PIVKA-II) was found to be elevated. Computed tomography (CT) revealed a 23-mm tumor with early-phase enhancement and late-phase washout in the 6th segment of the liver, and a 10-mm tumor with slight early-phase enhancement and late-phase washout in the 7th segment of the liver. Magnetic resonance imaging (MRI) revealed that the two tumors in the 6th and 7th segments showed low intensity on T1-weighted images and high intensity on T2-weighted images. Based on those preoperative examinations, the liver tumors were diagnosed as multiple primary hepatocellular carcinomas. The patient underwent a posterior segmentectomy. A histopathological examination revealed that the tumor of the 6th segment of the liver was moderately differentiated HCC, and that the tumor of the 7th segment of the liver was CoCC. The postoperative course was uneventful. However, lymph node recurrence was observed 6 months later and the patient died 20 months after surgery. There are only six reported surgical cases of synchronous double primary liver cancers consisting of HCC and CoCC. We are of the opinion that curative resection may be an effective treatment for double cancer consisting of HCC and CoCC, and that it may provide long-term survival.

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The histopathological examination of the two tumors. a The tumor of the 6th segment of the liver was moderately differentiated hepatocellular carcinoma (Hematoxylin and eosin staining, ×200). b The tumor of the 7th segment of the liver was cholangiolocellular carcinoma (Hematoxylin and eosin staining, ×200). c The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were CK7 positive (×200). d The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were CK19 positive (×200). e The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were EMA positive (×200). f The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were MUC1/DF3 positive (×200). g The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were EpCAM negative (×200)
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Fig5: The histopathological examination of the two tumors. a The tumor of the 6th segment of the liver was moderately differentiated hepatocellular carcinoma (Hematoxylin and eosin staining, ×200). b The tumor of the 7th segment of the liver was cholangiolocellular carcinoma (Hematoxylin and eosin staining, ×200). c The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were CK7 positive (×200). d The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were CK19 positive (×200). e The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were EMA positive (×200). f The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were MUC1/DF3 positive (×200). g The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were EpCAM negative (×200)

Mentions: Abdominal ultrasonography (US) showed a well-defined 23-mm hypoechoic mass that was heterogeneous on the inside in the 6th segment of the liver (Fig. 1a), and a slightly ill-defined 10-mm hypoechoic mass that was homogeneous on the inside in the 7th segment of the liver (Fig. 1b). Abdominal computed tomography (CT) revealed a 23-mm tumor with early phase-enhancement and late-phase washout in the 6th segment of the liver (Fig. 2a, b), and a 10-mm tumor with slight early-phase enhancement and late-phase washout in the 7th segment of the liver (Fig. 2c, d). Abdominal magnetic resonance imaging (MRI) revealed that the two tumors in the 6th (Fig. 3a, b) and 7th (Fig. 3c, d) segments showed low intensity on T1-weighted images and high intensity on T2-weighted images. Based on these preoperative examinations, the liver tumors were diagnosed as multiple primary hepatocellular carcinomas. The patient underwent a posterior segmentectomy. We did not perform lymph node dissection, because we diagnosed multiple primary hepatocellular carcinomas preoperatively. The resected specimen showed that the tumor of the 6th segment of the liver was a 23-mm well-defined yellowish-white soft elastic lesion (Fig. 4a), and that the tumor of the 7th segment was a 10-mm irregular yellowish-white slightly hard elastic lesion (Fig. 4b). A histopathological examination revealed that the tumor of the 6th segment of the liver was moderately differentiated hepatocellular carcinoma (Fig. 5a), while that of the 7th segment was cholangiolocellular carcinoma (Fig. 5b). The pathological findings of the non-cancerous tissue were liver cirrhosis. An immunohistochemical examination of the tumor cells in the 7th segment of the liver was positive for CK7, CK19, EMA, and MUC1/DF3 and was negative for EpCAM (Fig. 5c–g).Fig. 1


Synchronous double cancers of primary hepatocellular carcinoma and cholangiolocellular carcinoma: a case report
The histopathological examination of the two tumors. a The tumor of the 6th segment of the liver was moderately differentiated hepatocellular carcinoma (Hematoxylin and eosin staining, ×200). b The tumor of the 7th segment of the liver was cholangiolocellular carcinoma (Hematoxylin and eosin staining, ×200). c The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were CK7 positive (×200). d The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were CK19 positive (×200). e The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were EMA positive (×200). f The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were MUC1/DF3 positive (×200). g The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were EpCAM negative (×200)
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Fig5: The histopathological examination of the two tumors. a The tumor of the 6th segment of the liver was moderately differentiated hepatocellular carcinoma (Hematoxylin and eosin staining, ×200). b The tumor of the 7th segment of the liver was cholangiolocellular carcinoma (Hematoxylin and eosin staining, ×200). c The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were CK7 positive (×200). d The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were CK19 positive (×200). e The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were EMA positive (×200). f The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were MUC1/DF3 positive (×200). g The immunohistochemical examination of tumor cells from the 7th segment of the liver revealed that they were EpCAM negative (×200)
Mentions: Abdominal ultrasonography (US) showed a well-defined 23-mm hypoechoic mass that was heterogeneous on the inside in the 6th segment of the liver (Fig. 1a), and a slightly ill-defined 10-mm hypoechoic mass that was homogeneous on the inside in the 7th segment of the liver (Fig. 1b). Abdominal computed tomography (CT) revealed a 23-mm tumor with early phase-enhancement and late-phase washout in the 6th segment of the liver (Fig. 2a, b), and a 10-mm tumor with slight early-phase enhancement and late-phase washout in the 7th segment of the liver (Fig. 2c, d). Abdominal magnetic resonance imaging (MRI) revealed that the two tumors in the 6th (Fig. 3a, b) and 7th (Fig. 3c, d) segments showed low intensity on T1-weighted images and high intensity on T2-weighted images. Based on these preoperative examinations, the liver tumors were diagnosed as multiple primary hepatocellular carcinomas. The patient underwent a posterior segmentectomy. We did not perform lymph node dissection, because we diagnosed multiple primary hepatocellular carcinomas preoperatively. The resected specimen showed that the tumor of the 6th segment of the liver was a 23-mm well-defined yellowish-white soft elastic lesion (Fig. 4a), and that the tumor of the 7th segment was a 10-mm irregular yellowish-white slightly hard elastic lesion (Fig. 4b). A histopathological examination revealed that the tumor of the 6th segment of the liver was moderately differentiated hepatocellular carcinoma (Fig. 5a), while that of the 7th segment was cholangiolocellular carcinoma (Fig. 5b). The pathological findings of the non-cancerous tissue were liver cirrhosis. An immunohistochemical examination of the tumor cells in the 7th segment of the liver was positive for CK7, CK19, EMA, and MUC1/DF3 and was negative for EpCAM (Fig. 5c–g).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Synchronous double cancers consisting of hepatocellular carcinoma (HCC) and cholangiolocellular carcinoma (CoCC) are extremely rare. We herein report a surgical case of synchronous double cancers in a patient with primary HCC and CoCC. A 45-year-old man with hepatitis B was admitted to our hospital with hepatic tumors. The level of protein induced by vitamin K antagonist (PIVKA-II) was found to be elevated. Computed tomography (CT) revealed a 23-mm tumor with early-phase enhancement and late-phase washout in the 6th segment of the liver, and a 10-mm tumor with slight early-phase enhancement and late-phase washout in the 7th segment of the liver. Magnetic resonance imaging (MRI) revealed that the two tumors in the 6th and 7th segments showed low intensity on T1-weighted images and high intensity on T2-weighted images. Based on those preoperative examinations, the liver tumors were diagnosed as multiple primary hepatocellular carcinomas. The patient underwent a posterior segmentectomy. A histopathological examination revealed that the tumor of the 6th segment of the liver was moderately differentiated HCC, and that the tumor of the 7th segment of the liver was CoCC. The postoperative course was uneventful. However, lymph node recurrence was observed 6 months later and the patient died 20 months after surgery. There are only six reported surgical cases of synchronous double primary liver cancers consisting of HCC and CoCC. We are of the opinion that curative resection may be an effective treatment for double cancer consisting of HCC and CoCC, and that it may provide long-term survival.

No MeSH data available.


Related in: MedlinePlus