同时性肝细胞癌和肝内胆管癌双原发癌临床病例分析

Clinical analysis of synchronous double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma

目的探讨同时性肝细胞癌和肝内胆管癌双原发癌(synchronous double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma,sdpHCC-ICC)的临床、影像及病理特征,以加深对该疾病的认识,减少临床误诊、误治。方法回顾性分析2014年1月1日—2018年12月31日四川大学华西医院收治的术后病理证实为sdpHCC-ICC患者的临床病史、影像及病理资料。结果共筛选符合条件的sdpHCC-ICC患者11例,其中男10例,女1例;发病年龄47～73岁,中位年龄55.6岁;乙型肝炎病毒感染者8例;8例患者同时观察到血清甲胎蛋白及糖类抗原19-9升高。患者初诊时分别行增强CT、彩色多普勒超声、增强MRI和超声造影等影像学检查,其中2例患者术前仅发现1个病灶,9例患者术前至少发现2个病灶。多为肝细胞癌典型表现:8例患者中观察到增强动脉期病灶明显强化,门脉或延迟期迅速廓清,其中1例患者另一病灶呈现周围环状强化等肝内胆管癌影像学表现。11例sdpHCC-ICC患者无一例术前被准确诊断。所有患者均接受了手术治疗。病理检查发现肝细胞癌病灶分布于肝内各个部位,而肝内胆管癌病灶10例均位于肝右叶,其中肝细胞癌、肝内胆管癌病灶中位直径分别为3.5、2.1 cm,均经常规苏木精-伊红染色和免疫组织化学明确。结论 sdpHCC-ICC临床及影像表现不典型,肿瘤标志物具有一定的提示作用,术前诊断困难,明确诊断依靠病理学检查。

Objective To explore the clinical, imaging, and pathological features of patients with synchronous double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma(sdpHCC-ICC), to enhance our understanding of the disease and reduce the rate of misdiagnosis and missed diagnosis. Methods The clinical, imaging,and pathological data of patients who were histologically confirmed as sdpHCC-ICC in West China Hospital of Sichuan University between January 1 st 2014 and December 31 st 2018 were studied retrospectively. Results A total of 11 patients with sdpHCC-ICC were screened for the study, of which 10 were male and 1 was female. The median age of patients was55.6 years(ranged from 47 to 73 years). Eight patients were chronically infected with hepatitis B virus. Both increased alpha-fetoprotein and carbohydrate antigen 19-9 were observed in 8 patients. Contrast enhanced CT was performed in 8 cases,color doppler ultrasound in 4 cases, enhanced MRI in 3 cases, and contrast-enhanced ultrasound in 1 case. Among them,one solitary lesion was found in 2 patients, and two or more lesions were observed in 9 patients. Most of the patients had typical imaging performance of hepatocellular carcinoma(HCC): 8 patients showed strong enhancement of HCC during the hepatic arterial phase and progressive hyper-attenuation on venous and delayed phases, 1 patient showed peripheral rim enhancement in the arterial phase of intrahepatic cholangiocarcinoma(ICC) in another lesion could be observed at the same time. None of the 11 patients with sdpHCC-ICC was diagnosed accurately before operation. All patients underwent surgical treatment. HCC lesions were distributed in all parts of the liver, while ICC lesions were located in the right lobe of the liver in 10 cases. The median diameter of HCC and ICC was 3.5 cm and 2.1 cm, respectively. All of them were confirmed by hematoxylin-eosin staining and immunohistochemistry. Conclusions The clinical characteristics of sdpHCC-ICC are usually atypical. It is difficult to make an accurate preoperative diagnosis. Tumor markers may be valuable to the diagnosis of sdpHCC-ICC. The definite diagnosis of sdpHCC-ICC depends on pathological examination.