Mixed Tumor Hepatocellular Carcinoma and Cholangiocarcinomain a Cirrhotic Patient: Case Report and Review of the Literature

Abstract

Combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) is a rare primary hepatic neoplasm that presents simultaneous differentiation into hepatocytes and cholangiocytes, predominantly in patients with chronic liver disease. Its diagnosis continues to be a challenge due to its clinical and imaging presentation similar to other liver tumors, especially in cirrhotic patients. We present the case of a 61-year-old female patient with liver cirrhosis secondary to nonalcoholic fatty liver disease, who was diagnosed with cHCC-CCA after a hepatic bisegmentectomy. During her evolution, she presented tumor recurrence at hepatic and lymph node level, managed by salvage surgery and immunotherapy. However, he developed acute on chronic hepatic failure, which forced to suspend treatment and opt for palliative management. This entity stands out for its high recurrence rate, limited response to systemic therapies and lack of standardized guidelines. The present case emphasizes the importance of an accurate histopathologic diagnosis and individualized evaluation for therapeutic selection.