肝原发性癌肉瘤临床病理观察

Clinicopathological features of carcinosarcoma of the liver

目的分析肝原发性癌肉瘤的临床病理学特点,探讨其诊断和鉴别诊断。方法对1例肝原发性癌肉瘤进行影像学、HE及免疫组化染色分析并复习相关文献。结果肿瘤由上皮性肿瘤细胞和间叶性肿瘤细胞混合构成,包括不同分化程度的肝细胞癌和肉瘤成分。免疫组化瘤细胞EMA、CKpan、CK7、S-100、vimentin、Glypican-3、CD34、CD10、SMA、CD57和CD99均(+),灶性过渡区域瘤细胞EMA和vimentin(+),Ki-67增殖指数20%。患者术后3个月出现肺转移。结论肝原发性癌肉瘤是一种极罕见的恶性肿瘤,确定诊断依靠组织形态学和免疫组化标记物。治疗以手术切除加术后放疗为主,但预后很差。

Objective To analyze the clinicopathologic features of primary diagnosis, differential diagnosis, therapy and prognosis. Methods A case of primary of the liver and to discuss the of the liver was analyzed by studying clinical history, imageology, HE staining and immunohistochemical staining and related literatures were reviewed. Results The patient suffered dull pain of abdomen and liver swelling lightly. A low echo mass was found by abdominal ultrasonography. The tumor comprised of a mixture of carcinomatous and sarcomatous elements including various differentiated hepatocellular carcinoma and different sarcoma, such as fibrosarcoma, osteosarcoma and chondrosarcoma. EMA, CKpan, CK7, S-100, vimentin, glypican-3, CD34, CD10, SMA, CD57 and CD99 were positively expressed in corresponding areas. Transitional features of carcinomatous elements and sarcomatous elements were present in a limited area, and these were positive for both EMA and vimentin. The proliferation rate of Ki-67 was 20%. The patient was diagnosed as lung metastases 3 months after surgical operation. Conclusions Primary carcinosarcoma of the liver is a very rare malignant tumor. Definite diagnosis depends on histomorphology and immunohistochemical staining. Surgical resection combined with preoperative chemotherapy is the main treatment method. The prognosis is very poor.