Korean J Transplant.  2021 Jun;35(2):116-123. 10.4285/kjt.20.0037.

Salvage living donor liver transplantation for post-resection recurrence of combined hepatocellular carcinoma-cholangiocarcinoma

• Kim M
• Hwang S
• Song GW
• Ahn CS
• Moon DB
• Jung DH
• Park GC
• Lee SG

• KMID: 2517295
• DOI: http://doi.org/10.4285/kjt.20.0037

Abstract

Salvage liver transplantation (LT) is a definite treatment for recurrent hepatocellular carcinoma (HCC) after hepatectomy. Combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CC) is not eligibly indicated for LT because of high post-transplant recurrence. We present a case of salvage living donor liver transplantation (LDLT) in a patient with tumor recurrence after surgical resection of cHCC-CC. A 61-year-old male patient diagnosed with chronic hepatitis B underwent right posterior sectionectomy for HCC. The pathological diagnosis revealed presence of a 3.2-cm-sized cHCC-CC with stem cell features and intermediate cell-subtype. Intrahepatic tumor recurrence occurred 9 months later and transarterial chemoembolization was performed. Due to the progress of recurrent tumors, ABO-incompatible LDLT was performed. The explant liver pathology revealed four small masses of cHCC-CC with stem cell features. Pulmonary metastasectomy and chest wall resection were performed for metastatic lesions at 10 months after LT. Multiple tumor recurrence was detected at 21 months after LT with progression despite sorafenib administration. Currently, the patient is alive for past 26 months after LT. In conclusion, the clinical sequences of this case suggest that the role of salvage LT for cHCC-CC is much more limited than that for HCC because the tumor biology of cHCC-CC is more aggressive compared with HCC.

Keyword

Hepatectomy; Tumor marker; Neoadjuvant therapy; Recurrence; Tumor biology

Figure

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  Fig. 1 Initial preoperative imaging studies. Dynamic computed tomography (A, B) and magnetic resonance imaging (C, D) show a 2-cm-sized single mass (arrows) located in the liver segment VII with a diagnosis of hepatocellular carcinoma or intrahepatic cholangiocarcinoma.

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  Fig. 2 Gross photograph of the resected specimens. (A) Liver specimen following right posterior sectionectomy shows a 3.2-cm-sized tumor. (B) The explant liver specimen shows the presence of multiple tumors (arrows). The resected specimens from the lung (C) and chest wall (D) show metastatic tumors.

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  Fig. 3 Imaging study findings of tumor recurrence taken at 9 months after hepatic resection. Computed tomography images show a recurrent intrahepatic mass in the liver segment II (A, B). (C) Transarterial chemoembolization shows hypervascular tumor staining. (D) Computed tomography scan taken 2 days later shows diffuse lipiodol uptake at the mass. Arrows indicate the recurrent mass.

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  Fig. 4 Pretransplant imaging study findings of the recurrent tumors. Liver magnetic resonance imaging taken 10 months after hepatic resection shows two masses at the liver segments II and III (A, B). There was no noticeable progression of the two recurrent lesions on liver computed tomography taken 1 month later (C, D). Arrows indicate the recurrent masses.

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  Fig. 5 Early posttransplant imaging study findings. Computed tomography images taken 3 weeks after transplantation show no abnormal findings at the arterial (A) and portal (B) phase images.

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  Fig. 6 Post-transplant imaging study findings of the recurrent tumors. Computed tomography taken 8 months after transplantation shows a nodule in the right lower chest wall (A). A small nodule is identified in the upper lobe of the right lung in the chest computed tomography (B). These two recurrent lesions are visible in the fluorodeoxyglucose-positron emission tomography (C, D). Arrows indicate the recurrent masses. Progression of the recurrent lung and chest wall tumors is observed in the images taken at 21 months (E, F) and 24 months (G, H) after transplantation, respectively. Arrows indicate the recurrent masses.

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