Lee Kyung Hwa, Kim Young Bog, Cho Sung Bum, Lee Min Cheol, Park Chang Soo, Lee Jae Hyuk
Department of Pathology, Seonam University, College of Medicine, #720, Gwangchi-dong, Namwon, Jeollanamdo, 590-711, Republic of Korea.
Cases J. 2009 Aug 25;2:6789. doi: 10.4076/1757-1626-2-6789.
We present a unique case of hepatocellular carcinoma with mucin-producing gland formation. A 53-year-old man with hepatitis B infection presented with weight loss for the past month. Computed tomography demonstrated a 10 x 9.8 cm mass in the right hepatic lobe accompanied by cirrhotic changes in the hepatic parenchyma. Right hepatectomy was performed, and the tumor cut surface showed a poorly-circumscribed, white to pink tumor with numerous nodules and extensive necrosis. Microscopically, the tumor was composed of thick trabeculae and large, irregularly-shaped islands, both of which were filled with pleomorphic eosinophilic hepatoid cells or gland-forming columnar cells with mucin production. Those cells were immunoreactive for cytokeratin 19 in both the trabeculae and the glands. In some tumor cells, limited immunoreactivity for cytokeratin 7, epithelial membrane antigen and carcinoembryonic antigen was noted. The cells forming thick trabeculae were focally positive for hepatocyte paraffin 1 and alpha-fetoprotein. We suggest that this tumor shows bidirectional differentiation into hepatocytes and cholangiocytes, supporting the concepts that human hepatocarcinogenesis can be based on transformation of progenitor cells which can imply divergent differentiation.
我们报告一例独特的伴有黏液生成性腺形成的肝细胞癌病例。一名53岁的乙型肝炎感染男性患者，出现了过去一个月体重减轻的症状。计算机断层扫描显示右肝叶有一个10×9.8厘米的肿块，肝实质伴有肝硬化改变。进行了右肝切除术，肿瘤切面显示边界不清，呈白色至粉红色，有许多结节和广泛坏死。显微镜下，肿瘤由粗大的小梁和大的、不规则形状的岛状结构组成，两者均充满多形性嗜酸性肝样细胞或产生黏液的腺形成柱状细胞。这些细胞在小梁和腺体内对细胞角蛋白19均呈免疫反应阳性。在一些肿瘤细胞中，观察到对细胞角蛋白7、上皮膜抗原和癌胚抗原有有限的免疫反应。形成粗大小梁的细胞对肝细胞石蜡1和甲胎蛋白呈局灶性阳性。我们认为该肿瘤表现出向肝细胞和胆管细胞的双向分化，支持人类肝癌发生可基于祖细胞转化这一观点，而祖细胞转化可能意味着不同的分化。
