A case of diffuse type of combined hepatocellular and cholangiocellular carcinoma initially presented as a localized...

A combined hepatocellular and cholangiocellular carcinoma of diffuse type in a Japanese man is described. A small localized solitary tumor apparently grew rapidly into a diffuse-type carcinoma, and the liver weight increased about 4-fold during the last two months. The clinical course of this case was as expected for a diffuse type of hepatocellular carcinoma except that unusually high levels of serum carcinoembryonic antigen were found. The patient died of hepatic failure with systemic bleeding five months later. At autopsy, multiple small nodules were suspected to be intrahepatic metastatic foci because portal tumor thrombus was observed in the right antero-superior segment where the initial tumor was localized. Histologically, the tumor had components of both hepatocellular and mucin-producing cholangiocellular carcinoma. This is believed to be the first report on a diffuse type of combined hepatocellular and cholangiocellular carcinoma initially presented as a localized small nodule.