双表型肝细胞癌的临床病理分析

Clinicopathological analysis of dual-phenotype hepatocellular carcinoma

目的 探讨双表型肝细胞癌(DPHCC)的组织形态学特征、免疫表型、鉴别诊断要点及预后。方法 收集9例DPHCC患者的临床及病理资料,分析DPHCC组织的HE形态及免疫组织化学染色结果,并复习相关文献。结果 镜下肿瘤细胞排列成粗梁状、假腺样及团片状,间质伴丰富的血窦样腔隙,纤维间质少;肿瘤细胞呈多角形,胞浆丰富且嗜酸,核仁明显,核分裂象多见,其中3例见微血管侵犯。免疫表型:9例患者的肿瘤细胞均表达CK19,其中4例患者的肿瘤细胞同时表达CK7;9例患者的肿瘤细胞不同程度地表达一种或多种肝细胞标记物(Glypican-3、AFP、Hepatocyte-1、Arginase-1)。7例患者有完整的随访资料,其中4例患者确诊后20个月内死亡。结论 DPHCC组织形态学具有肝细胞癌特征,但免疫表型同时表达肝细胞癌及胆管细胞癌的标记物,与普通型肝细胞癌相比,其侵袭性更强,临床预后更差,准确认识并诊断DPHCC具有重要的临床意义。

Objective To investigate the histomorphological characteristics, immunophenotype, differential diagnosis and prognosis of dual-phenotype hepatocellular carcinoma(DPHCC).Methods The clinical and pathological data of 9 DPHCC patients were collected, the HE morphology and immunohistochemical staining results were analyzed, and related literatures were also reviewed.ResultsMicroscopically, tumor cells were arranged in thick beam, pseudoglandular and lumpy shape, with abundant blood sinus-like cavities in stroma and few fibrous stroma. The tumor cells were polygonal, rich in cytoplasm and acidophilic, with obvious nucleoli and common mitosis, and microvascular invasion was found in 3 cases. Immunophenotype: the tumor cells of 9 patients all expressed CK19,in which the tumor cells of 4 patients also expressed CK7;tumor cells of 9 patients expressed one or more hepatocyte markers in different degrees(including Glypican-3,AFP,Hepatocyte-1,Arginase-1).There were 7 patients with complete follow-up data, and 4 of them died within 20 months after diagnosis.Conclusion Histomorphology of DPHCC is characteristic of hepatocellular carcinoma, but immunophenotype co-expresses markers of hepatocellular carcinoma and cholangiocarcinoma, which is more aggressive and has worse prognosis compared with conventional hepatocellular carcinoma.Therefore, accurate recognition and diagnosis of DPHCC is of great clinical significance.