title: Combined hepatocellular and cholangiocarcinoma: CT findings with emphasis on multiphasic helical CT.
abstract: OBJECTIVE
  To describe CT findings of patients with combined hepatocellular carcinoma and cholangiocarcinoma (HCC-CC) in correlation with clinical data and histopathological results.
  
  
  METHODS
  Ten from 31 cases whose CT study was available were reviewed retrospectively in the aspect of imaging findings, clinical data, and pathological results.
  
  
  RESULTS
  Most of the tumors were hypodense solitary mass with gradually enhanced after contrast administration. Bile duct dilatation was observed in two cases. The overall CT findings were more similar to CC rather than HCC despite the pathological result showing predominant HCC component. Serum alpha-fetoprotein level was normal or mildly elevated while an elevated concentration of carbohydrate antigen 19-9 was observed. Hepatitis profiles showed positive to hepatitis B virus infection in four cases and hepatitis C virus infection in one case.
  
  
  CONCLUSIONS
  The diagnosis of combined HCC-CC should be considered if the tumor has similar findings to CC without bile duct dilatation on cirrhotic liver and the patient has normal or low rising of the AFP level with or without elevated CA 19-9 level. In non-cirrhotic liver, the finding is non-specific.
authors.affiliation: Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Rd, Rajchathewi, Bangkok 10400, Thailand. rasih@ma.hidol.ac.th
authors.forename: Sith
authors.initials: S
authors.lastname: Phongkitkarun
authors.forename: Tanop
authors.initials: T
authors.lastname: Srisuwan
authors.forename: Pattana
authors.initials: P
authors.lastname: Sornmayura
authors.forename: Janjira
authors.initials: J
authors.lastname: Jatchavala
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging*; D001653:Bile Ducts, Intrahepatic; D018395:CA-19-9 Antigen / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging*; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D018395:CA-19-9 Antigen; D000509:alpha-Fetoproteins