title: A case of primary biliary cirrhosis that complicated with combined hepatocellular and cholangiocellular carcinoma.
abstract: Primary biliary cirrhosis (PBC) is frequently complicated with hepatocellular carcinoma (HCC), but complication with combined hepatocellular and cholangiocellular carcinoma (cHCC-CC) or cholangiocellular carcinoma (CCC) has not been reported. Here, we describe a case of PBC in which cHCC-CC occurred. The patient was a 70-year-old man who had developed jaundice at 62 years old. He was diagnosed with PBC based on a liver biopsy and blood tests. In August 2006, blood tests showed elevated alpha-fetoprotein, and a liver tumor in the right lobe and a metastatic lymphadenopathy in the back near to the head of the pancreas were detected by abdominal contrast-enhanced CT. A (18)F-fluorodeoxyglucose-PET scan showed accumulation of the tracer in the tumor and in a lymph node at the back of the pancreas. The tumor and lymph node were removed, and the tumor was diagnosed pathologically as cHCC-CC based on the presence of features of HCC and CCC. This case is the first to show that a patient with PBC can develop cHCC-CC. This is of interest, since cHCC-CC may originate in hepatic stem cells or hepatic precursor cells. This case also suggests that cHCC-CC should be included as a differential diagnosis for a liver tumor complicated with PBC.
authors.affiliation: Department of Internal Medicine, Matsumoto Hospital, Matsumoto Medical Center, National Hospital Organization, 2-20-30 Muraimachi-Minami, Matsumoto, Nagano, 399-8701, Japan. mkoba@cmatumoto.hosp.go.jp.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Internal Medicine, Matsumoto Hospital, Matsumoto Medical Center, National Hospital Organization, 2-20-30 Muraimachi-Minami, Matsumoto, Nagano, 399-8701, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Furuta
authors.affiliation: Department of Surgery, Matsumoto Hospital, Matsumoto Medical Center, National Hospital Organization, 2-20-30 Muraimachi-Minami, Matsumoto, Nagano, 399-8701, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitamura
authors.affiliation: PET Center, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, Nagano, 390-8510, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Oguchi
authors.affiliation: Department of Surgery, Matsumoto Hospital, Matsumoto Medical Center, National Hospital Organization, 2-20-30 Muraimachi-Minami, Matsumoto, Nagano, 399-8701, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Arai
authors.affiliation: Department of Surgery, Matsumoto Hospital, Matsumoto Medical Center, National Hospital Organization, 2-20-30 Muraimachi-Minami, Matsumoto, Nagano, 399-8701, Japan.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Koike
authors.affiliation: Division of Laboratory Medicine, Matsumoto Hospital, Matsumoto Medical Center, National Hospital Organization, 2-20-30 Muraimachi-minami, Matsumoto, Nagano, 399-8701, Japan.
authors.forename: Koh
authors.initials: K
authors.lastname: Nakazawa
keywords: Hepatic stem cell; Liver tumor; Primary biliary cirrhosis; cHCC-CC