肝细胞-胆管细胞混合型肝癌的诊治进展

Patients with both hepatocellular and cholangiocarcinoma and their clinicopathological features

肝细胞-胆管细胞混合型肝癌（HCC-CC）是一少见的特殊类型的原发性肝癌。根据wH0肿瘤分类定义，HCC—CC为肝细胞癌与胆管细胞癌共存于同一肝脏同一瘤体中。在HCC-CC中，两种肿瘤成分的并存比例及形式存在高度异质性。确定性HCC—CC病理诊断，必须建立在明确的HCC和CC分化证据之上，通常可借助于免疫组化、粘液染色和电镜检查等手段。根据临床症状不能作出HCC-CC诊断，其影像学表现亦无特征性。虽然部分病例可出现AFP和CA19—9同时升高，但确诊仍有待术后病理诊断。HCC—CC的临床特点，既类似HCC常合并肝炎病毒和门静脉癌栓，又像ICC具有血供差、淋巴结转移等特点。HCC—CC的预后一般较HCC差，但与ICC相比结论不一。本文对HCC-CC近年来的诊治进展作一综述。

Combined hepatocellular and eholangiocar- cinoma （HCC-CC） is a unique primary epithelial tumor of the liver classified by the World Health Organization （WHO） as a tumor containing elements of both hepatocellu- lar carcinoma （HCC） and cholangiocarcinoma （CC）. The clinical diagnosis is established by histopathology and a firm pathological diagnosis from definitive evidence of HCC and CC differentiation. HCC-CC＇s clinical features tend to re- semble hepatocellular carcinoma in regards to venous infiltra- tion and like cholangiocarcinoma with respect to lymph node metastasis. To date, the biological behavior of HCC-CC re- mains ill-defined; however its prognosis seems to be worse than just HCC. Conversely, it is unclear whether the prog- nosis of HCC-CC is better than that of only ICC. This paper reviews recent studies on the clinicopathological behavior of HCC-CC.