Combined hepatocellular and cholangiocarcinoma arising in a cirrhotic liver. Report of an autopsy case.

A rare case of combined hepatocellular and cholangiocarcinoma arising in a 56-year-old female is reported. The autopsy disclosed the presence of two different kinds of tumors in the right lobe of the liver, which showed advanced cirrhosis; a massive rubbery, ill-defined and whitish-yellow cholangiocarcinoma and a nodular soft, encapsulated and dark green hepatocellular carcinoma. They were adjacent to each other, but showed no intermingling. Only the massive cholangiocarcinoma had invaded the portal vein and showed several intrahepatic metastatic foci and hepatic, pancreaticoduodenal and perigastric lymph node metastases. Immunohistochemically, carbohydrate antigen 19-9 was strongly positive only for the cholangiocarcinoma component, explaining the high titer of this antigen in the serum on admission. On the basis of these findings, the possible morphogenesis of the tumor observed in the cirrhotic liver is discussed.