Abstract：
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a liver tumor with features of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). It consists of intermingled malignant biliary and hepatic tissue and thus a distinct entity, rather than two separate coexisting malignancies. A 59-year-old female with a history of hepatitis C and cirrhosis presented with abdominal pain and altered mental status. She developed hematemesis, and despite extensive interventions, she expired one day after her initial presentation. At autopsy, the liver was diffusely and markedly fibrotic with numerous nodules of varying size with invasion into adjacent vasculature. Microscopic examination of the nodules revealed cHCC-CC with stem cell features, lymphovascular invasion, and tumor emboli scattered throughout the right lung. The patient had end-stage liver disease due to the accumulation of damage and consequent fibrosis. This led to portal hypertension with subsequent massive gastrointestinal bleeding, hemorrhagic shock, and death. cHCC-CC is a rare, aggressive primary liver tumor with a poor prognosis. It can present with a cirrhotomemetic pattern with small nodules that can evade clinical and radiographic detection. Autopsy findings can provide valuable insights into the pathogenesis and clinical course of cHCC-CC, highlight the aggressive nature of the disease, and may inform future diagnostic and therapeutic strategies. Accurate diagnosis of this tumor is important for patient management and prognostication.
摘要：
联合肝细胞胆管癌（cHCC-CC）是一种同时具有肝细胞癌（HCC）和肝内胆管癌（ICC）特征的肝肿瘤。它由混合的恶性胆道和肝脏组织组成，因此是一个独特的实体，而不是两个单独并存的恶性肿瘤。一名59岁女性，有丙型肝炎和肝硬化病史，表现为腹痛和精神状态改变。她出现了呕血,尽管进行了广泛的干预，她在初次陈述后的一天就过期了。尸检时,肝脏弥漫性和明显纤维化，有许多大小不同的结节，并侵入相邻的脉管系统。结节的显微镜检查显示cHCC-CC具有干细胞特征，淋巴管浸润,肿瘤栓子遍布右肺.由于损伤的积累和随后的纤维化,患者患有终末期肝病。这导致门静脉高压，随后大量胃肠道出血，出血性休克,和死亡。cHCC-CC是一种罕见的，侵袭性原发性肝肿瘤预后差。它可以呈现具有小结节的循环模式，可以逃避临床和影像学检查。尸检结果可以为cHCC-CC的发病机制和临床过程提供有价值的见解，突出了疾病的侵袭性，并可能为未来的诊断和治疗策略提供信息。该肿瘤的准确诊断对于患者管理和预后很重要。
