- 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, Â 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.