A case of Mixed Hepatocellular Carcinoma and Cholangiocarcinoma in a 27-year-old female patient with ulcerative colitis

Abstract

SUMMARY
We report the case of a 27-year-old female patient, with 8-
year history of ulcerative colitis (UC), admitted to our department
because of exacerbation of the disease. Hematology
and blood chemistry results confirmed the diagnosis
of UC exacerbation. Abdominal CT detected a left liver lobe
mass. Needle biopsy histological examination demonstrated
adenocarcinoma. The patient was treated with left hepatic
lobectomy. Histopathology of the resected lobe revealed
the presence of Mixed Hepatocellular Carcinoma and
Cholangiocarcinoma (MHCC) and changes characteristic
of sclerosing cholangitis of small bile ducts at a distance
from the carcinomatous areas. Our patient had no previous
history of liver disease. Liver function tests were normal,
except for mild increase in ã­‡T and alkaline phosphatase.
Serum values of CEA and CA19-9 were quite elevated,
while AFP was normal. The association of cholangiocarcinoma
with UC is well established, while MHCC is
reported in a few case reports. Primary sclerosing cholangitis
(PSC) of intrahepatic (pericholangitis) or extrahepatic
(classic PSC) bile ducts usually precedes the development
of cholangiocarcinoma, occasionally asymptomatic. MHCC
is a rare hepatobiliary complication of UC, probably in preexisting,
asymptomatic PSC of small bile ducts. The issue
of liver manifestations in patients with UC is discussed here. Key words: ulcerative colitis, mixed hepatocellular carcinoma
and cholangiocarcinoma, pericholangitis