Department of Pathology, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
Department of Pathology, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Ann Clin Lab Sci. 2024 Jan;54(1):106-111.
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a liver tumor with features of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). It consists of intermingled malignant biliary and hepatic tissue and thus a distinct entity, rather than two separate coexisting malignancies. A 59-year-old female with a history of hepatitis C and cirrhosis presented with abdominal pain and altered mental status. She developed hematemesis, and despite extensive interventions, she expired one day after her initial presentation. At autopsy, the liver was diffusely and markedly fibrotic with numerous nodules of varying size with invasion into adjacent vasculature. Microscopic examination of the nodules revealed cHCC-CC with stem cell features, lymphovascular invasion, and tumor emboli scattered throughout the right lung. The patient had end-stage liver disease due to the accumulation of damage and consequent fibrosis. This led to portal hypertension with subsequent massive gastrointestinal bleeding, hemorrhagic shock, and death. cHCC-CC is a rare, aggressive primary liver tumor with a poor prognosis. It can present with a cirrhotomemetic pattern with small nodules that can evade clinical and radiographic detection. Autopsy findings can provide valuable insights into the pathogenesis and clinical course of cHCC-CC, highlight the aggressive nature of the disease, and may inform future diagnostic and therapeutic strategies. Accurate diagnosis of this tumor is important for patient management and prognostication.
肝细胞癌-胆管细胞癌（cHCC-CC）是一种具有肝细胞癌（HCC）和肝内胆管癌（ICC）特征的肝脏肿瘤。它由混杂的恶性胆道和肝组织组成，因此是一种独特的实体，而不是两种同时存在的独立恶性肿瘤。一名 59 岁女性，有丙型肝炎和肝硬化病史，表现为腹痛和精神状态改变。她出现了呕血，尽管进行了广泛的干预，但在最初出现后的一天就去世了。尸检时，肝脏弥漫性和显著纤维化，有许多大小不一的结节，并侵犯相邻血管。结节的显微镜检查显示具有干细胞特征的 cHCC-CC，有淋巴血管侵犯，肿瘤栓子散布在整个右肺中。由于损伤和随之而来的纤维化的积累，患者患有终末期肝病。这导致门静脉高压，随后发生大量胃肠道出血、出血性休克和死亡。cHCC-CC 是一种罕见的、侵袭性的原发性肝脏肿瘤，预后不良。它可能表现为肝硬化性小结节模式，这些小结节可能会逃避临床和影像学检测。尸检结果可以深入了解 cHCC-CC 的发病机制和临床过程，突出疾病的侵袭性，并可能为未来的诊断和治疗策略提供信息。准确诊断这种肿瘤对于患者的管理和预后很重要。
