Combined Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Outcome After Liver Transplantation

Combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma is a rare hepatobiliary malignancy incorporating components derived from both hepatocyte and intrahepatic bile duct epithelium. The natural history, treatment, and prognosis of this distinct cancer differ from hepatocellular carcinoma (HCC) or cholangiocarcinoma (CC) and are not completely understood. There is considerable controversy about the classification, treatment, and survival, which in turn is related to the rarity of the condition. Treatment options include surgical resection and the prognosis is believed to be better than CC but worse than HCC alone. We report a single-center liver transplantation experience with the management of three patients with combined HCC-ICC with LT. Two patients were transplanted with presumed HCC within Milan criteria and the other patient was noted to have an incidental nodule in the explanted liver. Histomorphology and immunohistochemical studies revealed the presence of combined HCC-ICC in all three explants. One patient died 144 days after LT due to metastatic tumor. The second patient is alive and is tumor free at 8.5 years post-LT, and the third patient died of metastatic tumor at 155 days after LT. Good long-term survival can be achieved in at least some patients with this combined tumor type.