Liver transplantation for double primary hepatic cancer-hepatocellular carcinoma and intrahepatic cholangiocarcinoma

Impact of incidental/misdiagnosed intrahepatic cholangiocarcinoma and combined hepatocellular cholangiocarcinoma on the outcomes of liver transplantation: an institutional case series and literature review

Intrahepatic cholangiocarcinoma (ICC) or combined hepatocellular cholangiocarcinoma (cHCC-CC) is considered to be contraindications for liver transplantation (LT); however, recent studies have shown that the outcomes of LT in small incidental ICC/cHCC-CC tumors are comparable to those in HCC. Studies reporting the survival outcome of patient(s) undergoing LT and found to have incidental or misdiagnosed ICC and/or cHCC-CC in liver explants were reviewed. Our institutional data were also included in the review analysis. In this review, 21 studies reporting 19865 cases of liver transplantation were included. The incidence of misdiagnosed/incidental ICC/cHCC-CC in liver explants was found to be 0.7% (136/19636). Hepatitis B and C virus infection was reported in 19 and 47% of the cases, respectively. The recurrence rate after LT was 42%. The most common site for recurrence was extrahepatic (73%). The disease free survival rate at 3 years was reported to range 33-86%. The 3-year overall survival rate was reported be 22-70%. The outcome of LT in patients with incidental/misdiagnosed ICC/cHCC-CC was found to be poorer than that of matched patients with HCC in five studies; however, the outcome becomes equivalent to those of HCC in cases of small (<2 cm), well-differentiated ICC/cHCC-CC tumors without vascular invasion.

Synchronous development of HCC and CCC in the same subsegment of the liver in a patient with type C liver cirrhosis

As a result of having undergone computed tomography (CT), a 75-year-old woman with type-C liver cirrhosiswas shown to have two tumors on the ventral and dorsal sides of subsegment 3 (S3). The tumor on the ventral side was diagnosed as a classic hepatocellular carcinoma (HCC), while that on the dorsal side was considered atypical for a HCC. Although the indocyanine green (ICG) findings indicated poor hepatic reserve, the prothrombin time (PT) was relatively good. An operation was performed in February 2007; however, this resulted in exploratory laparotomy. Dynamic CT performed 12 mo after the operation revealed that the tumor on the dorsal side of S3 had apparently increased. The marginal portion of the tumor was shown to be in the early and parenchymal phases, while the internal portion was found to have grown only slightly in the delayed phase. We diagnosed this tumor as a cholangiocellular carcinoma (CCC). S3 subsegmentectomy was performed in April 2008. The tumor on the ventral side was pathologically diagnosed as a moderately differentiated HCC, and that on the dorsal side was diagnosed as a CCC. We can therefore report a rare case of synchronous development of HCC and CCC in the same subsegment of the liver in a patient with type-C liver cirrhosis. We also add a literature review for all the reported cases published in Japan and around the world, and summarize the features of double cancer exhibiting both HCC and CCC.