Shibahara Junji, Hayashi Akimasa, Misumi Kento, Sakamoto Yoshihiro, Arita Junichi, Hasegawa Kiyoshi, Kokudo Norihiro, Fukayama Masashi
*Department of Pathology †Department of Surgery, Hepato-Biliary-Pancreatic Division, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Am J Surg Pathol. 2016 May;40(5):608-16. doi: 10.1097/PAS.0000000000000579.
The aim of this study was to elucidate the clinicopathologic characteristics of hepatocellular carcinoma with reactive ductule-like components (HCC-RD), corresponding to combined hepatocellular-cholangiocarcinoma (CHC) with stem cell features, typical subtype. Retrospective clinicopathologic analysis was performed on HCCs surgically treated at the University of Tokyo Hospital between 1995 and 2013. RD components were defined as neoplastic ductular structures composed of small "stem/progenitor-like" cells. There were 46 HCC-RDs, comprising about 3% of all HCCs. Thirty-eight cases of CHC, classical type (classical CHC), were identified during the study period. When compared with conventional HCC, HCC-RD was characterized by younger patient age (P=0.016), higher frequency of female patients (P<0.001), and higher serum α-fetoprotein levels (P=0.005). Serum carbohydrate antigen 19-9 elevation was also more frequently observed in HCC-RD than in conventional HCC (P=0.002). Histologically, clear cell constituents and interstitial fibrosis were more frequent in HCC-RD than in conventional HCC (P=0.003 and <0.001, respectively). When compared with HCC-RD and conventional HCC, classical CHC was characterized by a poorly differentiated HCC component, frequent vascular invasion, and lymph node metastasis (P<0.05). There was little prognostic difference between HCC-RD and conventional HCC, whereas overall and disease-free survival in classical CHC was significantly worse than in conventional HCC. In conclusion, although HCC-RDs do have some unique clinicopathologic characteristics, they have no prognostic significance, and it is not reasonable to include these tumors in the CHC category.
本研究的目的是阐明具有反应性小胆管样成分的肝细胞癌（HCC-RD）的临床病理特征，其对应于具有干细胞特征的典型亚型的肝细胞胆管癌（CHC）。对1995年至2013年在东京大学医院接受手术治疗的肝细胞癌进行回顾性临床病理分析。RD成分定义为由小的“干细胞/祖细胞样”细胞组成的肿瘤性小胆管结构。共有46例HCC-RD，约占所有肝细胞癌的3%。在研究期间共识别出38例经典型CHC（经典CHC）。与传统肝细胞癌相比，HCC-RD的特点是患者年龄较轻（P=0.016）、女性患者比例较高（P<0.001）以及血清甲胎蛋白水平较高（P=0.005）。HCC-RD中血清糖类抗原19-9升高的情况也比传统肝细胞癌更常见（P=0.002）。组织学上，HCC-RD中透明细胞成分和间质纤维化比传统肝细胞癌更常见（分别为P=0.003和<0.001）。与HCC-RD和传统肝细胞癌相比，经典CHC的特点是肝细胞癌成分分化差、血管侵犯频繁和淋巴结转移（P<0.05）。HCC-RD和传统肝细胞癌之间的预后差异不大，而经典CHC的总生存期和无病生存期明显比传统肝细胞癌差。总之，尽管HCC-RD确实具有一些独特的临床病理特征，但它们没有预后意义，将这些肿瘤纳入CHC类别是不合理的。
