Cancer Res Treat.  2010 Dec;42(4):235-238.

A Case of Combined Hepatocellular-Cholangiocarcinoma with Favorable Response to Systemic Chemotherapy

• Kim GM
• Jeung HC
• Kim D
• Kim JH
• Yoon SH
• Jung ES
• Shin SJ

Abstract

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare form of primary liver cancer composed of cells with histopathologic features of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Because of its low incidence, the information on clinical outcomes of cHCC-CC is very limited and there are no published reports describing non-surgical treatment options for cHCC-CC. We report a case of cHCC-CC exhibiting a favorable response to systemic chemotherapy with doxorubicin and cisplatin. A 62-year-old man who recurred after a right lobectomy for cHCC-CC received sorafenib for palliative systemic therapy, but follow up imaging studies showed disease progression. He received 2nd line chemotherapy with doxorubicin at 60 mg/m2 together with cisplatin at 70 mg/m2. After 2 cycles of chemotherapy, a computed tomography scan of the chest showed markedly decreased size and number of the multiple lung metastases. After completing 8 cycles of 2nd line therapy, we changed the regimen to a fluorouracil (5-FU) mono therapy because of the toxicities associated with doxorubicin and cisplatin. To date, the patient has completed his 15th cycle of 5-FU mono therapy with the disease status remaining stable during 18 months of follow-up.

Keyword

Cholangiocarcinoma; Hepatocellular carcinoma; Doxorubicin; Cisplatin

MeSH Terms

Carcinoma, Hepatocellular
Cholangiocarcinoma
Cisplatin
Disease Progression
Doxorubicin
Fluorouracil
Follow-Up Studies
Humans
Incidence
Liver Neoplasms
Lung
Middle Aged
Neoplasm Metastasis
Niacinamide
Phenylurea Compounds
Thorax
Cisplatin
Doxorubicin
Fluorouracil
Niacinamide
Phenylurea Compounds

Figure

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  Fig. 1 Pathologic features of the combined hepatocellular-cholangiocarcinoma. There were two components - hepatocellular element showing bile production, an intercellular bile canaliculi, and a cholangiocellular component showing mucin production or definite gland formation. There was no transition from the hepatocellular carcinoma (right) to the cholangiocarcinoma (left) (H&E, ×100).

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  Fig. 2 The follow up imaging studies at disease progression after 2 cycles of sorafenib. (A) Whole body bone scan showed multiple uptakes in T-spine, left scapula, ribs. (B) Chest radiograph showed bilateral multiple various sized lung nodules. (C) CT scan of chest showed innumerable hematogenous lung metastasis.

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  Fig. 3 The follow up imaging studies after 2 cycles of chemotherapy with doxorubicin and cisplatin. (A) Chest radiograph showed much improved hematogeneous lung metastasis. (B) CT scans of chest showed markedly decreased size and number of multiple hematogenous lung metastases.

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