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Abstract：
BACKGROUND: Synchronous combined hepatocellular-cholangiocarcinoma (CHC) and hepatocellular carcinoma (HCC) is very rare, with few literature reports and poor clinical outcomes associated with the disorder. Surgical resection is the main treatment, which makes the preoperative diagnosis very important. However, due to imaging manifestations overlapping with HCC, diagnosis of this type of synchronous cancer is challenging and it tends to be misdiagnosed as multiple HCC. Herein, we report the contrast-enhanced ultrasound (CEUS) manifestations of a case of synchronous CHC and HCC, aiming at adding to the understanding of this disease. CEUS displayed exquisite vascularity and tissue perfusion in real time with good spatial and temporal resolution and more accurately reflect tumor washin and washout times than contrast-enhanced computed tomography (CT) in this case.
METHODS: The patient was a 69-year-old female with a 20-year history of chronic hepatitis B. Due to months of epigastric pain and anorexia, she reffered to our hospital for treatment. Five days before hospitalization, abdominal magnetic resonance imaging performed at another hospital detected a space-occupying lesion in the liver. After her hospitalization, laboratory tests showed elevated alpha-fetoprotein and carbohydrate antigen 19-9 level. Two suspicious liver lesions located in S4 and S6, respectively, were identified in a cirrhotic background by abdominal contrast-enhanced CT (CECT). Furthermore, the lesion in S4 and S6 were detected by CEUS and assigned to CEUS LI-RADS 5 and M categories, respectively. The patient underwent tumor radical resections. Post-operative pathology confirmed the S4 and S6 lesions to be HCC and CHC, respectively. A newly-found suspicious liver nodule with potential malignancy was detected in liver S1 by both CEUS and CECT 7 mo after operation.
CONCLUSIONS: The CEUS characteristics of CHC and HCC are different. CEUS features in combination with clinical information could help in effective diagnosis, clinical decision-making and better prognosis.
METHODS: The patient was a 69-year-old female with a 20-year history of chronic hepatitis B. Due to months of epigastric pain and anorexia, she reffered to our hospital for treatment. Five days before hospitalization, abdominal magnetic resonance imaging performed at another hospital detected a space-occupying lesion in the liver. After her hospitalization, laboratory tests showed elevated alpha-fetoprotein and carbohydrate antigen 19-9 level. Two suspicious liver lesions located in S4 and S6, respectively, were identified in a cirrhotic background by abdominal contrast-enhanced CT (CECT). Furthermore, the lesion in S4 and S6 were detected by CEUS and assigned to CEUS LI-RADS 5 and M categories, respectively. The patient underwent tumor radical resections. Post-operative pathology confirmed the S4 and S6 lesions to be HCC and CHC, respectively. A newly-found suspicious liver nodule with potential malignancy was detected in liver S1 by both CEUS and CECT 7 mo after operation.
CONCLUSIONS: The CEUS characteristics of CHC and HCC are different. CEUS features in combination with clinical information could help in effective diagnosis, clinical decision-making and better prognosis.
摘要：
背景：同时合并肝细胞胆管癌（CHC）和肝细胞癌（HCC）非常罕见，与该疾病相关的文献报道很少，临床结局不佳。手术切除是主要治疗手段,这使得术前诊断非常重要。然而,由于影像学表现与HCC重叠，这种类型的同步癌的诊断是具有挑战性的，它往往被误诊为多发性HCC。在这里，我们报告了一例同步CHC和HCC的超声造影（CEUS）表现，旨在增加对这种疾病的理解。在这种情况下，CEUS实时显示出精致的血管和组织灌注，具有良好的空间和时间分辨率，并且比对比增强计算机断层扫描（CT）更准确地反映了肿瘤的冲洗和冲洗时间。
方法：患者是一名69岁女性，有20年慢性乙型肝炎病史。她到我们医院接受治疗。住院前五天,在另一家医院进行的腹部磁共振成像检测到肝脏占位病变。她住院后,实验室检测显示甲胎蛋白和糖类抗原19-9水平升高.分别位于S4和S6的两个可疑肝脏病变，通过腹部对比增强CT（CECT）在肝硬化背景下鉴定。此外，通过CEUS检测到S4和S6中的病变，并将其分为CEUSLI-RADS5和M类别，分别。患者接受了肿瘤根治术。术后病理证实S4和S6病灶为HCC和CHC，分别。术后7mo通过CEUS和CECT在肝S1中检测到新发现的可疑肝结节，具有潜在的恶性。
结论：CHC和HCC的CEUS特征不同。CEUS特征结合临床信息有助于有效诊断,临床决策和更好的预后。
方法：患者是一名69岁女性，有20年慢性乙型肝炎病史。她到我们医院接受治疗。住院前五天,在另一家医院进行的腹部磁共振成像检测到肝脏占位病变。她住院后,实验室检测显示甲胎蛋白和糖类抗原19-9水平升高.分别位于S4和S6的两个可疑肝脏病变，通过腹部对比增强CT（CECT）在肝硬化背景下鉴定。此外，通过CEUS检测到S4和S6中的病变，并将其分为CEUSLI-RADS5和M类别，分别。患者接受了肿瘤根治术。术后病理证实S4和S6病灶为HCC和CHC，分别。术后7mo通过CEUS和CECT在肝S1中检测到新发现的可疑肝结节，具有潜在的恶性。
结论：CHC和HCC的CEUS特征不同。CEUS特征结合临床信息有助于有效诊断,临床决策和更好的预后。
