Breast Metastasis From a Combined Hepatocellular–Cholangiocarcinoma

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a unique entity that contains mixed elements of both hepatocellular carcinoma and cholangiocarcinoma. We report a 62-year-old woman with alcoholic cirrhosis with elevated α-fetoprotein of 25.3 ng/mL. Abdominal computed tomography showed a poorly defined subcapsular nodular lesion in the VIII segment, showing enhancement during the arterial phase and washout in the delayed phase. Histological examination of hepatic segmentectomy revealed a malignant epithelial neoplasia constituted by 2 distinct components, consistent with the diagnosis of cHCC-CC, classical type. One year after surgical resection, the patient noticed a nodule in the right breast. Histological examination of core needle biopsy was compatible with a metastasis in the breast of the previously diagnosed liver cancer. To our knowledge, this is the first report of breast metastases from a cHCC-CC, denoting disseminated metastatic disease and poor prognosis.