A case report of primary hepatocellular carcinoma with gallbladder cancer

Objective: To a rare case of double primary cancer (hepatocellular carcinoma with gallbladder) to guide clinical application. Methods and Results: We reported one case of primary hepatocellular carcinoma and gallbladder. A male patient, 54 years old, had main complaints of intermittent right upper quadrant pain for 4 days. The abdominal CT of the local county hospital showed gallstones, gallbladder with liver infiltration. And then he went to the First Affiliated Hospital of Xi'an Jiaotong University for further treatment. Laboratory examination revealed: HBsAg(+), HBcAb(+), alpha-fetoprotein (AFP)>60 500 ng/mL, carcinoembryonic antigen (CEA) 5.25 ng/mL. Abdominal CT showed hilar slightly stronger light echo groups: liver cancer or gallbladder cancer? Hepatic artery and portal vein CT imaging (CTA+CTV) examination showed the malignant tumor shadow in the inside of the left hepatic lobe huge, uneven thickening of the gallbladder wall, suspected liver disease with gallbladder infringement or gallbladder disease with liver infringement. With the preoperative preliminary consideration of primary liver cancer with infiltration of the gallbladder, we chose the operation as the resection of segment IV b and V of the liver, cholecystectomy and T tube drainage. Pathological examination postoperative showed the bulky liver carcinoma grade Ⅲ and the poorly differentiated adenocarcinoma of gallbladder. A month later, abdominal CT showed the tumor spread intrahepatic, prompting the poor prognosis. Conclusion: The two which are not continuous, which is the standard of double primary cancer, are not suitable for all double primary cancers. This case provides useful experience for future similar diagnosis and treatment of disease, and also helps us with timely and accurate identification of "metastatic" or "primary", which is the key point for clinicians to give patients an effective treatment.