Combined hepatocellular and cholangiocellular carcinoma in a 62 year old men with cirrhosis – surprising intraoperative findings

Case report: After having performed MRI of the liver, a 62 year old man presented for CEUS examination because of suspected focal nodular hyperplasia. Native sonography showed a cirrhotic liver with a well-defined inhomogeneous tumor without calcifications at segment V. CEUS revealed in the arterial phase an irregular, chaotic vascular pattern in nearly the whole lesion and only a few small areas without vascularisation. From minute two on the lesion showed an increasing wash-out. The findings were classified as an AFP negative hepatocellular carcinoma and the patient was operated. During operation the tumor was…