Ariizumi Shun-ichi, Takasaki Ken, Otsubo Takehito, Yamamoto Masakazu, Nakano Masayuki
Department of Gastroenterological Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku-ku, Tokyo 162-8666, Japan.
J Gastroenterol. 2002;37(9):750-4. doi: 10.1007/s005350200123.
We present a rare case of four immunohistochemically different primary liver cancers developing in a 54-year-old Japanese man with chronic hepatitis C. In 1989, a liver tumor had been detected at another hospital during follow-up of hepatitis C virus (HCV) infection. He was first admitted to our hospital in July 1991, when a well defined hypervascular tumor, measuring 2.5 cm in diameter was found in the S5 subsegment of the liver on computed tomography (CT); S5 subsegmentectomy was therefore performed, in July 1991. Histopathological examination revealed scirrhous hepatocellular carcinoma (SHCC). Immunohistochemical analysis showed that the tumor was negative for mouse monoclonal anti-human hepatocyte antibody (Hep), but was partially positive for a mouse monoclonal antibody specific for cytokeratin 19 (CK19). Six years after the operation, a large tumor, measuring 10 cm in diameter, was found in the S4 subsegment and a 3-cm tumor was found in the caudate lobe on CT scans. Extended left hepatic lobectomy and partial resection of the caudate lobe were performed in August 1997. Histopathological examination revealed a moderately differentiated hepatocellular carcinoma (HCC) with a trabecular pattern, an SHCC with well differentiated HCC at its periphery, and a small incidental cholangiocellular carcinoma (CCC), measuring 1 cm in diameter. The HCC and CCC showed typical immunostaining for Hep and CK19, respectively. The SHCC was positive for both Hep and CK19, showing characteristics different from those of the previously resected SHCC on immunohistochemical analysis. In conclusion, we experienced four immunohistochemically different primary liver cancers in a patient with chronic hepatitis C.
我们报告了一例罕见病例，一名54岁的日本慢性丙型肝炎男性患者发生了四种免疫组化结果不同的原发性肝癌。1989年，在丙型肝炎病毒（HCV）感染随访期间，另一家医院检测到肝脏肿瘤。他于1991年7月首次入住我院，当时计算机断层扫描（CT）显示肝脏S5亚段有一个边界清晰的高血供肿瘤，直径2.5 cm；因此，于1991年7月进行了S5亚段切除术。组织病理学检查显示为硬化型肝细胞癌（SHCC）。免疫组化分析显示，该肿瘤对小鼠单克隆抗人肝细胞抗体（Hep）呈阴性，但对细胞角蛋白19（CK19）特异性小鼠单克隆抗体呈部分阳性。术后六年，CT扫描显示S4亚段有一个直径10 cm的大肿瘤，尾状叶有一个3 cm的肿瘤。1997年8月进行了扩大左肝叶切除术和尾状叶部分切除术。组织病理学检查显示为中等分化的肝细胞癌（HCC），呈小梁状，外周为高分化HCC的SHCC，以及一个直径1 cm的小的偶然发现的胆管细胞癌（CCC）。HCC和CCC分别对Hep和CK19呈典型免疫染色。SHCC对Hep和CK19均呈阳性，免疫组化分析显示其特征与先前切除的SHCC不同。总之，我们在一名慢性丙型肝炎患者中遇到了四种免疫组化结果不同的原发性肝癌。
