Purpose

The combined hepatocellular carcinoma and cholangiocarcinoma is a comparatively rare form of primary liver cancer that includes both hepatocellular carcinoma and cholangiocarcinoma components in the same tumor or in the same liver. We report here on a case with the combined hepatocellular carcinoma and cholangiocarcinoma, which had the metastasis to the small bowel manifested by intestinal obstruction.

Case description

A 46-year-old man was referred to our hospital for evaluation of a hepatic mass that was detected on abdominal computed tomography (CT) at a local clinic. He had experienced indigestion, bloated abdomen, nausea and vomiting for solid food since 2 months ago. A abdominal radiograph showed that mild ileus was suggested. The abdominal CT showed the about 35mm sized nodule with low attenuation in S6 of the liver, the diffuse wall thickening and a 2.5cm sized nodule with low attenuation in small bowel loops. The biopsy for hepatic mass was performed by guide of ultrasonography. The pathologic finding and immunohistochemical stains with cytokeratin 7, hepatocyte paraffin-1 antibody, mucicarmine revealed that the lesion of liver was diagnosed as the combined hepatocellular carcinoma and cholangiocarcinoma, type III by Goodman’s classification. Therefore he underwent the right lateral segmentectomy of liver and the segmental resection of jejunum. The tumor of jejunum has histologically identical morphology with the hepatic tumor. After the three times of chemotherapy with 5-FU and cisplatin, the multiple lymph nodes of upper abdomen were decreased on abdominal CT. He was followed up over 12 months until now.

Conclusion

We report a case of combined hepatocellular carcinoma and cholangiocarcinoma with distant metastasis, who showed promising outcome with surgical resection and adjuvant chemotherapy