Combined Hepatocellular-Cholangiocarcinoma: Report of Two Cases

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is an uncommon primary liver cancer composed of cells with both hepatocellular and biliary epithelial differentiation. The incidence has been reported to be 0.54% to 14.2% of primary liver cancers. The clinical and demographic features may be similar to either hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC), with a high prevalence of multiplicity, portal vein or hepatic vein invasion and lymph node metastasis. Accurate preoperative diagnosis is important; however, misdiagnosis frequently occurs with noninvasive serological and radiological studies and even invasive percutaneous biopsy. Complete tumor resection with hilar lymph node dissection may provide the best chance of cure in patients with compensated liver reserve. The role of liver transplantation is yet to be determined. Herein, we report two cases of cHCC-CC, a double-cancer type and a mixed-type, and focus on the importance of preoperative clinical suspicion using noninvasive diagnostic tools.