复合性肝癌临床病理学观察

Clinicopathologic features of combined hepatic carcinoma

目的 探讨肝细胞癌、胆管细胞癌及神经内分泌癌共同存在于同一肝肿瘤的临床及病理组织学特征.方法 对2例肝肿瘤的手术切除标本进行了详细的组织学观察和多种免疫组织化学检查,以证实其中复合癌的成分,并复习相关文献.结果 2例均为男性,平均年龄57.5岁,HBsAg均为阳性.2例肿瘤均明确由以下3种成分混合构成：（1）部分为多边形异型上皮细胞呈条索状或小梁状排列,免疫组织化学：Hepatocyte和甲胎蛋白均阳性,为肝细胞癌（HCC）,其中1例可见胆汁形成;（2）部分区域为椭圆或短梭形小蓝细胞呈巢片状或器官样排列,免疫组织化学：突触素和（或）嗜铬粒素A和（或）CD56阳性,为神经内分泌癌（NEC）;（3）部分区域为卵圆形异型上皮细胞呈弥漫巢团状或腺样排列,免疫组织化学：CK19和CK7均阳性,为胆管细胞癌（CC）.病理诊断：2例均为复合性肝癌,由HCC、NEC和CC成分组成,3种成分所占比例均≥20％.结论 HCC、NEC和CC组成的复合性肝癌非常罕见,可能来源于肝癌干细胞,预后较差.

Objective To investigate clinicopathological features of combined hepatocellularcholangiocarcinoma （C-HCC-CC） with neuroendocrine carcinoma （NEC） differentiation and to review the literature.Methods The clinical data,histological manifestations and immunohistochemical staining results of two cases of C-HCC-CC were analyzed along with a review of the current literature.Results Both patients were male with an average age of 57.5 years.Both patients were positive for hepatitis B virus antigen.The tumors of both cases demonstrated the following 3 unequivocal mixed elements：（1） polygonal epithelial tumor cells growing in nests or trabeculae with positive staining for Hepatocyte and AFP,diagnostic of hepatocellular carcinoma （HCC）.Cytoplasmic bile production was present in the tumor cells in one case ; （2） elliptic or short spindle-shape small blue tumor cells growing in nests or organoid pattern with Syn,/CgA/ CD56 positivity confirming the presence of neuroendocrine carcinoma （NEC） component ; （3） oval tumor cells growing in nests or glandular forms with positivity of CK19 and CK7 confirming differentiation of cholangiocarcinoma （CC）.In both cases,the tumors contained at least 20% of each of HCC,NEC and CC components.Conclusion C-HCC-CC with NEC is a rare form of primary malignancy of the liver with a poor prognosis.