Liver Transplantation in Mixed Hepatocellular Carcinoma and Cholangiocarcinoma

Mixed hepatocellular carcinoma and cholangiocarcinoma (HCC-CC) are rare tumors, and the risk factors associated with them are not well understood yet. Moreover, the diagnosis of mixed HCC-CC can be complicated due to the difficulty in distinguishing mixed HCC-CC from HCC and intrahepatic CCC on radiological images. Serum tumor markers are useful when the radiological images are inconclusive. It remains unclear whether the prognosis of mixed HCC-CC differs from that of HCC. However, several studies have reported that the tumor recurrence and patient survival rates of mixed HCC-CC were similar to those of HCC after liver transplantation (LT) and liver resection. In this paper, we report that LT in patients with mixed HCC-CC achieves outcomes which are similar to those seen in LT for HCC. Therefore, the diagnosis of mixed HCC-CC should not be considered as a contraindication for LT.

Primary hepatic neuroendocrine carcinoma

A 67-year-old woman was admitted to our hospital under suspicion of a hepatic tumor, which had been previously diagnosed to be an adenocarcinoma by fine needle aspiration. Computed tomography and magnetic resonance imaging revealed a large tumor measuring 9 cm in diameter in Couinaud's hepatic segments 4, 5, and 8. We diagnosed the patient to have primary liver cancer, and suspected intrahepatic cholangiocarcinoma preoperatively. We performed a central hepatectomy. According to the immunohistochemical findings of the resected specimen, the tumor was diagnosed to be a primary neuroendocrine carcinoma in the liver. The patient is presently alive without recurrence at 3 months after hepatic resection.

Introduction of 7th AJCC TNM Staging for Liver and Intrahepatic Bile Duct Malignancies

PURPOSE: Cancer staging is essential in clinical cancer practice in medical and surgical oncology. Staging based on the guidelines of the American Joint Committee on Cancer (AJCC) is the most popular and is widely used in clinical fields. Early this year, the 7th edition of the AJCC cancer staging manual was published. I have compared and described the changes in the new edition from the older version to facilitate staging in clinical settings, especially for liver and intrahepatic bile duct malignancies. METHODS: On the basis of the new 2010 edition of the 7th AJCC TNM cancer staging manual, I have compared hepatobiliary malignancy in Chapter 18, liver malignancy and intrahepatic bile duct malignancy in Chapter 19. RESULTS: One of the major changes in the 7th AJCC manual compared to the 6th AJCC staging manual published in 2002 is separation of the Liver and Intrahepatic bile duct cancer chapters. In the previous edition, intrahepatic bile duct cancer was included in the liver malignancy chapter. CONCLUSION: There are no universal and permanent staging systems for cancer. The staging systems are ever changing to adjust for changes in treatment and prognosis of malignancies. We need to collect data in order to modify the staging correctly in collaboration with multi-institutional efforts to reduce biases in staging liver and intrahepatic bile duct cancers.