Orikasa H, Ohyama R, Tsuka N, Eyden B P, Yamazaki K
Department of Pathology, Saiseikai Central Hospital, Tokyo, Japan.
J Submicrosc Cytol Pathol. 2001 Jan-Apr;33(1-2):195-200.
A case of lipid-rich clear-cell hepatocellular carcinoma arising in non-alcoholic steatohepatitis is described in a patient with diabetes mellitus. The patient was a 67 year-old Japanese female with a history of tuberculosis, appendicitis, ischaemic heart disease, and non-insulin-dependent diabetes mellitus. The patient denied alcohol consumption. A liver mass was diagnosed as hepatocellular carcinoma of clear-cell type with early cirrhosis of the peri-tumoral liver tissue. Tumour cells had clear cytoplasm containing lipid droplets, and Mallory bodies. Surrounding non-tumoral liver tissue also showed lipid, and fibrosis in peri-portal areas with moderate bridging fibrosis. The features were consistent with clear-cell hepatocellular carcinoma arising in the fibrosis of non-alcoholic steatohepatitis. By electron microscopy, tumour cells had lipid droplets, glycogen, swollen mitochondria, rough endoplasmic reticulum, Mallory bodies, small bile canaliculi, desmosomes and gap junctions. Surrounding non-tumoral hepatocytes had a largely normal ultrastructure with prominent glycogen and lipid droplets. Clear-cell hepatocellular carcinoma within non-alcoholic steatohepatitis associated with diabetes mellitus is an extremely rare condition, and this report provides a detailed histopathological description with both immunohistochemical and ultrastructural data.
本文描述了一例发生于非酒精性脂肪性肝炎的富含脂质的透明细胞型肝细胞癌病例，患者患有糖尿病。该患者为一名67岁的日本女性，有肺结核、阑尾炎、缺血性心脏病和非胰岛素依赖型糖尿病病史。患者否认饮酒。肝脏肿块被诊断为透明细胞型肝细胞癌，周围肝组织有早期肝硬化。肿瘤细胞的细胞质透明，含有脂滴和马洛里小体。周围非肿瘤性肝组织也有脂质，门周区域有纤维化，并伴有中度桥接纤维化。这些特征与非酒精性脂肪性肝炎纤维化中发生的透明细胞型肝细胞癌一致。通过电子显微镜观察，肿瘤细胞有脂滴、糖原、肿胀的线粒体、粗面内质网、马洛里小体、小胆管、桥粒和缝隙连接。周围非肿瘤性肝细胞的超微结构基本正常，糖原和脂滴明显。非酒精性脂肪性肝炎合并糖尿病时发生的透明细胞型肝细胞癌极为罕见，本报告提供了详细的组织病理学描述以及免疫组化和超微结构数据。
