FINE-NEEDLE ASPIRATION DIAGNOSIS OF COMBINED HEPATOCELLULAR-CARCINOMAAND CHOLANGIOCARCINOMA - A CASE-REPORT

BACKGROUND: The finding of a dual cellular population in a liver fine needle aspirate, in the appropriate clinical context, raises many diff erential diagnoses, including combined hepatocellular carcinoma and ch olangiocarcinoma, a relatively rare form of primary liver carcinoma. C ASE: A hepatitis C-positive patient with cirrhosis and rapidly worseni ng liver failure underwent fire needle aspiration of two radiologicall y detected liver masses. Abundant material composed of two cell popula tions, one typical of hepatocellular carcinoma and one with features o f mucin-producing adenocarcinoma, were found. Both components were pos itive for low molecular weight cytokeratins, the hepatocellular carcin oma component was positive for carcinoembryonic antigen (CEA) (B18 iso form) in a typical canalicular pattern, and the cholangiocarcinomatous component was positive for high molecular weight cytokeratins and CEA (isoforms B18 and D14). Both components were negative for alpha-fetop rotein. CONCLUSION: Identification of a dual cell population, such as this, in a liver fine needle aspirate should raise the possibility of a combined hepatocellular carcinoma and cholangiocarcinoma and is unli kely to represent metastatic disease. This variant of hepatocellular c arcinoma is rare and constitutes 1-5% of primary liver carcinomas. It is important to make this diagnosis and to separate this tumor from th e usual hepatocellular carcinoma and metastatic carcinoma, since it ma y give rise to pure cholangio carcinomatous metastatic deposits, addin g to the diagnostic difficulties.