Synchronous Double Primary Hepatic Cancer: Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma

Jin Ok Kim; Dae Won Jun; Kiseok Jang

doi:10.4166/kjg.2013.62.2.135

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Kim, Jun, and Jang: Synchronous Double Primary Hepatic Cancer: Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma

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Korean J Gastroenterol 2013;62(2):135-139.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.2.135

Synchronous Double Primary Hepatic Cancer: Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma

Jin Ok Kim, Dae Won Jun, Kiseok Jang¹

Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea

¹Department of Pathology, Hanyang University College of Medicine, Seoul, Korea

Correspondence to: Dae Won Jun, Department of Internal Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea. Tel: +82-2-2290-8338, Fax: +82-2-2298-9183, E-mail: noshin@hanyang.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Fig. 1.

Abdominal CT scan and liver MRI findings of right (arrows) and left (arrowheads) lobe tumors. (A) Arterial phase abdominal CT scan shows 11.6 cm sized hypoattenuated mass with irregular margin in the right lobe and 4.2 cm sized early enhancing mass in the left lobe. (B) Delayed phase abdominal CT scan shows peripheral enhancement of the mass in the right lobe with central “filling in” whereas the tumor in the left lobe shows early wash out pattern. (C) Unenhanced T1-weighted liver MRI shows a hypointense mass in the right lobe and an isointense tumor in the left lobe. (D) Unenhanced T2-weight-ed liver MRI demonstrates that the tumor in the right lobe shows heterogeneous signal intensity and the tumor in the left lobe shows high signal intensity.

Fig. 2.

PET-CT findings of hepatic tumors. (A) PET and (B) PET-CT show about 7–8 cm sized large mass with hypermetablic rim in the right lobe (SUVmax 6.65; arrow) and isometa-bolic mass in the left lobe (arrow head).

Fig. 3.

Microscopic findings of hepatic tumors. (A) The mass in the right lobe demonstrates invasive duct-like structure lined by atypical cuboidal cells consistent with cholangiocarcinoma (H&E, ×200). (B) The mass in the left lobe demonstrates thickened hepatocytic plate with trabecular growth pattern consistent with hepatocellular carcinoma (H&E, ×200). (C) Immunohistochemical stain for cytokeratin 7 of the right hepatic mass shows immunoreactivity in the cytoplasm of tumor cells (×200). (D) Immunohistochemical stain for HepPar-1 of the left hepatic mass reveals positive staining in the cytoplasm of tumor cells (×200).

Fig. 4.

Hepatic arteriography and transcatheter arterial chemoembolization (TACE) findings. (A) Hepatic arteriogram reveals huge irregular marginated mass with faint inhomogeneous tumor staining in the right lobe (arrow) and about 3.5 cm sized mass with dense tumor staining in the left lobe (arrowhead). (B) TACE was performed on the left lobe tumor.

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