Abstract
Background: Synchronous double primary hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) (sdpHCC-ICC) located separately within a single liver is extremely rare. The purpose of this study is to investigate the clinical, imaging, pathological characteristics and prognosis of patients with sdpHCC-ICC, in order to enhance our understanding of the disease and improve diagnostic and therapeutic effect.Case presentation: A 49-year-old female patient with obvious liver cirrhosis, who carried hepatitis B virus, was admitted to our hospital for physical examination. The level of α-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9) was found to be elevated. Abdominal ultrasonography and enhanced computed tomography revealed two solid masses located in segments (S) 4 and 6 of the liver, with malignant behaviors. The preoperation diagnosis was multiple primary hepatocellular carcinomas. We performed hepatic resection of both segments. The resected specimens revealed that the tumors in segments 4 and 6 were well-defined lesions of 5.0 cm and 2.5cm, respectively. Histopathological examination confirmed that the tumor of the 4th segment to be moderately and poorly differentiated ICC, and that the tumor of the 6th segment to be poorly differentiated HCC. Immunohistochemically, the ICC in S4 was positive for CK19 and negative for Heppar-1, while the HCC in S6 was positive for Heppar-1 and negative for CK19. Unfortunately，metastasis and recurrence of multiple organs and lymph nodes were observed only 3 months later.Conclusions: The clinical characteristics of sdpHCC-ICC are usually atypical. It is of difficulty to make an accurate preoperative diagnosis. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection were both the independent risk factor to the development of sdpHCC-ICC. In patients with chronic liver disease, careful observation with imaging examination should be necessary. Tumor markers may be valuable to the diagnosis of it. The definite diagnosis depends on pathological examination. Hepatic resection may be the preferred and most effective treatment. The prognosis of synchronous occurrence of double hepatic cancers was poorer than for either HCC or ICC, and the origin of it needs further study.
Synchronous double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma
