간 및 경부 림프절 생검으로 진단된 혼합 간세포-담관상피암종

강혜원,박재정,문일환,김서우,김현경,오현정,김고흔,최윤정,허현미,노영욱,김태헌,유 권,배지윤,송동은 이화여자대학교 의과대학 2009 EMJ (Ewha medical journal) Vol.32 No.2

Mixed hepatocellular-cholangiocarcinoma accounts for about 1% of all hepatocellular carcinoma. In many cases, mixed hepatocellular-cholangiocarcinoma has been misdiagnosed as hepatocellular carcinoma or cholangiocarcinoma because of the indistinctive clinical course and radiologic findings. The clinical course and the pathologic characters are not known well, but it resembles the characteristics of hepatocellularcarcinoma rather than cholangiocarcinoma. So mixed hepatocellular-cholangiocarcinoma was classified as a kind of hepatocellular carcinoma. But the growth and dissemination rate is faster than that of hepatocellular carcinoma and the prognosis more poor. So the exact diagnosis is important. Authors experienced a patient who has the mixed hepatocellular-cholangiocarcinoma diagnosed by liver and neck node biopsy in patient who complain-ed abdominal discomfort and palpable mass, so we report the case.

Combined Hepatocellular-Cholangiocarcinoma in Extrahepatic Bile Duct with Co-existing of Scirrhous Type of Hepatocellular Carcinoma

Sang Hoon Lee,Moon Jae Chung Korean Society of Gastrointestinal Cancer 2014 Journal of digestive cancer reports Vol.2 No.1

We report a patient with combined hepatocellular-cholangiocarcinoma confined in the common hepatic duct and scirrhous type of hepatocellular carcinoma in the caudate lobe of liver simultaneously. The patient was a 55-yearsold Korean man with hepatitis B virus (HBV) carrier who was referred from a local hospital due to detected liver mass on abdominal computed tomography (CT). He has presented jaundice and weight loss for the previous 3 weeks. Laboratory examination showed AST/ALT elevation and hyperbilirubinemia. HBsAg was positive. The tumor marker study showed elevated AFP and DCP, not CEA and CA 19-9. Abdominal CT disclosed an about 2.1×0.9 cm sized soft tissue density in hilum with both intrahepatic duct (IHD) dilatations and an about 3×2.1 cm sized arterial enhancing lesion at segment 8 of the liver. Patient received 15 cycles of Gemcitabine/Cisplantin chemotherapy from February 27, 2013 to December 31, 2013. Caudate lobectomy of liver, segmental resection of bile duct and Roux-en-Y hepaticojejunostomy was performed on February 10, 2014. The final pathologic report showed double primary liver cancer, combined hepatocellular-cholangiocarcinoma in common hepatic bile duct and scirrhous type of hepatocellular carcinoma in segment 1 of the liver. This is a very unusual case in which combined hepatocellular-cholangiocarcinoma confined in the large bile duct and two rare hepatic cancers coexisted.

Identification of Differentially Expressed Genes in Hepatocellular Carcinoma Using Representational Difference Analysis

Park, Keon Uk 東國大學校醫學硏究所 2003 東國醫學 Vol.10 No.2

간암 특이발현 유전자의 대량 발굴을 위하여 RDA를 이용하는 subtracive library를 구축하였다. 간암 조직과 비교조직에서 발굴된 subtractive library 클론 각각 288개씩을 임의로 선택하여 이를 이용한 유전자칩을 제작하여 보다 정확한 검색을 시도하였다. 모두 50여종의 특이발현 유전자를 발굴하였으며, 간암조직에 특이적으로 발현된 유전자는 alpha fetoprotein, glypican-3, preferentially expressed antigen in melanoma (PRAME), fucosidase alpha, carcinoembryonic antigen (CEA), 그리고 topoisomerase Ⅱ 등이었다. 그 중 가장 많은 클론을 차지한 glypican 3 유전자에 대해서 좀 더 연구하였다. In situ hybridization 결과, glypican 3는 간암세포에 특이적으로 발현되고 있음을 알 수 있었다. 7종의 hepatocellular carcinoma와 hepatoblastoma 암세포주를 northern과 RT-PCR 법으로 검사한 결과 HepG2, Hep3B, SNU368, SNU398의 4종의 세포에서 glypican 3가 발현됨을 알아내었다. Glypican 3는 간암세포 표면에 특이적으로 발현되는 단백질이므로 간암의 진단이나 예후판정에 유용하게 이용될 수 있을 뿐 아니라 장차 glypican 3에 대한 항체 제작으로 간암의 면역치료요법의 표적물질이 될 수 있을 것으로 기대된다. To identify differentially expressed genes in human hepatocellular carcinoma (HCC), subtractive library by representational difference analysis (RDA) was constructed in hepatocellular carcinoma (HCC) and the corresponding background liver tissue. After TA cloning and random selection of subtractive library clones, they were used for microarray hybridization. After screening, more than 50 HCC specific gene fragments were identified, including alpha fetoprotein, glypican-3, preferentially expressed antigen in melanoma (PRAME), fucosidase alpha, carcinoembryonic antigen (CEA), and topoisomerase Ⅱ. We further characterized one of differentially expressed gene, glypican 3. In situ hybridization showed that glypican 3 was moderate to intensely expressed in HCC but not in normal hepatocytes. Northern blot and RT-PCR of glypican 3 gene in 7 hepatocellular/hepatoblastoma cell lines showed, HepG2 cells express high levels and Hep3B and SNU368 cells express moderate to low levels of glypican 3. Because glypican 3 is specifically expressed in hepatocellular carcinoma and is a cell surface protein, it can be a useful diagnostic marker and be a good target molecule for gene therapy or immunotherapy in hepatocellular carcinoma.

Case Reports : A Case of Combined Hepatocellular-Cholangiocarcinoma with Underlying Schistosomiasis

Chang Kyun Hong,Jin Mo Yang,Bong Koo Kang,Jin Dong Kim,Young Chul Kim,U Im Chang,Jin Young Yoo 대한내과학회 2007 The Korean Journal of Internal Medicine Vol.22 No.4

Combined hepatocellular-cholangiocarcinoma is a rare form of primary liver cancer showing features of both hepatocellular and biliary epithelial differentiation. We report here on a case with collision tumor, which apparently was the coincidental occurrence of both hepatocellular carcinoma and cholangiocarcinoma underlying schistosomiasis. A 39-year-old-Philippine female was transferred to our hospital for evaluation of a liver mass that was found on ultrasonography at a local hospital. HBsAg and Anti-HCV were negative and serum alpha-fetoprotein (AFP) level was normal. The tumor mass was histologically diagnosed as adenocarcinoma by sono-guided biopsy before the operation. Partial lobectomy was performed and we histologically identified the concurrent occurrence of hepatocellular carcinoma and cholangiocarcinoma, (a "collision type carcinoma").

대장암을 동반한 복합 간세포담관암종 1예

김재희,이용구,이준,정철권,김형태,강혜윤,고광현,홍성표,황성규,박필원,임규성 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.2

Combined hepatocellular-cholangiocarcinoma is a rare form of primary liver cancer, featuring both hepatocellular and biliary epithelial differentiations. An intrahepatic tumor may be considered as a metastatic lesion. It has been suggested in the literature that the likelihood of metastasis in the cirrhotic liver is lower than that in the non-cirrhotic liver. A rare case of combined hepatocellular-cholangiocarcinoma and second primary colon adenocarcinoma in a 67-year-old male patient with liver cirrhosis is presented. Histologically, the intrahepatic mass was composed of a spindle cell sarcomatous component; a hepatocellular carcinoma component; and a cholangiocarcinoma component. There were focal transitional regions among the different components. Immunohistochemically, the cholangiocarcinoma component of the intrahepatic mass showed positive reaction for CK-7 but negative reactions for CK-20. The adenocarcinoma of the colon showed positive reactions for CK-20 but negative reactions for CK-7. (Korean J Hepatol 2004;10:142-147)

간세포담관암종의 담낭 침범 1예

남궁경영,강명진,임홍목,김미성,고병성,안현택,이종률,김종옥 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.2

Metastasis of hepatocellular carcinoma occurs at a relatively late stage of the disease. Hematogenous and lymphatic metastases are the most common routes for dissemination of tumor cells. Hepatocellular carcinoma also extends into the adjacent portal vein and bile ducts. Since there is no peritoneum between the body of the gallbladder and the liver fossa, gallbladder cancer can easily cross the boundary. Gallbladder invasion of hepatocellular carcinoma, however, is quite rare. We report a case of hepatocellular-cholangiocarcinoma in a non-cirrhotic liver that invaded the gallbladder mimicking the gallbladder carcinoma complicated by cholecystitis and liver abscess. (Korean J Hepatol 2004;10:148-153)

Prognostic Role of CA 19-9 in Patients with Hepatocellular Carcinoma

( Hae Lim Lee ),( Sung Won Lee ),( Jeong Won Jang ),( Si Hyun Bae ),( Jong Young Choi ),( Nam Ik Han ),( Seung Kew Yoon ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Serum carbohydrate antigen 19-9 (CA 19-9) is a commonly used tumor marker for pancreatic and biliary cancer. However, it was recently suggested that CA 19-9 level could be elevated in hepatocellular carcinoma (HCC) patients with aggressive phenotype or stemness features. This study aimed to evaluate the significance and prognostic role of serum CA 19-9 in patients diagnosed with HCC. Methods: This study enrolled 534 consecutive patients newly diagnosed with HCC and with serum CA 19-9 values at baseline between 2008 and 2017. Patients with combined hepatocellular-cholangiocarcinoma and other malignancies at baseline were excluded. Results: During a median follow-up of 27.5 months (range 0.1-141.1), 178 patients (33.6%) survived and 180 (34.0%) expired. Baseline CA 19-9 level was within normal range in 410 patients (77.5%) and elevated (CA 19-9 > 37 U/mL) in 119 (22.5%). Patients with elevated CA 19-9 had a larger tumor size, a higher proportion of multiple tumors and portal vein tumor thrombosis than patients with normal CA 19-9 (all P values were < 0.05), and therefore presented with more advanced tumor characteristics. The cumulative overall survival (OS) in patients with elevated CA 19-9 was significantly lower than that in patients with normal CA 19-9 (P< 0.001). In the multivariate analysis, elevated CA 19-9 was an independent prognostic factor for OS (HR, 1.52; 95% CI, 1.06-2.16; P=0.021). Subgroup analysis revealed that elevated CA 19-9 was associated with poor prognosis across all BCLC stages. The validity of CA 19-9 increased particularly in patients with CTP class A or AFP > 100 ng/ml. Conclusions: Elevated CA 19-9 level is significantly associated with poor prognosis and advanced tumor characteristics in HCC patients. The CA 19-9 test is a simple adjuvant method that can be performed to predict the prognosis of HCC patients.

재발한 혼합 간세포 담관상피암종 및 저혈관성 간세포암종 동시 절제 1예

김태형 ( Tae Hyung Kim ),엄순호 ( Soon Ho Um ),박상정 ( Sang Jung Park ),박승운 ( Seung Woon Park ),이한아 ( Han Ah Lee ),서연석 ( Yeon Seok Seo ),유영동 ( Young Dong Yu ),김동식 ( Dong-sik Kim ),김주영 ( Joo Young Kim ) 대한간암학회 2017 대한간암학회지 Vol.17 No.1

Liver cancer is more complex to treat compared to cancers in other organs, since liver function should be considered. In addition, only a few patients can be applied curative treatment due to advanced stage at diagnosis. Therefore, early stage detection is important and has been increased through screening and surveillance programs using image modalities recently. However, it is still difficult to diagnose small or hypovascular hepatocellular carcinoma (HCC) even using advanced image modalties. In particular, hypovascular HCCs do not show arterial contrast enhancement which is a typical finding of HCC on computed tomography (CT) and magnetic resonance imaging (MRI). Those also account for a considerable portion of early HCC. We present 54 years-old man who had recurrent hypervascular and hypovascular nodules on three phase CT and gadoxetic acid-enhanced MRI. The nodules were removed by surgical resection and confirmed as combined hepatocellular-cholangiocarcinoma and well differentiated HCC respectively. (J Liver Cancer 2017;17:94-99)

화농성 간농양으로 오인한 혼합형 간세포-담관암종 1예

백승석 ( Seung Suk Baek ),윤아일린 ( Eileen L. Yoon ),김현정 ( Hyun-jung Kim ),배경은 ( Kyung Eun Bae ),박경미 ( Kyeongmee Park ),최원충 ( Won-choong Choi ) 대한간암학회 2017 대한간암학회지 Vol.17 No.2

Heterogeneous features of liver cancer can mimic liver abscess. Therefore it is essential to double- check tumor markers in the diagnosis of liver abscess. Herein, we report a case of combined hepatocellular-cholangiocarcinoma (cHC) occurred in an unrecognized chronic hepatitis B patient initially misdiagnosed as liver abscess. A 49-year old male initially presented with chill, right upper quadrant pain, and a liver mass. Mass showed peripheral enhancement in arterial phase of computed tomography, which was not typical for hepatocellular carcinoma (HCC). Strikingly elevated alpha-fetoprotein and fine needle aspirated pathology revealed HCC. Despite discordant image findings he was treated with transarterial chemoembolization. He was treated with sorafenib due to metastatic retrocaval lymphadenopathy afterwards. The mass presumed to be HCC progressed with sorafenib. It was surgically resected and he was finally confirmed as cHC. Discordant tumor markers with presumptive image findings should prompt the suspicion of rare type of primary liver cancer, the cHC. (J Liver Cancer 2017;17:174-181)

Clinicopathological Characteristics in Combined Hepatocellular-Cholangiocarcinoma: A Single Center Study in Korea

박하나,박준용,최기홍,최새별,최종원,김도영,안상훈,김경식,최진섭,한광협,전재윤 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.5

Purpose: Combined hepatocellular-cholangiocarcinoma (CHCC) is an uncommon form of cancer, and its clinicopathological features have rarely been reported in detail. This study was undertaken to evaluate the clinicopathological characteristics and prognostic factors of CHCC. Materials and Methods: The clinicopathological features of patients diagnosed with CHCC at Severance Hospital between January 1996 and December 2007 were retrospectively studied by comparing them with the features of patients with hepatocellular carcinoma (HCC) or cholangiocarcinoma (CC) who had undergone a hepatic resection during the same period. Results: Forty-three patients diagnosed with CHCC were included in this study (M : F=35 : 8, median age, 55 years). According to the parameters of the American Joint Committee on Cancer staging, there were 6 (14.0%), 9 (20.9%), 25 (58.1%), and 3 (7.0%) patients with stages I, II, III, and IV cancer, respectively. Thirty-two of the 43 patients underwent resection with curative intent. After resection, 27 patients (84.4%) had tumor recurrence during the follow-up period of 18 months (range: 6-106 months), and the median time to recurrence was 13 months. Overall median survival periods after hepatic resection of CHCC, HCC and CC were 34, 103 and 38.9 months, respectively (p<0.001). The median overall survival for all patients with CHCC was 21 months, and the 5-year survival rate was 18.1%. The presence of portal vein thrombosis and distant metastasis were independent prognostic factors of poor survival. Conclusion: Even after curative hepatic resection, the presence of a cholangiocellular component appeared to be a poor prognostic indicator in patients with primary liver cancer.