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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,间质纤维组织增生,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AFP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 investigate the clinicopathological features of primary hepatocellular carcinoma accompanied with hepatocellular carcinoma and cholangiocarcinoma. Methods Six cases of primary hepatocellular carcinoma accompanied by hepatocellular carcinoma and cholangiocarcinoma were analyzed by light microscope and immunohistochemistry. Results There were 5 males and 1 females in 6 cases of liver cancer, aged from 36 to 52 years old (average 47.2 years), 5 cases of hepatitis B virus infection, 4 cases of liver cirrhosis, 2 cases of intravascular thrombosis and 1 case of nerve Violation. Multi-nodules in 2 cases, single nodules in 4 cases, diameter 2.5 ~ 8cm. Microscopically, the tumor was composed of two different types of tissue. One type was typical moderately differentiated hepatocellular carcinoma. The other type was mostly diffusely arranged. Some of the tumor cells showed adenoid structures, and the cells were polygonal and fusiform. Fibrous tissue hyperplasia, interstitial four cases associated with more or massive neutrophil infiltration. Two kinds of tissue morphology arranged in different ways, the two structures for the separation of nodules in 2 cases, the two structures connected, most of the clear part of the local migration in 3 cases, 1 case of hepatocellular carcinoma nodules wrapped in diffuse arrangement Cholangiocarcinoma-like tissue, mixed existence. Immunohistochemistry: Four cases of AFP (+), three cases of HepPa-1 (+), one case of CK19 were weak (+), EMA were (-); in one case of cholangiocarcinoma with diffuse arrangement, CK19 , Both EMA and AFP (+), HepPa-1 (-), Ki-67 index was significantly higher than that of hepatocellular carcinoma. Conclusions Primary hepatocellular carcinoma accompanied with hepatocellular carcinoma and cholangiocarcinoma is a rare tumor composed of hepatocellular carcinoma and cholangiocarcinoma. Its prognosis is similar to that of cholangiocarcinoma but worse than that of hepatocellular carcinoma.