Mixed Plate Ductal Intrahepatic Cholangiocarcinoma Mimicking Hepatocellular Carcinoma

TL;DR

A rare case of mixed plate ductal intrahepatic cholangiocarcinoma is presented, which mimicked hepatocellular carcinoma and highlights the need for tissue diagnosis.

Contribution

The paper presents a novel case of a rare variant of intrahepatic cholangiocarcinoma with mixed features of hepatocellular carcinoma.

Findings

The case highlights the difficulty in diagnosing mixed plate ductal intrahepatic cholangiocarcinoma using imaging alone.

A biopsy confirmed the diagnosis, which is crucial for accurate management due to the aggressive nature of the disease.

Abstract

Cholangiocarcinoma (CCA) refers to malignancies of the bile ducts that arise in the intrahepatic, perihilar, or distal (extrahepatic) biliary tree, excluding the gallbladder and ampulla of Vater. Although rare, the majority of these cancers are locally advanced at presentation, making them extremely fatal. We present a case of a 65-year-old man who came in for abdominal pain and ascites and was found to have portal vein thrombosis. Initial imaging showed a hepatic lesion, raising suspicion of a hepatic malignancy. Despite the multiple imaging modalities used, the diagnosis remained uncertain. Eventually, a biopsy of the lesion showed it to be a variant of intrahepatic CCA, which has mixed features of hepatocellular carcinoma and CCA. This variant is highly malignant and poorly responsive to treatment, leading to a poor prognosis. Our patient on diagnosis was categorized as stage 4 cancer, and although treatment was initiated, she succumbed to the disease in six months. Based on our experience with this patient, we would like to highlight the significance of a multimodal imaging approach and the necessity of tissue diagnosis when the initial work-up is inconclusive since these factors will also impact the course of management.

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