HBV-associated intrahepatic cholangiocarcinoma with high serum alpha-fetoprotein: a case report with review of literature

Intrahepatic cholangiocarcinoma (ICC) is a rare malignant tumor. The etiology of ICC remains poorly understood. Recently, hepatitis B virus (HBV) infection has been implicated as a potential risk factor for ICC, particularly in HBV-endemic areas. Elevation of serum alpha-fetoprotein (AFP) is seen in approximately 20 % of ICC patients. However, serum AFP levels higher than 10,000 ng/mL have only been reported in a few ICC patients. We report an unusual case of HBV-associated ICC occurring in a male with a markedly elevated serum AFP.

A 60-year-old East Asian male presented with complaints of epigastric distention and right shoulder pain. Laboratory tests showed HBV infection, HBV deoxyribonucleic acid (DNA) slightly elevated (21 IU/mL) and serum AFP markedly elevated (12,310 ng/mL). Computed tomography (CT) scan found a large and irregular mass in the left lobe of the liver. The patient underwent the left hepatic lobe resection. Histopathological examination showed chronic hepatitis B in the background liver and the immunohistochemical (IHC) findings strongly supported the diagnosis of ICC with aberrant expression of AFP. Serum AFP and HBV DNA declined to normal level postoperatively. The patient received four cycles of gemcitabine plus oxaliplatin and took entecavir to prevent HBV reactivation. The patient kept disease free for 18 months in the latest follow-up.

ICC patients with HBV infection should be distinguished from other ICC cases, based on distinct clinicopathological features and favorable outcome. Screening for HBV infection should be carried out before initiation of chemotherapy. Antiviral therapy is indicated for prevention of HBV reactivation.