Hepatocellular-Cholangiocarcinoma Collision tumor (cHCC-CC) manifesting as Extrahepatic biliary obstruction: A case report

Background and Aim: Hepatocellular-Cholangiocarcinoma Collision tumor (cHCC-CC) is a rare variant of primary hepatic malignancy. The prevalence varies between 0.1 -2 % in various studies. postulated origin by subsequent de-differentiation hepatocellular or cholangiocarcinoma into the other forms, from same progenitor cells incidental coexistence both types malignancies. 1 Case Report: 66 years Female, follow up case CLD, HCV related, Post SVR status presented with complaints jaundice pruritus for month history intermittent high-grade fever associated chills rigors. Triple Phase CT Abdomen revealed nodular liver volume redistribution, an ill-defined, arterially enhancing lesion (28 — 25mm) washout on venous phases segment IV another nodule ∼11mm (not showing washout) extending adjacent LHD upstream biliary dilatation left IHBRs, suggestive collision (HCC-ICCa). Cholangioscopy filling defect near hilum, bilateral plastic stents placed drainage. patient developed recurrent stent block cholangitis. Repeat ERCP cholangioscopy large seen at hilum dilatation, drainage planned. was planned hepatectomy. Conclusion: diagnosis cHCC-CC poses challenge since there no typical pattern contrast uptake dynamic cross-sectional imaging. presentation extrahepatic cholestasis mimics benign etiologies. Survival prognosis have not been well established.