Department of Pathology, Cliniques Universitaires Saint Luc, Brussels, Belgium.
Semin Liver Dis. 2011 Feb;31(1):104-10. doi: 10.1055/s-0031-1272838. Epub 2011 Feb 22.
The authors present an interesting case of a 60-year-old man who underwent right hepatectomy for a diagnosis of hepatocellular carcinoma (HCC) on a background of noncirrhotic chronic hepatitis C. Pathologic examination confirmed the presence of HCC near the porta hepatis, which invaded the right portal vein branch. In addition, a well-demarcated 13.5 × 7.8 × 4.0 cm yellow and firm area upstream of the HCC was noted. This yellow area corresponded to a tumoral ductular proliferation, which cytologically was extremely bland, but invaded portal tracts and the adjacent liver parenchyma. This tumoral proliferation mimicked ductular reaction, except that it had more anastomosing structures and was associated with abundant hyalinized fibrotic stroma. Cytologically, the tumor cells had round to oval nuclei with fine chromatin, indistinct nucleoli, and scant cytoplasm. They exhibited immunohistochemical features of hepatic progenitor cells, i.e., expressing CK7, CK19, and N-CAM; and their malignancy was supported by the p53 and Ki67 immunoreactivity. The authors concluded that the patient had cholangiolocellular carcinoma with an aggressive hepatocellular carcinoma component. Cholangiolocellular carcinoma has been reported to be associated with chronic hepatitis C viral infection and to derive from hepatic progenitor cells, which explains why hepatocellular carcinoma and/or cholangiocarcinoma component may be present.
作者报告了一例有趣的病例，一名 60 岁男性因非肝硬化性慢性丙型肝炎背景下的肝细胞癌（HCC）而行右肝切除术。病理检查证实 HCC 位于肝门附近，侵犯右门静脉分支。此外，还注意到 HCC 上游有一个界限清楚的 13.5×7.8×4.0cm 的黄色和坚实区域。这个黄色区域对应于肿瘤性小管增生，其细胞学上极其温和，但侵犯门脉区和相邻的肝实质。这种肿瘤性增生类似于胆管反应，只是它具有更多的吻合结构，并伴有丰富的玻璃样纤维化基质。细胞学上，肿瘤细胞具有圆形到椭圆形核，染色质细，核仁不明显，细胞质稀少。它们表现出肝祖细胞的免疫组织化学特征，即表达 CK7、CK19 和 N-CAM；p53 和 Ki67 免疫反应支持其恶性程度。作者得出结论，患者患有具有侵袭性肝细胞癌成分的胆管细胞癌。胆管细胞癌已被报道与慢性丙型肝炎病毒感染有关，并源自肝祖细胞，这解释了为什么可能存在肝细胞癌和/或胆管癌成分。
