Terada Tadashi, Taniguchi Masami
Department of Pathology, Shizuoka Municipal Shimizu Hospital, Shimizu-Miyakami, Shizuoka, Japan.
Pathol Int. 2004 Feb;54(2):116-23. doi: 10.1111/j.1440-1827.2004.01594.x.
A very rare case of intraductal oncocytic papillary carcinoma of the liver is reported. A 63-year-old Japanese man was admitted to our clinic because of abdominal pain and jaundice. Imaging techniques revealed a unilocular cystic neoplasm of 14 cm diameter in the medial segment of the left hepatic lobe. Combined percutaneous and endoscopic retrograde cholangiographies revealed the unilocular cystic neoplasm contained a lot of mucus and communicated with the left segmental intrahepatic bile duct, and that mucus filled the left segmental and hepatic ducts. Left lobectomy was performed. The postoperative course was good, and the patient is free of disease 30 months after operation. Pathological examination revealed that the cavity of the neoplasm was continuous with the left segmental intrahepatic bile duct, and that a lot of mucus was present in the neoplasm, as well as in the left segmental and hepatic ducts. The neoplasm consisted of papillary growth of atypical epithelial cells with oncocytic changes. Atypical goblet cells were also recognized. No invasion into the surrounding liver was noted. Non-tumorous intrahepatic bile ducts near the lesion occasionally showed epithelial dysplasia and contained a lot of mucus. Immunohistochemically, the tumor cells were rich in mitochondria and were immunoreactive for cytokeratins 7, 18 and 19, carbohydrate antigen 19-9, and hepatocyte-specific antigen. Some tumor cells were immunoreactive for pancreatic alpha-amylase and lipase. Ultrastructurally, the tumor cells showed numerous mitochondria and mucus droplets. Intraductal neoplasm communicating with the intrahepatic bile ducts has rarely been reported. The present case suggests that intraductal oncocytic papillary neoplasm, as described in the pancreas, may also occur in the intrahepatic bile ducts, and that such hepatic intraductal neoplasm may express hepatocellular and pancreatic acinar phenotypes.
报告了一例非常罕见的肝内导管嗜酸性乳头状癌。一名63岁的日本男性因腹痛和黄疸入住我院。影像学检查显示左肝叶内侧段有一个直径14 cm的单房囊性肿瘤。经皮和内镜逆行胆管造影联合检查显示，该单房囊性肿瘤含有大量黏液，并与左肝段肝内胆管相通，黏液充满了左肝段胆管和肝内胆管。行左肝叶切除术。术后恢复良好，患者术后30个月无疾病复发。病理检查显示肿瘤腔与左肝段肝内胆管相连，肿瘤内以及左肝段胆管和肝内胆管内均有大量黏液。肿瘤由具有嗜酸性改变的非典型上皮细胞呈乳头状生长构成。还发现了非典型杯状细胞。未见肿瘤侵犯周围肝脏。病变附近的非肿瘤性肝内胆管偶尔可见上皮发育异常，并含有大量黏液。免疫组化显示，肿瘤细胞富含线粒体，对细胞角蛋白7、18和19、糖类抗原19-9以及肝细胞特异性抗原呈免疫反应。一些肿瘤细胞对胰α淀粉酶和脂肪酶呈免疫反应。超微结构显示，肿瘤细胞含有大量线粒体和黏液滴。与肝内胆管相通的导管内肿瘤很少见。本例提示，如胰腺中所描述的导管内嗜酸性乳头状肿瘤也可能发生于肝内胆管，且这种肝内导管内肿瘤可能表达肝细胞和胰腺腺泡表型。
