HBV与血吸虫双重感染伴发多形性肝细胞癌临床病理特征及文献复习

Clinical pathological features and literature review of both HBV and Schistosome infection accompanied with pleomorphic hepatocellular carcinoma

目的对乙型肝炎病毒(HBV)与血吸虫双重感染伴多形性肝细胞肝癌(HCC)的临床病理特征进行综合分析。方法收集研究对象的临床资料,对1例术后肝肿物及其周围部分肝组织做常规石蜡切片、HE染色及免疫组织化学染色,肉眼及光镜观察。结果镜下见肝肿瘤细胞呈片状或巢团型生长,细胞大小不一,半数以上的癌细胞呈典型的多边形,可见奇异的单核或多核瘤巨细胞,核分裂相易见;肿瘤周围组织见肝硬化及陈旧性血吸虫结节;免疫组织化学显示,肿瘤细胞HepPar1(+)、AFP(+)、CD34微血管(+)、CEA(+)、p53(少数+)、E钙黏蛋白(少数+);CK7(-)、CK19(-)、VIM(-)、EMA(-);肿瘤周围部分肝细胞HBsAg呈阳性表达。结论 HBV与血吸虫双重感染对肝癌的发生有协同作用,术后行病理学检查更能准确诊断、客观评价和分析HCC的进程。

ObjectiveTo analyze the clinical pathological features of both HBV and schistosome infection accompanied with pleomorphic hepatocellular carcinoma.Methods The clinical data from one case of patient who after liverneoplasm surgery was collected, Hematoxylin Eosin and immunohistochemical staining were performed on conventional parafifn-embeded tissues of neoplasm and section of normal liver, then these silces under a microscope were observed.Results Tumor cells grew in the flake or nesting patterns, varied in sizes. More than half of the tumor cells presented as typical polygon, bizarre nomonuclear or multinucleated giant cells could be seen, nuclear mitotic ifgures were frequent; and there were obsolete schistosome nodi surrounded with tumor. Immunohistochemistry results showed that HepPar1 （＋）, AFP （＋）, CD34 in microvasculature （＋）, CEA （＋）,p53 （minority ＋） and E-cadherin （minority ＋）, CK7 （-）, CK19 （-）, VIM （-）, EMA （-）. HBsAg was positive in part of the normal hepatic cells around the tumor. Conclusions HBV and schistosoma infection may facilitate to the development of HCC, and postoperative pathological examination could be more accurate diagnosis, objective evaluation and analyze the process of HCC.