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Case Report

Successful living donor liver transplantation in a cystic
Successful living donor liver transplantation in a cystic
fi
fi brosis patient with combined hepatocellular carcinoma and brosis patient with combined hepatocellular carcinoma and
cholangiocarcinoma
cholangiocarcinoma

Falk Rauchfuß, Felix Dondorf, René Fahrner, Michael Ardelt, Yves Dittmar, Utz Settmacher
Department of General, Visceral and Vascular Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, 07747 Jena, Germany

ABSTRACT
Combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) is a rare tumor entity. In this report, we describe
a case of a young patient who developed a liver tumor in a cirrhotic liver caused by cystic fi brosis. All diagnostic fi ndings
suggested that this tumor was an HCC. We performed living donor liver transplantation. Histological examination of the
tumor revealed combined HCC and CC as an incidental fi nding. Two years after the transplantation, the patient is in good
clinical condition and is disease-free.

Key words: Cholangiocarcinoma; cystic fi brosis; hepatocellular carcinoma; liver transplantation; liver tumor; living donation

Address for correspondence:
Dr. Falk Rauchfuß, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Friedrich-Schiller-University Jena,
Erlanger Allee 101, 07747 Jena, Germany. E-mail: Falk.Rauchfuss@med.uni-jena.de
Received: 29-01-2015, Accepted: 16-02-2015

INTRODUCTION patient who was transplanted at our center with an incidental
finding of a combined HCC and CC in a cirrhotic liver due to CF.
Liver cirrhosis is one of the major risk factors for the
development of hepatocellular carcinoma (HCC), which CASE REPORT
is the one of the leading causes of cancer-related deaths
worldwide. Cystic fibrosis (CF) might be associated A 29-year-old patient was admitted to our transplantation
[1]
with liver diseases including liver cirrhosis requiring liver unit due to a recently diagnosed liver tumor with underlying
transplantation or combined lung-liver transplantation. These liver cirrhosis. The cirrhosis was known and treated for
hepatobiliary diseases are the third-leading cause of death in years since the patient suffered from CF since his childhood.
CF patients. Combined HCC and cholangiocarcinoma (CC) The single liver tumor was localized in segment V with a
[2]
is a rare tumor entity, which is defined as a tumor in which diameter of 6.5 cm. The computed tomography scan showed
both HCC and CC components co-exist in either the same a hyper-vascularized tumor in the arterial phase with the
tumor or the same liver. [3] aforementioned extent [Figure 1]. Tumor marker analysis
showed a marked elevation of -fetoprotein (808.7 ng/mL,
As yet, there is no report of a combined HCC and CC in normal range: < 6.6 ng/mL) and a slight increase of carbohydrate
cirrhotic liver caused by CF. We present a case of a young antigen (CA) 19-9 (48.9 U/mL, normal range: < 37 U/mL).
All other tumor markers were normal. Taken together, we
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Quick Response Code diagnosed an HCC in a cirrhotic liver caused by CF. To rule out
Website: any extra-hepatic tumor manifestation, a positron emission
http://www.hrjournal.net/ tomography scan (18-fludeoxyglucose, activity: 222 MBq)
was performed showing a moderately increased glucose
DOI: metabolism within the liver tumor (standard uptake volume
10.4103/2394-5079.153288 in tumor: 6.5; standard uptake volume in liver: 2.4), but no
signs of any extra-hepatic tumor spread [Figure 2].

46 Hepatoma Research | Volume 1 | Issue 1 | April 15, 2015