肝细胞腺瘤临床病理学观察  

Clinicopathologic observation of hepatocellular adenoma and immunohistochemical study

作　　者：付华辉 金光值 刘海平[2] 丛文铭[2] 

机构地区：[1]上海奉贤区中心医院病理科,上海201400 [2]第二军医大学东方肝胆外科医院病理科,上海200438

出　　处：《临床与实验病理学杂志》2014年第1期42-46,共5页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的观察肝细胞腺瘤(hepatocellular adenoma,HCA)的临床病理学特征和免疫表型特点,探讨该病的发病机制、诊断及鉴别诊断。方法观察166例手术切除的HCA临床病理学特征,采用免疫组化法检测57例HCA中Glypican-3、β-catenin、CD34表达,并与50例高分化肝细胞癌(well-differentiated hepatocellular carcinoma,wHCC)和203例肝局灶性结节性增生(focal nodular hyperplasia,FNH)的免疫表型进行比较分析。结果 166例HCA中,男性114例(68.67%),平均年龄(40.0±2.1)岁;女性52例(31.33%),平均年龄(33.4±3.8)岁,男性患者的平均年龄明显大于女性患者(t=2.97,P=0.004)。154例有BMI数据的HCA患者中,男性超重/肥胖(BMI≥24 kg/m2)者74例,显著多于女性的9例(χ2=34.67,P<0.001)。男性HCA患者的BMI均数为(25.78±0.75)kg/m2,显著高于女性的(21.70±0.81)kg/m2(t=7.21,P<0.001)。免疫表型:HCA中Glypican-3阳性率(5.56%),远低于wHCC(χ2=13.04,P<0.001);HCA中β-catenin阳性率为29.27%,远高于FNH(χ2=11.59,P=0.001)。结论中国HCA患者以中年男性为主,超重/肥胖是其发病的重要特点。结合临床表现、病理组织学形态可以对HCA作出正确诊断,联合检测CD34、β-catenin和Glypican-3可有效把HCA与wHCC和FNH区分。Purpose To investigate the clinicopathologic features and immunotypes of hepatoeellular adenoma （ HCA）, and to explore the pathogenesis, diagnosis and differential diagnosis by the observation of clinicopathological features in 166 HCA. Methods The elinicopathological features of 166 reseeted HCA were observed, Glypican-3, β-catenin, CD34 expression in 57 HCA, 50 well-differ- entiated hepatoeellnlar carcinoma （wHCC） and 203 focal nodular hyperplasia （FNH） were detected immunohistoehemically. Results Of 166 HCA, 114 cases （68.67%） were males and 52 cases （31.33%） were females, average age in male patients was （40. 0 ± 2. 1 ） years, significantly higher than that in female patients （t =2.97, P =0. 004）. In 154 HCA patients with BMI data, overweight/ obesity （ BMI ≥ 24 kg/m2 ） patients were 74 in males and 9 in females （ X2 = 34.67, P 〈 0. 001 ） and average BMI in male patients was （25.78 ±0. 75） kg/m2, significantly higher than that io females （21.70 ±0. 81 ） kg/m2（t =7. 21, P 〈0. 001 ）. Immunohistochemi- caiiy, Gltypican-3 positive rate was 5.56% in YICA, siguificantly lower than that in wttCC （ X2 = 13.04, P 〈 0. 001 ）. β-catenin posi- tive rate was 29. 27% in HCA, significantly higher than that in FNH （ x2 = 11.59, P = 0. 001 ）. Conclusion Chinese HCA is fre- quently occurred in middle-aged males, overweight/obesity is one of the important characteristics of HCA pathogenesis. According to the clinical manifestation, especially pathological morphology of HCA, we can make the correct diagnosis. Based on combined applica- tion of CD34, 13-eatenin and Glypican-3, we may be able to distinguish HCA from wHCC and FNH.

关 键 词：肝细胞腺瘤 临床病理 免疫组织化学 诊断 鉴别诊断 

分 类 号：R735.7[医药卫生—肿瘤] R365[医药卫生—临床医学]