COMBINED HEPATOCELLULAR AND CHOLANGIOCARCINOMA - CORRELATION BETWEEN CT FINDINGS AND CLINICOPATHOLOGICAL FEATURES

Purpose: The purpose of this study was to clarify characteristics elf combined hepatocellular and cholangiocarcinoma (HCC-CC) on CT and clin icopathological examinations. Method: Dynamic incremental CT was perfo rmed on 15 combined HCC-CC patients. CT of the early phase was started at 30 s and of the late phase at 120-140 s. after the start of contra st medium injection at a rate of 3 ml/s. The images and clinico-pathol ogical findings were retrospectively compared. Results: Lesions grossl y resembling HCC (WCC type, n = 6) were well enhanced in the early pha se and changed to low attenuation areas in the late phase. In lesions grossly resembling CC (CC type, n = 9), s of 9 lesions were enhanced o nly at the peripheral portions in the early phase and changed to low a ttenuation areas or had only central portions enhanced in the late pha se. The other CC-type lesion was not enhanced in either the early or t he late phase. In all 15 cases, there was no dilatation of the intrahe patic bile ducts. Hepatitis B virus surface antigen was positive in fi ve cases. Hepatitis C virus antibody was positive in 10 cases. Serum a lpha-fetoprotein (AFP) levels were greater than or equal to 200 ng/ml in seven cases. Conclusion: In the CC type, enhanced CT images were co mpatible with CC. but positivities for Virus markers and serum AFP lev els were almost equivalent to those in HCC. Therefore, the CC type can be diagnosed as combined HCC-CC by evaluating virus markers and serum AFP levels with CT. In addition, no association of intrahepatic bile duct dilatation was considered to be a characteristic feature of combi ned HCC-CC.