Li Rui, Yang Dan, Tang Chun-Lin, Cai Ping, Ma Kuan-Sheng, Ding Shi-Yi, Zhang Xiao-Hang, Guo De-Yu, Yan Xiao-Chu
Department Hepato-biliary-Pancreatic Surgery, Southwest Hospital, Gaotangyan street, Shapingba, Chongqing, 400038, P. R China.
Department Ultrasound, Southwest Hospital Affiliated to Third Military Medical University, Shapingba, Chongqing, 400038, P. R China.
BMC Cancer. 2016 Feb 25;16:158. doi: 10.1186/s12885-016-2156-x.
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is an uncommon primary liver malignancy and little known about the clinical and imaging characteristics of cHCC-CC. We aim to define the demographics, imaging features of cHCC-CC on contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CT) in this study.
From January 2005 to December 2014, 45 patients with pathologically proven cHCC-CC who underwent preoperative CEUS and 43 patients who had additional CT scan in our institution were included. A retrospective review of the imaging studies and clinical data in these patients was conducted.
In our series, cHCC-CC accounted for 1.6 % of all primary liver malignancy. Mean age of patient with cHCC-CC was 52.8 year (range: 28-74 year) and 88.9 % (40/45) of patients were male. Thirty of forty five patients (66.7 %) had cirrhosis and 20 % (9/45) of patients had chronic hepatitis B without cirrhosis. Alpha--fetoprotein (AFP) was elevated in 62.2 % (28/45) of patients and carbohydrate antigen 19-9 (CA19-9) elevated in 22.2 % (10/45) of patients). Both AFP and CA19-9 were simultaneously elevated in 15.6 % (7/45) of patients. Enhancement pattern resembling cholangiocarcinoma (CC) was noted in 53.3 % (24/45) of patients (on CEUS and in 30.2 % (13/43) of patients at CT. Enhancement pattern resembling hepatocellular carcinoma (HCC) was observed in 42.2 % (19/45) of patients on CEUS and in 58.1 % (25/43) of patients at CT. The percentage of tumors showing CC enhancement pattern (27.9 %, 12/43) was comparable with that of tumors showing HCC enhancement pattern (44.2 %, 19/43) on both CEUS and CT (p = 0.116). Simultaneous elevation of tumor markers (AFP and CA19-9) or tumor marker elevation (AFP or CA19-9) in discordance with enhancement pattern on CEUS was demonstrated in 51.1 % (23/45) of patients and on CT in 53.5 % (23/43) of patients, which was significantly more than simultaneous elevation of tumor markers (AFP and CA19-9) alone (p = 0.000).
The clinical characteristics of cHCC-CC are similar to those of HCC. The cHCC-CC tumors display enhancement patterns resembling CC or HCC in comparable proportion on both CEUS and CT. Combination of simultaneous elevation of tumor makers (AFP and CA19-9) and tumor mark elevation (AFP or CA19-9) in discordance with presumptive imaging findings on CEUS or CT may lead significantly more patients to be suspicious of the diagnosis of cHCC-CC.
肝内胆管癌合并肝细胞癌（cHCC-CC）是一种罕见的原发性肝脏恶性肿瘤，人们对其临床和影像学特征知之甚少。本研究旨在明确cHCC-CC的人口统计学特征、对比增强超声（CEUS）及对比增强计算机断层扫描（CT）的影像学特征。
纳入2005年1月至2014年12月期间在我院接受术前CEUS检查且病理证实为cHCC-CC的45例患者，以及另外43例行CT检查的患者。对这些患者的影像学检查和临床资料进行回顾性分析。
在我们的研究系列中，cHCC-CC占所有原发性肝脏恶性肿瘤的1.6%。cHCC-CC患者的平均年龄为52.8岁（范围：28 - 74岁），88.9%（40/45）的患者为男性。45例患者中有30例（66.7%）患有肝硬化，20%（9/45）的患者患有慢性乙型肝炎但无肝硬化。62.2%（28/45）的患者甲胎蛋白（AFP）升高，22.2%（10/45）的患者糖类抗原19-9（CA19-9）升高。15.6%（7/45）的患者AFP和CA19-9同时升高。53.3%（24/45）的患者（CEUS检查时）及30.2%（13/43）的患者（CT检查时）表现出类似胆管癌（CC）的强化模式。42.2%（19/45）的患者CEUS检查时及58.1%（25/43）的患者CT检查时表现出类似肝细胞癌（HCC）的强化模式。在CEUS和CT检查中，表现为CC强化模式的肿瘤比例（27.9%，12/43）与表现为HCC强化模式的肿瘤比例（44.2%，19/43）相当（p = 0.116）。51.1%（23/45）的患者CEUS检查时及53.5%（23/43）的患者CT检查时出现肿瘤标志物（AFP和CA19-9）同时升高或肿瘤标志物升高（AFP或CA19-9）但与强化模式不一致的情况，这一比例显著高于单纯肿瘤标志物（AFP和CA19-9）同时升高的比例（p = 0.000）。
cHCC-CC的临床特征与HCC相似。cHCC-CC肿瘤在CEUS和CT检查中表现出类似CC或HCC强化模式的比例相当。肿瘤标志物（AFP和CA19-9）同时升高以及肿瘤标志物升高（AFP或CA19-9）但与CEUS或CT上的推测影像学表现不一致，可能会使更多患者被怀疑患有cHCC-CC。
