Liver and intrahepatic bile ducts - tumor
Other malignancies
Combined hepatocellular carcinoma - cholangiocarcinoma

Author: Nat Pernick, M.D. (see Authors page)

Revised: 1 December 2017, last major update August 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Combined hepatocellular cholangiocarcinoma[TI]

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Cite this page: Pernick, N. Combined hepatocellular carcinoma - cholangiocarcinoma. website. Accessed January 19th, 2019.
Definition / general
  • Serum alpha fetoprotein usually normal, usually negative for hepatitis B and C serum markers
Case reports
Gross description
  • 3 - 16 cm, solitary or multiple tumor nodules
  • Pale tan to bile stained, variably fibrotic and hemorrhagic or necrotic
Gross images

Images hosted on other servers:

mass with
extensive necrosis

Microscopic (histologic) description
  • Intimate admixture of tumor cells with features of unequivocal hepatocellular carcinoma and cholangiocarcinoma (cuboidal / columnar cells with amphophilic cytoplasm, inconspicuous nucleoli, gland formation and mucin)
  • May have sarcomatoid component or cirrhosis
  • Transitional tumors have no distinct hepatocellular or cholangiocarcinoma-like areas; usually no cirrhosis; areas with "antler-like" morphology in 33% (irregular thin branching columns of hepatoid cells separated by broad desmoplastic stromal bands), rarely papillary
Microscopic (histologic) images

Images hosted on other servers:

Various images

Left: H&E; right: CK7

Positive stains
Differential diagnosis
  • Hepatocellular carcinoma with pseudoglandular spaces but not true glands
  • Undifferentiated carcinoma: features suggestive but not diagnostic of both tumor types, may represent metastatic diseases