肝肉瘤样癌的临床病理特征

Clinicopathologic analysis of sarcomatoid hepatocellular carcinoma

目的:探讨肝肉瘤样癌患者的临床病理学特征、诊断、鉴别诊断、治疗方法和预后.方法:以我院收治的1例肝肉瘤样癌患者为对象,分析其临床表现及诊疗经过,并进行随访,同时对送检标本进行病理学检查,结合有关文献探讨该病的临床病理学特点.结果:肿瘤位于肝脏右后叶,呈浸润性生长.组织学上可见上皮源性肿瘤成分与梭形细胞肉瘤成分同时存在并伴有移行现象;肿瘤中见大片凝固性坏死.免疫组织化学显示肿瘤细胞呈CK(Pan)和EMA强阳性,AFP和Hepar-1呈弱阳性表达,免疫组织化学阴性为:CK7,CK8,CK18,CK(H),CD34,CD117,Dog-1,Actin,SMA,Caldesmon,Desmin,CD10,CD21,CD23,CD35,CD1a,CD2,CD3,CD20,CD45,ALK,CD68,CD163,CD30,CD15,HMB45,S-100.病理诊断:肝肉瘤样癌.结论:肝肉瘤样癌是一种罕见的高度恶性肿瘤,临床与病理上需要与肝癌肉瘤、炎症性滤泡树突细胞肉瘤、炎性肌纤维母细胞肉瘤等相鉴别,预后与肿瘤分期有关.

AIM：To explore the clinical and pathological features of sarcomatoid hepatocellular carcinoma and to discuss its diagnosis,differential diagnosis,treatment and prognosis.METHODS：One case of sarcomatoid hepatocellular carcinoma was treated at our hospital.The clinical,pathological,histopathological and immunohistological features,diagnosis and treatment of this disease were investigated.A literature review was performed to summarize the characteristics of the disease.RESULTS：The tumor was located in the right lobe of the liver,demonstrating an infiltrative growth pattern.Histopathological and immunohistochemistry analyses showed coexistence of epithelial carcinoma and spindle cell sarcoma and presence of transitional area between carcinoma and sarcoma.Coagulative necrosis was noted in some areas of the tumor.Immunohistochemistrically,the tumor cells were strongly positive for CK （Pan） and EMA,weakly positive for AFP and Hepar-1,and negative for CK7,CK8,CK18,CK （H）,CD34,CD117,Dog-1,Actin,SMA,Caldesmon,Desmin,CD10,CD21,CD23,CD35,CD1a,CD2,CD3,CD20,CD45,ALK,CD68,CD163,CD30,CD15,HMB45 and S-100.CONCLUSION：Sarcomatoid hepatocellular carcinoma is a rare tumor with high malignancy.Clinically,differential diagnosis is needed to distinguish sarcomatoid hepatocellular carcinoma from hepatic carcinosarcoma,inflammatory follicular dendritic cell sarcoma and inflammatory myofibroblastoma.The prognosis of sarcomatoid hepatocellular carcinoma is correlated with tumor stage and morphological characteristics.