title: Double primary hepatic cancer (hepatocellular carcinoma and intrahepatic cholangiocarcinoma) originating from hepatic progenitor cell: a case report and review of the literature.
abstract: BACKGROUND
  Synchronous development of primary hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) in different sites of the liver have rarely been reported before. The purpose of this study is to investigate the clinicopathological characteristics of synchronous double cancer of HCC and ICC.
  
  
  METHODS
  A 56-year-old Chinese man without obvious liver cirrhosis was preoperation diagnosed with multiple HCC in segments VI (SVI) and VII (SVII) by the abdominal computed tomography (CT) and contrast-enhanced ultrasonography (CEUS). We performed hepatic resection of both segments. The tumors in SVI and SVII were pathologically diagnosed as ICC and HCC, respectively. Immunohistochemically, the HCC in SVII was positive for HepPar-1 and negative for CK19, while the ICC in SVI tumor was positive for CK19 and negative for HepPar-1. Interestingly, the immunohistochemical results also showed that the classic hepatic progenitor cell (HPCs) markers CD34 and CD117 were both positive of the two tumors. The patient still survived and at a 1-year follow-up did not show evidence of metastasis or new recurrent lesions. We speculate that the two masses may have originated from HPCs based on the findings of this patient.
  
  
  CONCLUSIONS
  Synchronous development of HCC and ICC is very rare with unique clinical and pathological features. The correct preoperative diagnosis of double hepatic cancer of HCC and ICC is difficult. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection were both the independent risk factor to the development of double liver cancer. Hepatic resection is the preferred and most effective treatment choice. The prognosis of synchronous occurrence of double hepatic cancer was poorer than for either HCC or ICC, and the origin of it needs further study.
authors.affiliation: Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Nanchang, 330006, China.
authors.forename: Junwen
authors.initials: J
authors.lastname: Hu
authors.affiliation: Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Nanchang, 330006, China.
authors.forename: Rongfa
authors.initials: R
authors.lastname: Yuan
authors.affiliation: Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Nanchang, 330006, China.
authors.forename: Changwen
authors.initials: C
authors.lastname: Huang
authors.affiliation: Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Nanchang, 330006, China.
authors.forename: Jianghua
authors.initials: J
authors.lastname: Shao
authors.affiliation: Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Nanchang, 330006, China. zousb999@163.com.
authors.forename: Shubing
authors.initials: S
authors.lastname: Zou
authors.affiliation: Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Nanchang, 330006, China. jxndefywk@hotmail.com.
authors.forename: Kai
authors.initials: K
authors.lastname: Wang
mesh_terms: D001650:Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D011379:Prognosis
keywords: Double hepatic cancer; Hepatic progenitor cell; Hepatocellular carcinoma; Intrahepatic cholangiocarcinoma; Prognosis