Primary biliary cholangitis metachronously complicated with combined hepatocellular carcinoma-cholangiocellular carcinoma and hepatocellular carcinoma

Figure 1 The initial tumor. A: Low-echoic tumor of 15 mm in size in segment 8 in US; B: The enhanced tumor on the early phase in dynamic CT; C: Low-intensity tumor on the hepatocyte phase in MRI; D: Cut surface of the 15-mm solid mass in segment 8; E: HE staining of the resected specimen; F: Adenocarcinoma in the component of CCC; G: HCC with a trabecular pattern; H: Dense fibrous tissue was formed and intrahepatic biliary ducts were showing destruction, while a loose lymphoid aggregate indicated stage 3 of primary biliary cirrhosis. CCC: Cholangiocellular carcinoma; CT: Computed tomography; HCC: Hepatocellular carcinoma; HE: Hematoxylin-eosin; MRI: Magnetic resonance imaging; US: Ultrasonography.

Figure 2 Immunohistochemistry findings for the initial tumor. A: HCC component stained positive for hepatocyte; B: HCC component stained positive for CK18; C: Both HCC and CCC components stained negative for alpha fetoprotein; D: CCC component stained positive for CK7; E: CCC component stained positive for CK19; F: Epithelial cell adhesion molecule stained positive for the HCC component and weakly positive for the CCC component. CCC: Cholangiocellular carcinoma; CK: Cytokeratin; HCC: Hepatocellular carcinoma.

Figure 3 The second tumor. A: The enhanced tumor of 10 mm in diameter in segment 5 on the early phase in dynamic CT; B: The iso-density tumor on the delayed phase; C: Low intensity tumor on the hepatocyte phase in MRI; D: Cut surface of the 10-mm solid mass in segment 5; E: HE staining showing a pseudoglandular pattern of HCC. CT: Computed tomography; HCC: Hepatocellular carcinoma; HE: Hematoxylin-eosin; MRI: Magnetic resonance imaging.