• A 58 year old male presented with significant weight loss in recent past
  • Past history- hepatitis B carrier, not on Rx.
  • Serological examination- Negative for HCV,  HIV and Liver screen
  • Other laboratory tests- elevated levels of ALP (140 IU/L), CEA (9.81 ng/ml), (AFP-95.4 IU/ml), (CA 19.9-504.2 U/ml) and AST (58 IU/L), Bilirubin ( 1.1mg/dl), INR (1.4), Albumin (3.2gm/dl)
  • Hepatitis B – Started on antiviral treatment with Tenofovir 245mg OD before operation.
  • Child Pugh Turcott – Stage A, no co-morbidities.
  • CT Abdomen- 9 x 9 cm heterogeneously enhancing mass in the right lobe of liver with cirrhotic changes and right portal vein thrombosis
  • Management- right hepatectomy with cholecystectomy
  • Microscopic examination of specimen- predominantly HCC with cirrhotic parenchyma
  • IHC study- dual phenotypic differentiation of tumor in to both hepatocytes and biliary epithelium

Expert comments-

  • CHC is a rare primary liver neoplasm containing both elements of hepatocellular and cholangiocarcinoma
  • Clinically, CHC has overlapping features with HCC; hepatic cirrhosis and common viral markers are often positive, and the AFP level is frequently elevated.
  • Although CHC is more closely related to HCC than to CC, it follows a more aggressive clinical course than that of ordinary HCC

Take home message-

  • Most hepatocellular carcinoma arises in the setting of chronic liver disease.
  • HCC is usually diagnosed multiple imaging modalities because of its arterial phase enhancement & venous phase washout.
  • 20% of HCC are AFP non secretors.

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