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Peer-reviewedCC BY 4.0Frontiers in Oncology

Synchronous hepatocellular carcinoma and IPNB-associated intrahepatic cholangiocarcinoma in a patient with resolved viral hepatitis: a case report of diagnostic pitfall and margin-negative resection

  • Tong Zhou1,2,3
  • Shuqing Wu1,2,3
  • Tianze Guo1,2,3
  • Weihua Zhu1,2,3
  • Chen Wang4
  • Jie Gao1,2,3
4 affiliations
  1. 1Department of Hepatobiliary Surgery, Peking University People’s Hospital
  2. 2Peking University Research Center for Diagnosis and Treatment of Liver Cancer
  3. 3Peking University Institute of Organ Transplantation
  4. 4Department of Pathology, Peking University People’s Hospital
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Abstract

Background: Synchronous hepatocellular carcinoma (HCC) and intraductal papillary neoplasm of the bile duct (IPNB)-associated intrahepatic cholangiocarcinoma (ICC) is a rare dual-lineage hepatobiliary malignancy. Although radical resection for conventional synchronous HCC and ICC has been well documented, reported experience with margin-negative (R0) resection for this specific tumor complex remains scarce.

Case Summary: A 77-year-old male with resolved hepatitis B virus (HBV) infection and hepatitis C virus (HCV) infection with sustained virological response (SVR) presented with intermittent right upper quadrant pain, abdominal distension, scleral icterus, pruritus, nausea, and vomiting. Imaging studies revealed multifocal hepatic lesions and a biliary tract mass, and he was initially misdiagnosed as metastatic cholangiocarcinoma. Staging laparoscopy confirmed resectability, followed by open margin-negative resection. Intraoperative cholangioscopy and frozen-section analysis identified a pedunculated IPNB arising from the right hepatic duct and confirmed negative bile duct margins. Final pathology confirmed well-differentiated HCC and a separate high-grade IPNB with associated moderately to poorly differentiated ICC. The HCC and biliary lesion were separated by non-neoplastic parenchyma without a transition between them, excluding combined hepatocellular-cholangiocarcinoma (cHCC-CCA). Regional lymph nodes were not removed or histologically examined (pNx for both tumors). Margins exceeded 1 cm for both components. The patient recovered uneventfully; at 3-month follow-up, tumor markers were normal with no radiological recurrence.

Conclusion: This report presents a rare case of margin-negative (R0) resection with unassessed nodal status (pNx) for synchronous HCC and IPNB-associated ICC in a patient with resolved HBV infection and HCV infection with SVR. The coexistence of multifocal hepatic lesions with a biliary tract mass should not be presumed to indicate metastatic disease; in this case, surgical exploration with intraoperative frozen-section analysis and cholangioscopy was useful for diagnosis and management, with the 3-month follow-up documenting only an early postoperative outcome.

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Cite

BibTeXRIS
BibTeX
@article{zhou2026synchronous,
  title = {{Synchronous hepatocellular carcinoma and IPNB-associated intrahepatic cholangiocarcinoma in a patient with resolved viral hepatitis: a case report of diagnostic pitfall and margin-negative resection}},
  author = {Tong Zhou and Shuqing Wu and Tianze Guo and Weihua Zhu and Chen Wang and Jie Gao},
  journal = {Frontiers in Oncology},
  year = {2026},
  month = oct,
  doi = {10.3389/fonc.2026.1894631},
  url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1894631/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Synchronous hepatocellular carcinoma and IPNB-associated intrahepatic cholangiocarcinoma in a patient with resolved viral hepatitis: a case report of diagnostic pitfall and margin-negative resection
AU  - Tong Zhou
AU  - Shuqing Wu
AU  - Tianze Guo
AU  - Weihua Zhu
AU  - Chen Wang
AU  - Jie Gao
PY  - 2026
DA  - 2026/10/28
JO  - Frontiers in Oncology
DO  - 10.3389/fonc.2026.1894631
UR  - https://www.frontiersin.org/articles/10.3389/fonc.2026.1894631/full
AB  - Background: Synchronous hepatocellular carcinoma (HCC) and intraductal papillary neoplasm of the bile duct (IPNB)-associated intrahepatic cholangiocarcinoma (ICC) is a rare dual-lineage hepatobiliary malignancy. Although radical resection for conventional synchronous HCC and ICC has been well documented, reported experience with margin-negative (R0) resection for this specific tumor complex remains scarce.  Case Summary: A 77-year-old male with resolved hepatitis B virus (HBV) infection and hepatitis C virus (HCV) infection with sustained virological response (SVR) presented with intermittent right upper quadrant pain, abdominal distension, scleral icterus, pruritus, nausea, and vomiting. Imaging studies revealed multifocal hepatic lesions and a biliary tract mass, and he was initially misdiagnosed as metastatic cholangiocarcinoma. Staging laparoscopy confirmed resectability, followed by open margin-negative resection. Intraoperative cholangioscopy and frozen-section analysis identified a pedunculated IPNB arising from the right hepatic duct and confirmed negative bile duct margins. Final pathology confirmed well-differentiated HCC and a separate high-grade IPNB with associated moderately to poorly differentiated ICC. The HCC and biliary lesion were separated by non-neoplastic parenchyma without a transition between them, excluding combined hepatocellular-cholangiocarcinoma (cHCC-CCA). Regional lymph nodes were not removed or histologically examined (pNx for both tumors). Margins exceeded 1 cm for both components. The patient recovered uneventfully; at 3-month follow-up, tumor markers were normal with no radiological recurrence.  Conclusion: This report presents a rare case of margin-negative (R0) resection with unassessed nodal status (pNx) for synchronous HCC and IPNB-associated ICC in a patient with resolved HBV infection and HCV infection with SVR. The coexistence of multifocal hepatic lesions with a biliary tract mass should not be presumed to indicate metastatic disease; in this case, surgical exploration with intraoperative frozen-section analysis and cholangioscopy was useful for diagnosis and management, with the 3-month follow-up documenting only an early postoperative outcome.
SN  - 2234-943X
ER  -