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

Topic Completed: 1 August 2012

Revised: 24 April 2019

Copyright: 2002-2019,, Inc.

PubMed Search: Combined hepatocellular cholangiocarcinoma[TI]

Nat Pernick, M.D.
Page views in 2019: 3,292
Page views in 2020 to date: 979
Cite this page: Pernick N. Combined hepatocellular carcinoma - cholangiocarcinoma. website. Accessed April 1st, 2020.
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
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