肝细胞癌胆管癌并存6例临床病理分析  

Combined hepatocellular and cholangiocarcinoma:a clinicopathological study of 6 cases

作　　者：王玉兰[1] 杜经丽[1] 韦立新[1] 石怀银[1] 宋欣[1] 

机构地区：[1]解放军总医院病理科

出　　处：《诊断病理学杂志》2009年第2期92-95,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨同时伴发肝细胞癌与胆管癌的原发性肝癌的临床病理学特征。方法对6例同时伴发肝细胞癌与胆管癌的原发性肝癌进行临床资料分析、光镜观察及免疫组化研究。结果6例肝癌中男性5例，女性1例，年龄36～52岁，平均47．2岁，乙型肝炎病毒感染者5例，肝硬化4例，2例有脉管内癌栓形成并1例伴神经侵犯。肿块多结节2例，单结节4例，直径2．5～8cm。镜下见肿瘤由两种不同的组织形态组成，一种为典型的中分化肝细胞癌，另一种瘤细胞多弥散排列，部分区域可见腺样结构，细胞呈多角形及梭形，问质纤维组织增生，4例间质伴有较多或大量中性粒细胞浸润。两种组织形态以不同的方式排列，两种结构为分离结节者2例，两种结构相连、大部分界清局部有移行者3例，1例见肝细胞癌结节包裹在弥散排列的胆管癌样癌组织中，混杂存在。免疫组化：4例肝细胞癌区AFP（＋），3例HepPa-1（＋），1例CK19弱（＋），EMA均（-）；在1例弥散排列的胆管癌样区，CK19、EMA和船1P均（＋），HepPa-1均（-），Ki-67指数明显高于肝细胞癌区。结论同时伴发肝细胞癌与胆管癌的原发性肝癌是一类少见的肿瘤，由肝细胞癌与胆管癌样结构组成，其预后类似于胆管细胞癌但较肝细胞癌差。Objective To study the ehnicopathologieal features of combined hepatocellular and cholangiocarcinoma. Methods The elinicolopathological features and immunohistochemistry were investigated in 6 surgically resected cases of combined hepatocellular and cholangiocarcinoma. Results There were 6 males and 1 female, and the age ranged from 36 to 52 years （mean age = 47.2 years）. 5 cases had hepatitis B viral infection, 4 had cirrhosis, 2 had vascular/nervous invasion, 2 eases had multiple nodules, and 4 had single mass. The sizes of tumors were from 2.5 cm to 8 era. Histologically, the tumors were comprised of two elements, one was moderately-differentiated hepatocellular carcinoma cells, and another tumor cells were spindle and diffusely arranged, sometimes forming gland-like structures with rich stroma. 4 tumors were infiltrated by many inflammatory cells in the cholangioeareinoma-like area. The two elements arranged in differem patterns, 2 cases had separate nodules, 3 eases had transition from typical hepatocellular carcinoma to adenocarcinoma, and 1 ease had lobular structures with hepatocellular carcinoma existing centrally and eholangiocareionoma peripherally, lmmunohistochemieally, the hepatocellular carcinoma components were positive for AFP in （4/5） eases, and HepPa-1 in （3/5） cases, but negative for EMA in all cases, weak positive for CK19 in I case, and the cholangiocarcinoma-like components were positive for CK19 and EMA in all cases, positive for AFP in 1 case, negative for HepPa-1 in all eases. The mean Ki-67 labeling index of eholangiocarcinorna-like components was higher than that of the hepatocellular carcinoma component. Conclusion Combined hepatocellular-cholangiocarcinoma is an rare subtype of primary liver cancer comprising of both hepatocellular carcinoma and eholangiocarcinoma, and its prognosis is similar to cholangiocarcinoma but worse than hepatocellular carcinoma.

关 键 词：混合型肝癌 临床病理学 免疫组化 

分 类 号：R735.7[医药卫生—肿瘤]