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Article Abstract
A 73-year-old woman, taking antiviral medication for hepatitis B virus, underwent radiofrequency ablation(RFA)for hepatocellular carcinoma(HCC)in the anterior segment of the liver. Six months, 24 months, and 32 months after the first treatment, RFA was performed for non-local recurrent HCC in segment 4, segment 5, and segment 5, respectively. Nine years and 7 months after the first RFA, a new lesion in the liver, close to the location of the first lesion, was detected on CT and MRI. Simultaneously, a tumor with a diameter of 9 mm was detected in the neck of the pancreas. Laparoscopic anterior segmentectomy of the liver was performed, followed by laparoscopic middle pancreatectomy 10 days later. Pathological study of the specimen revealed biloma in the region of the first RFA and a tumor close to the biloma consisted of HCC partially mixed with cholangiolocellular carcinoma, which is classified as combined hepatocellular-cholangiocarcinoma in the 5th edition of the WHO classification. The tumor in the neck of the pancreas was a poorly differentiated adenocarcinoma without lymph node metastasis. The patient has remained alive for 18 months post-surgery, without recurrence. It is difficult to differentiate HCC from cholangiolocarcinoma or combined hepatocellular-cholangiocarcinoma. Therefore, in case of multiple liver cancers, the intermingling of those tumors should be considered.
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