Combined hepatocellular cholangiocarcinoma: A rare hepatic malignancy exhibiting concurrent imaging features of hepatocellular carcinoma and intrahepatic cholangiocarcinoma

Combined hepatocellular cholangiocarcinoma (cHCC-CC) is a rare primary hepatic neoplasm characterized by the coexistence of hepatocellular and cholangiocellular differentiation within the same tumor. The diagnosis is challenging because imaging characteristics may resemble those of hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC), depending on the dominant histologic component. We present a case of cHCC-CC demonstrating discrete regions with imaging features of both HCC and ICC, along with elevation of both alpha-fetoprotein and carbohydrate antigen 19-9. Recognition of discrete imaging features of HCC and ICC in the same mass should raise suspicion for cHCC-CC when evaluating primary liver neoplasms. Accurate diagnosis of cHCC-CC is important for prognostication and to guide clinical decision-making.