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World J Gastroenterol. May 14, 2016; 22(18): 4459-4465
Published online May 14, 2016. doi: 10.3748/wjg.v22.i18.4459
Combined hepatocellular cholangiocarcinoma: Controversies to be addressed
An-Qiang Wang, Yong-Chang Zheng, Juan Du, Cheng-Pei Zhu, Han-Chun Huang, Shan-Shan Wang, Liang-Cai Wu, Xue-Shuai Wan, Hao-Hai Zhang, Ruo-Yu Miao, Xin-Ting Sang, Hai-Tao Zhao
An-Qiang Wang, Yong-Chang Zheng, Juan Du, Cheng-Pei Zhu, Han-Chun Huang, Shan-Shan Wang, Liang-Cai Wu, Xue-Shuai Wan, Hao-Hai Zhang, Xin-Ting Sang, Hai-Tao Zhao, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100191, China
Juan Du, Department of Health Management, General Hospital Rocket Forces of the Chinese People’s Liberation Army Medical Association, Beijing 100088, China
Ruo-Yu Miao, Liver Center and The Transplant Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
Author contributions: Wang AQ and Zheng YC contributed equally to this study, and they designed the study and wrote the manuscript; Du J, Zhu CP, Huang HC and Wang SS searched related articles; Wu LC, Wan XS, Zhang HH and Miao RY were involved in editing the manuscript; Sang XT and Zhao HT co-ordinated and provided financial support for this work.
Conflict-of-interest statement: There are no potential conflicts of interest relevant to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hai-Tao Zhao, MD, Assistant Professor, Chief Doctor, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing 100730, China. zhaoht@pumch.cn
Received: February 16, 2016
Peer-review started: February 17, 2016
First decision: March 7, 2016
Revised: March 16, 2016
Accepted: April 7, 2016
Article in press: April 7, 2016
Published online: May 14, 2016
Abstract

Combined hepatocellular cholangiocarcinoma (CHC) accounts for 0.4%-14.2% of primary liver cancer cases and possesses pathological features of both hepatocellular carcinoma and cholangiocarcinoma. Since this disease was first described and classified in 1949, the classification of CHC has continuously evolved. The latest definition and classification of CHC by the World Health Organization is based on the speculation that CHC arises from hepatic progenitor cells. However, there is no evidence demonstrating the common origin of different components of CHC. Furthermore, the definition of CHC subtypes is still ambiguous and the identification of CHC subtype when a single tumor contains many components has remained unresolved. In addition, there is no summary on the newly recognized histopathology features or the contribution of CHC components to prognosis and outcome of this disease. Here we provide a review of the current literature to address these questions.

Keywords: Progenitor cell origin, Pathology classification, Combined hepatocellular cholangiocarcinoma

Core tip: This review article focuses on the current views about the histopathology and clinical characteristics of combined hepatocellular cholangiocarcinoma (CHC). Whether the different components of CHC share a common cell origin is still ambiguous. Furthermore, the definition of CHC subtype is still ambiguous and the identification of CHC subtype when a single tumor contains many components has remained unresolved. The features between hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) make CHC has better prognosis than CC but poorer than HCC.