Published online Apr 16, 2022. doi: 10.12998/wjcc.v10.i11.3615
Peer-review started: December 12, 2021
First decision: January 26, 2022
Revised: February 8, 2022
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: April 16, 2022
Synchronous combined hepatocellular-cholangiocarcinoma (CHC) and hepatocellular carcinoma (HCC) is very rare, with few literature reports and poor clinical outcomes associated with the disorder. Surgical resection is the main treatment, which makes the preoperative diagnosis very important. However, due to imaging manifestations overlapping with HCC, diagnosis of this type of synchronous cancer is challenging and it tends to be misdiagnosed as multiple HCC. Herein, we report the contrast-enhanced ultrasound (CEUS) manifestations of a case of synchronous CHC and HCC, aiming at adding to the understanding of this disease. CEUS displayed exquisite vascularity and tissue perfusion in real time with good spatial and temporal resolution and more accurately reflect tumor washin and washout times than contrast-enhanced computed tomography (CT) in this case.
The patient was a 69-year-old female with a 20-year history of chronic hepatitis B. Due to months of epigastric pain and anorexia, she reffered to our hospital for treatment. Five days before hospitalization, abdominal magnetic resonance imaging performed at another hospital detected a space-occupying lesion in the liver. After her hospitalization, laboratory tests showed elevated alpha-fetoprotein and carbohydrate antigen 19-9 level. Two suspicious liver lesions located in S4 and S6, respectively, were identified in a cirrhotic background by abdominal contrast-enhanced CT (CECT). Furthermore, the lesion in S4 and S6 were detected by CEUS and assigned to CEUS LI-RADS 5 and M categories, respectively. The patient underwent tumor radical resections. Post-operative pathology confirmed the S4 and S6 lesions to be HCC and CHC, respectively. A newly-found suspicious liver nodule with potential malignancy was detected in liver S1 by both CEUS and CECT 7 mo after operation.
The CEUS characteristics of CHC and HCC are different. CEUS features in combination with clinical information could help in effective diagnosis, clinical decision-making and better prognosis.
Core Tip: Synchronous hepatocellular-cholangiocarcinoma (CHC) and hepatocellular carcinoma (HCC) is rare and tend to be misdiagnosed as multiple HCC in clinical settings. Patients afflicted with this disorder generally have poor prognosis, moreover, preoperative imaging diagnosis is often challenging. This paper introduces contrast-enhanced ultrasound (CEUS) manifestations of a case of synchronous CHC and HCC, which showed different imaging features on CEUS images. Overall, the combination of CEUS characteristics with clinical information could help in effective diagnosis of synchronous CHC and HCC, as well as clinical decision-making and patients’ prognosis.