具有丙型肝炎病毒抗原标志的肝细胞癌的病理学特征

Pathological features of hepatocellular carcinoma carrying hepatitis C virus antigen

目的系统地分析具有不同肝炎病毒抗原标志的肝细胞癌（ＨＣＣ）的组织病理学特征。方法用免疫组化ＰＡＰ法、ＡＢＣ法显示６９例组织中ＨＢＶ及ＨＣＶ抗原，运用ＣＡＳ－２００系统对癌组织进行图像分析。结果与单独ＨＢＶ感染者相比，单独ＨＣＶ感染相关ＨＣＣ中透明细胞型肝癌发生率较高（７／９比４／３３），分化较好；癌周肝窦内和汇管区淋巴细胞浸润及肝细胞坏死较轻（Ｐ＜０．０１）；小胆管破坏较常见，且与淋巴滤泡样结构形成关系密切（Ｐ＜０．０５）。此外，该组患者年龄较大，临床症状较轻，手术预后较佳。结论单独ＨＣＶ感染相关ＨＣＣ具有不同于单独ＨＢＶ感染相关ＨＣＣ的临床及病理学特征，癌细胞核ＤＮＡ含量及形态学参数定量分析结果与其生物学行为相符。

Objective To analyze the pathological features of hepatocellular carcinomas (HCCs) carrying different hepatitis virus antigens histopathologically and systematically. Methods PAP and ABC kits were used in the immunohistochemical study, and CAS200 System was applied in the image cytometry. Results As compared with HCCs carrying HBV marker(s), the HCCs carrying HCV marker showed more cases of clear cell type (7/9 vs 4/33), better differentiation of cancers, less necrosis of hepatocytes, milder lymphocyte infiltration in the hepatic sinuses or periportal areas (P<0.01), higher incidence of bile ductule damages, and bore a close relation to the formation of lymphoid follicle in the surrounding tissues (P<0.05). These patients were elder, with lower grade of symptoms and better prognosis after operation. Conclusion HCCs carrying only HCAg have different pathological features and clinical characteristics from which carrying HBV marker(s). The results of image cytometry are in accordance with the biological behaviour of HCC.