Coexistence of primary clear cell subtype of hepatocellular carcinoma, cholangiocarcinoma, and ordinary type hepatocellular carcinoma: A case report.

ABSTRACT

INTRODUCTION AND IMPORTANCE Primary Clear Cell subtype of Hepatocellular Carcinoma (PCHCC) is a rare kind of Hepatocellular Carcinoma (HCC). The coexistence of PCHCC, Intrahepatic Cholangiocarcinoma (ICC), and ordinary-type HCC(OHCC) in different parts of the liver is seldom reported in the literature. CASE PRESENTATION A 66 years old man with three masses in his liver was admitted. Positron emission tomography-computed tomography suggested that 2 of the lesions were low-density and likely malignant, while the 3rd lesion was considered benign. Magnetic Resonance Imaging indicated all were malignant tumors. Minor hepatectomies were underwent respectively, and the pathology indicated the 3 tumors were PCHCC, ICC, and OHCC. Twelve months post operation, the patient was readmitted because of the recurrence of a 10.2 × 9.2 × 8.9 cm hepatic tumor. Transarterial chemoembolization and three courses of systemic chemotherapy were carried out, but the effectiveness was limited. The patient passed away 20 months after surgery. CLINICAL DISCUSSION: Surgical resection is the primary treatment of CHCC and minor hepatectomy should be considered especially when complicated with cirrhosis. Considering the poor prognosis and the high recurrence rate, sequential treatments like hepatectomy, targeted therapy, and TACE are recommended. CONCLUSION: PCHCC, ICC, and OHCC coexisted in a different part of one liver is particularly rare, comprehensive treatment with minor hepatectomy should be recommended, but the prognosis is poor.