肝细胞癌合并胆管错构瘤:2例报告及文献复习
Hepatocellular carcinoma in association with bile duct hamartomas: report on 2 cases and review of the literature.
作者信息
Heinke Thais, Pellacani Lucila Bohme, Costa Henrique de Oliveira, Fuziy Rogério Aoki, Franco Marcello
机构信息
Department of Pathology, Paulista School of Medicine/Federal University of São Paulo, EPM/UNIFESP 04023-900 São Paulo SP, Brazil.
出版信息
Ann Diagn Pathol. 2008 Jun;12(3):208-11. doi: 10.1016/j.anndiagpath.2006.12.003. Epub 2007 Aug 10.
Biliary hamartomas are hepatic lesions related to defects in the ductal plate and are part of the spectrum of adult polycystic disease. Microscopically, the lesions are small and consist of irregular bile ducts amidst a fibrous stroma. There are reports on the malignant transformation of biliary hamartomas, particularly on cholangiocarcinoma. Case 1: a 19-year-old woman presented with increased abdominal volume, lumbar pain, jaundice, choluria, cachexia, and progression to hepatic insufficiency. At autopsy, the liver weighed 8850 g and showed a 20.5-cm mass in the right lobe and nodules in the left lobe. Case 2: a 39-year-old man presented with an asymptomatic nodule in the right hepatic lobe. A 6.5-cm liver segment containing a 3.0-cm nodule was excised. Histopathology of both cases revealed hepatocellular carcinoma associated with multiple bile duct hamartomas (von Meyenburg complex). Bile duct hamartoma is generally an incidental finding at laparotomy and autopsy because its course is asymptomatic. The literature has documented its possible progression to malignant neoplasia. However, this relationship has only been established with cholangiocarcinomas. We report herein for the first time on the association of the lesion with hepatocellular carcinoma.
胆管错构瘤是与胆管板缺陷相关的肝脏病变,是成人多囊病谱系的一部分。显微镜下,病变较小,由纤维基质中不规则的胆管组成。有关于胆管错构瘤恶性转化的报道,尤其是胆管癌。病例1:一名19岁女性,出现腹部膨隆、腰痛、黄疸、胆尿、恶病质,并进展为肝功能不全。尸检时,肝脏重8850克,右叶有一个20.5厘米的肿块,左叶有结节。病例2:一名39岁男性,右肝叶出现无症状结节。切除了一个6.5厘米的肝段,其中含有一个3.0厘米的结节。两例病例的组织病理学均显示肝细胞癌合并多发胆管错构瘤(冯·迈恩伯格复合体)。胆管错构瘤通常在剖腹手术和尸检时偶然发现,因为其病程无症状。文献记载了其可能进展为恶性肿瘤。然而,这种关系仅在胆管癌中得到证实。我们在此首次报告该病变与肝细胞癌的关联。