复合性肝癌临床病理学观察-论文.pdf

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1、·824·中华病理学杂志2013年l2月第42卷第l2期ChinJPathol，December2013，Vo1．42，No．12．论著．人体病理学．复合性肝癌临床病理学观察何偬尹洪芳柳萍张莹张剑波【摘要】目的探讨肝细胞癌、胆管细胞癌及神经内分泌癌共同存在于同一肝肿瘤的临床及病理组织学特征。方法对2例肝肿瘤的手术切除标本进行了详细的组织学观察和多种免疫组织化学检查，以证实其中复合癌的成分，并复习相关文献。结果2例均为男性，平均年龄57．5岁，HBsAg均为阳性。2例肿瘤均明确由以下3种成分混合构成：(1)部分为多边形异型上皮细胞呈条索状或小梁状排列，免疫组织

2、化学：Hepatocyte和甲胎蛋白均阳性，为肝细胞癌(HCC)，其中1例可见胆汁形成；(2)部分区域为椭圆或短梭形小蓝细胞呈巢片状或器官样排列，免疫组织化学：突触素和(或)嗜铬粒素A和(或)CD56阳性，为神经内分泌癌(NEC)；(3)部分区域为卵圆形异型上皮细胞呈弥漫巢团状或腺样排列，免疫组织化学：CK19和CK7均阳性，为胆管细胞癌(CC)。病理诊断：2例均为复合性肝癌，由HCC、NEC和CC成分组成，3种成分所占比例均≥20％。结论HCC、NEC和CC组成的复合性肝癌非常罕见，可能来源于肝癌干细胞，预后较差。【关键词】肝肿瘤；癌，肝细胞；胆管上皮癌；

3、癌，神经内分泌ClinicopathologicfeaturesofcombinedhepaticcarcinomaHECai，YINHong-fang，LIU，ZHANGYing，ZHANGJian—bo．DepartmentofPathology，PekingUniversityFirstHospital，Beijing100034，Ch，inaCorrespondingauthor：YIN舶扣，E—mail：yinhf@hotmaiLcorn【Abstract】objectiveToinvestigateclinic0pathol0gicalfeatu

4、resofcombinedhepatocellular—cholangiocarcinoma(C—HCC—CC)withneuroendocrinecarcinoma(NEC)differentiationandtoreviewtheliterature．MethodsTheclinicaldata，histologicalmanifestationsandimmunohistochemicalstainingresultsoftwocasesofC—HCC—CCwereanalyzedalongwithareviewofthecurrentliteratu

5、re．ResultsBothpatientsweremalewithanaverageageof57．5years．BothpatientswerepositiveforhepatitisBvirusantigen．Thetumorsofbothcasesdemonstratedthefollowing3unequivocalmixedelements：(1)polygonalepithelialtumorcellsgrowinginnestsortrabeeulaewithpositivestainingforHepatocyteandAFP，diagno

6、sticofhepatocellularcarcinoma(HCC)．Cytoplasmicbileproductionwaspresentinthetumorcellsinonecase；(2)ellipticorshortspindle—shapesmallbluetumorcellsgrowinginnestsororganoidpatternwithSyn／CgA／CD56positivityconfirmingthepresenceofneuroendocrinecarcinoma(NEC)component；(3)ovaltumorcellsgr

7、owinginnestsorglandularformswithpositivityofCK19andCK7confirmingdifferentiationofcholangiocarcinoma(CC)．Inbothcases，thetumorscontainedatleast20％ofeachofHCC，NECandCCcomponents．ConclusionC—HCC—CCwithNECisarareformofprimarymalignancyoftheliverwithapoorprognosis·【Keywords】Liverneoplasm

8、s；Carcinoma，hepatocellular