Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan.
World J Gastroenterol. 2011 Apr 14;17(14):1923-6. doi: 10.3748/wjg.v17.i14.1923.
A case of intraductal papillary neoplasm of the bile duct (IPNB) arising in a patient with hepatitis B-related liver cirrhosis with hepatocellular carcinoma (HCC) is reported. A 76-year-old man was admitted to our hospital with recurrent HCC. Laboratory data showed that levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated. He died of progressive hepatic failure. At autopsy, in addition to HCCs, an intraductal papillary proliferation of malignant cholangiocytes with fibrovascular cores was found in the dilated large bile ducts in the left lobe, and this papillary carcinoma was associated with an invasive mucinous carcinoma (invasive IPNB). Interestingly, extensive intraductal spread of the cholangiocarcinoma was found from the reactive bile ductular level to the interlobular bile ducts and septal bile ducts and to the large bile ducts in the left lobe. Neural cell adhesion molecule, a hepatic progenitor cell marker, was detected in IPNB cells. It seems possible in this case that hepatic progenitor cells located in reactive bile ductules in liver cirrhosis may have been responsible for the development of the cholangiocarcinoma and HCC, and that the former could have spread in the intrahepatic bile ducts and eventually formed grossly visible IPNB.
本文报告了 1 例乙型肝炎相关肝硬化合并肝细胞癌（HCC）患者发生的胆管内乳头状肿瘤（IPNB）。1 名 76 岁男性因复发性 HCC 入院。实验室数据显示癌胚抗原和碳水化合物抗原 19-9 水平升高。他死于进行性肝功能衰竭。尸检时，除 HCC 外，还在左叶扩张的大胆管中发现了恶性胆管细胞的导管内乳头状增生，伴有纤维血管核心，该乳头状癌与浸润性粘蛋白癌（浸润性 IPNB）相关。有趣的是，从反应性胆管水平到小叶间胆管和间隔胆管以及左叶大胆管，都发现了广泛的胆管癌腔内播散。在 IPNB 细胞中检测到神经细胞黏附分子，一种肝祖细胞标志物。在这种情况下，位于肝硬化反应性胆管中的肝祖细胞可能负责胆管癌和 HCC 的发生，前者可能在肝内胆管内扩散，并最终形成肉眼可见的 IPNB。
