A Case of the Double Cancer Which Was Difficult to Distinguish Intrahepatic Cholangiocarcinoma From Multiple Hepatocellular Carcinomas

A man in his 60s was introduced for a further examination of chronic hepatitis C virus infection, and two nodules were detected in the liver by abdominal ultrasonography (US). Serum alpha-fetoprotein was elevated (56 ng/ml). The nodules were identified in various imaging examinations (abdominal US, contrast-enhanced US, contrast-enhanced CT and Gd-EOB-DTPA MRI) in segment 8 of the liver, both of which showed a typical contrast-enhanced pattern of hepatocellular carcinoma (HCC). Preoperatively diagnosed as HCC, a surgery was performed on these lesions. The pathological examinations of resected specimens showed of the two nodules were HCC and cholangiocellular carcinoma (ICC), respectively. There are only a few reports for double cancer complicated HCC and ICC at the same time. Then, it should be noted that many of them are preoperatively assumed as multiple HCC. Our case indicates that we need to take into consideration the likelihood of ICC even when multiple HCC are suggested from imaging diagnosis, because the treatment strategies for HCC and ICC are quite different.