Ito Yuichiro, Fujioka Hikaru, Matsuzaki Sumihiro, Yamamoto Osamu, Okudaira Sadayuki, Azuma Takashi, Furui Junichiro, Kanematsu Takashi
Department of Surgery II, Nagasaki University School of Medicine, 1-12-4 Sakamoto, Nagasaki, 852-8501 Japan.
Hepatogastroenterology. 2003 Jan-Feb;50(49):65-8.
Separate hepatocellular and cholangiocellular carcinoma (double cancer) in the liver are extremely rare subtypes of primary hepatic carcinomas. We report a case of double primary liver carcinomas that were surgically resected simultaneously. A 66-year-old man was admitted because of elevation of serum levels of alpha-fetoprotein. Abdominal computed tomography and angiography showed two hypervascular masses in S4 and S8 hepatic segments. With the diagnosis of multiple hepatocellular carcinomas, the tumors were surgically resected. Histological examination showed that the tumor in S4 segment was moderately differentiated cholangiocellular carcinoma, the other in S8 segment was trabecular, moderately differentiated hepatocellular carcinoma. Immunohistochemically, a positive staining in carcinoembyonic antigen and cytokeratin 7 supported the diagnosis of cholangiocellular carcinoma for the tumor in S4 segment. The frequency of double cancer in the liver is much lower than mixed or combined cancer (0.1-0.5%). The different epithelial malignant tumors of hepatocellular carcinoma and cholangiocellular carcinoma, which were located in different hepatic lobes and resected simultaneously, has been reported in only two cases including the present case.
肝内肝细胞癌和胆管细胞癌（双癌）是原发性肝癌极为罕见的亚型。我们报告一例同时接受手术切除的双原发性肝癌病例。一名66岁男性因血清甲胎蛋白水平升高入院。腹部计算机断层扫描和血管造影显示肝S4和S8段有两个高血运肿块。诊断为多发性肝细胞癌后，对肿瘤进行了手术切除。组织学检查显示，S4段肿瘤为中度分化胆管细胞癌，S8段另一个肿瘤为小梁状、中度分化肝细胞癌。免疫组化方面，癌胚抗原和细胞角蛋白7阳性染色支持S4段肿瘤为胆管细胞癌的诊断。肝双癌的发生率远低于混合性或合并性癌（0.1 - 0.5%）。肝细胞癌和胆管细胞癌这两种不同的上皮性恶性肿瘤位于不同肝叶并同时切除的情况，包括本病例在内仅报道过两例。
