Heterochronous development of intrahepatic cholangiocellular carcinoma following hepatocellular carcinoma in a hepatitis B virus carrier

A 68-year-old Japanese woman was admitted to our hospital in September 1995 , because of a mass detected by ultrasonography during a follow-up examinat ion for chronic hepatitis B. Hepatocellular carcinoma (HCC) in the right li ver lobe was diagnosed based on imaging studies and elevated alpha-fetoprot ein (AFP). Percutaneous ethanol injection therapy (PEIT) was performed. PEI T was repeated in November 1998, because the tumor had enlarged and serum A FP was re-elevated. Follow-up ultrasonography (US) demonstrated low echoic mass in the left liver lobe in August 1999; serum AFP was normal, but serum carbohydrate antigen 19-9 (CA19-9) was elevated to 420 U/ml. In October 19 99, radiofrequency interstitial tissue ablation (RITA((R))) was performed a fter tumor biopsy. Pathological findings revealed adenocarcinoma and pathol ogical diagnosis was made as intrahepatic cholangiocellular carcinoma (ICC) . Three weeks later, her serum CA 19-9 was remarkably decreased (180 U/ml). The patient has been well for 5 months. Her latest AFP and CA 19-9 in the serum were 2 ng/ml and 89 U/ml, respectively. The incidence of double cance r in the liver is rare. This is also the first case report to discuss ICC t reated with RITA((R)).