双表型肝细胞癌的临床病理特征  

Clinicopathologic features of dual-phenotype hepatocellular carcinoma

作　　者：史连国[1] 方庆全[1] 陈宏[2] Shi Lianguo;Fang Qingquan;Chen Hong(Department of Pathology,First Affiliated Hospital of Xiamen University,Xiamen 361003,China;Department of Pharmacy,First Affiliated Hospital of Xiamen University,Xiamen 361003,China)

机构地区：[1]厦门大学附属第一医院病理科,361003 [2]厦门大学附属第一医院药剂科,361003

出　　处：《中国实用医刊》2021年第10期13-16,共4页Chinese Journal of Practical Medicine

摘　　要：目的:探讨双表型肝细胞癌(DPHCC)的临床病理特征。方法:收集2017年9月至2020年5月厦门大学附属第一医院收治的DPHCC患者10例,回顾性描述其肿块大体形态、病理切片镜下形态、免疫组化特征。结果:10例DPHCC患者中男8例,女2例,年龄57.4(41~73)岁,其中3例有慢性乙型病毒性肝炎病史,影像学检查显示肿瘤最大径为6.1(3.0~10.1)cm。大体类型:巨块型2例,单块型2例,多结节型4例,单结节型2例。镜下见肿瘤细胞呈假腺样、粗梁状、巢状及实性片状排列,细胞呈肝细胞样,胞质中等、嗜碱性、细颗粒状,细胞核圆形或略不规则,核膜较厚,染色质粗块状,大部分可见明显核仁,核分裂象多见,少数可见灶性坏死,未见瘤巨细胞及间变细胞。免疫组化:细胞角蛋白19(CK19)细胞质阳性10例,细胞角蛋白7、细胞角蛋白8强弱不等阳性10例,磷脂酰肌醇蛋白多糖-3大部分阳性,肝细胞抗原部分阳性,糖类抗原199强弱不等的阳性,绒毛蛋白部分阳性,婆罗双树样基因-4均为阴性,Ki67增殖指数30%~70%。结论:DPHCC具有肝细胞癌特征并同时表达肝细胞癌和胆管癌的标志物,病理诊断主要依据独特的形态和免疫表型特征,CK19免疫组化染色呈强阳性。Objective To investigate the clinicopathologic features of dual-phenotype hepatocellular carcinoma(DPHCC).Methods A total of 10 patients with DPHCC admitted to First Affiliated Hospital of Xiamen University from September 2017 to May 2020 were collected.The gross morphology,pathological biopsy microscopic morphology,and immunohistochemical characteristics of the tumor were described retrospectively.Results Of the 10 DPHCC patients,8 were males and 2 were females,aged 57.4(41-73)years old.Three of the patients had a history of chronic viral hepatitis B.The imaging examination showed that the maximum diameter of the tumor was 6.1(3.0-10.1)cm.General type:2 cases of giant block type,2 cases of single block type,4 cases of multi-nodular type,and 2 cases of single nodular type.Microscopically,the neoplastic cells show thick beam shape,nests and solid sheet,sample cells in liver cells,medium,basophilic cytoplasm,fine particle,rounded or slightly irregular nucleus and nuclear membrane thicker,chromatin coarse block,most are prominent nucleoli,nuclear fission like see more,a few cases of visible focal necrosis,no tumor giant cells and between cells.Immunohistochemistry:10 cases were positive for cytokeratin 19(CK19),and 10 cases were positive for cytokeratin 7 and cytokeratin 8.Glypican-3 was positive,hepatocyte paraffin-1 was partially positive,carbohydrate antigen 199 was positive,Villin was positive,sal-like-4 was negative,and Ki67 was negative(30%-70%).Conclusions DPHCC has the characteristics of hepatocellular carcinomaand expression of hepatocellular carcinoma and cholangiocarcinoma markers,the pathological diagnosis of mainly according to the unique shape and immune phenotypic characteristics,CK19 immunohistochemical staining is strongly positive.

关 键 词：癌 双表型肝细胞癌 细胞角蛋白19 

分 类 号：R735.7[医药卫生—肿瘤]