Learning objectives
Emphasize clinical importance of diagnosis of primary liver carcinoma with biphenotypic differentiation/ combined hepatocellular carcinoma (CHC).
To review the classification systems for CHC.
Examine relationship between the clinical,
radiological and pathological features of CHC.
Outline treatment options.
Background
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are the most common primary hepatic neoplasms accounting for around 70% and 15% of cases respectively. Mixed hepatocellular-cholangiocarcinoma (CHC) is a rare subtype of primary liver carcinoma (2.4 - 14.2% of primary liver tumors) with both hepatocellular and biliary epithelial differentiation which shares imaging features of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) with a poor prognosis closer to that of ICC than HCC.
CHC was first described in 1949 by Allen & Lisa,
however due to...
Findings and procedure details
CLASSIFICATION SYSTEMS
Classification of CHC has evolved over time with Allen & Lisa originally describing 3 distinct subtypes in 1949.
This was subsequently updated by Goodman et al in 1989. The most recent and widely accepted WHO classification recognizes the important role of hepatic progenitor cells in the development of CHC and updated the classification into classical type and subtypes with stem cell features.
Allen & Lisa (1949)
Type A : Synchronous separate nodules of HCC and ICC
Type B: Contiguous masses that may mingle...
Conclusion
CHC is a rare primary liver tumor increasingly recognized as a distinct entity.
The mixed pathological nature of the tumor results in overlapping clinical and radiologic features of HCC and ICC.
Radiologists play a vital role in raising the possibility of CHC in patients with presumed HCC.
If suspected,
biopsy should be performed to confirm diagnosis,
prevent inappropriate liver transplantation and ensure optimum treatment stratification.
Personal information
Personal information
Contact details:
Dr.
Niamh Long
Department of Radiology,
Memorial Sloan Kettering Cancer Center,
1275 York Avenue,
New York,
NY 10065,
USA
Email:
[email protected]
References
Massarweh NN,
El-Serag HB.
Epidemiology of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma.
Cancer Control.
2017;24(3)
Goodman ZD,
Ishak KG,
Langloss JM,
Sesterhenn IA,
Rabin L.
Combined hepatocellular-cholangiocarcinoma.
A histologic and immunohistochemical study.
Cancer.
1985;55:124–135.
Allen RA,
Lisa JR.
Combined liver and bile duct carcinoma.
Am J Pathol.
1949;25:647–655.
Wang AQ,
Zheng YC,
Du J,
et al.
Combined hepatocellular cholangiocarcinoma: Controversies to be addressed.
World J Gastroenterol.
2016;22(18):4459-65.
Kim,
K.H.,
Lee,
S.G.,
Park,
E.H.
et al.
A Case of Combined Hepatocellular-Cholangiocarcinoma with Favorable Response to Systemic Chemotherapy....