Cholangiocellular carcinoma occurrence after HCV eradication therapy: case series and review of the literature
Authors: Cerban Razvan ,   Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,   Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania,   Razvan Cerban, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania. E-mail: claudiu.cerban@umfcd.ro, Croitoru Adina ,   Department of Oncology, Fundeni Clinical Institute, Bucharest, Romania, Becheanu Gabriel ,   Pathology Department, Fundeni Clinical Institute, Bucharest, Romania, Iacob Speranta ,   Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,   Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania, Ester Carmen ,   Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,   Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania, Ghioca Mihaela ,   Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania, Grasu Mugur ,   Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,   Pathology Department, Fundeni Clinical Institute, Bucharest, Romania, Dumitru Radu ,   Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,   Pathology Department, Fundeni Clinical Institute, Bucharest, Romania, Preda Carmen ,   Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,   Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania, Florescu Madalina ,   Radiology Department, Fundeni Clinical Institute, Bucharest, Romania, Gheorghe Liliana ,   Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,   Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
Published: November 2022

Hepatitis C viral (HCV) treatment has rapidly advanced with the use of direct-acting antivirals (DAA), and many patients achieve sustained virological response (SVR). Although the risk of liver tumors is greatly reduced, there are still patients who achieve SVR but will progress to hepatocellular carcinoma (HCC). HCV infection is also a known risk for cholangiocellular carcinoma (CLC), although it is considered a relative infrequent liver malignancy. We report a series of five cases of CLC in patients that achieved SVR after HCV treatment with DAA. There were three women and two males with a median age of 62 years (range 49 to 77 years). Four patients had liver cirrhosis at the time of their HCV treatment. The interval from achieving SVR until CLC diagnosis varied, ranging from 4 to 36 months (median=12). Three patients presented with advanced disease and had extrahepatic spread at the time of their diagnosis. One patient had a resectable tumor, with no recurrence 4 years later. In one case, the tumor was initially considered an atypical HCC and was treated by radiofrequency ablation. Three years later, she was diagnosed with a large tumor recurrence that was demonstrated to be a CLC on liver biopsy. The last two patients were older males with HCV compensated cirrhosis diagnosed with CLC more than two years after achieving SVR. Palliative chemotherapy was started in both. Only a handful of CLC cases have been reported in HCV patients after SVR. Clinicians should take into account the possible development of an aggressive CLC.