肝细胞癌累及胆管：胆管刷检样本中罕见的发生情况及不良预后指标。
Bile duct involvement by hepatocellular carcinoma: A rare occurrence and poor prognostic indicator in bile duct brushing samples.
机构信息
Department of Biology, Georgia State University, Atlanta, Georgia.
Department of Pathology, Mayo Clinic, Rochester, Minnesota.
出版信息
Cancer Cytopathol. 2019 Nov;127(11):691-699. doi: 10.1002/cncy.22185. Epub 2019 Sep 13.
BACKGROUND
Hepatocellular carcinoma (HCC) rarely involves the biliary tree and may be inadvertently sampled on bile duct brushings (BDBs).
METHODS
The pathology archives of 5 institutions were searched for BDBs with HCC involvement.
RESULTS
A total of 17 BDBs from 14 patients were obtained. There was a male:female ratio of 6:1; the median age of the patients was 59.5 years (range, 22-80 years). The median hepatic tumor size was 6.2 cm (range, 2.2-13.0 cm). HCC risk factors included viral hepatitis (5 patients), cirrhosis (5 patients), hemochromatosis (1 patient), and alcoholic steatohepatitis (1 patient). Jaundice with elevated bilirubin, liver enzymes, and α-fetoprotein was common. Endoscopic retrograde cholangiopancreatography demonstrated bile duct dilatation, polypoid intraductal masses (5 samples), clots/debris (2 samples), or strictures (4 samples). All BDBs had single and clustered large cells with naked atypical nuclei, granular cytoplasm, high nuclear/cytoplasmic ratios, and nuclei with prominent macronucleoli. Less common findings included clear/microvesicular cytoplasm (35%), papillae (29%), and anisonucleosis (35%). Classic HCC features (widened trabeculae [35%], endothelial wrapping [24%], multinucleation [24%], and cytoplasmic bile pigment [35%]) were uncommon. A total of 11 BDBs were diagnosed as malignant (10 with HCC and 1 with cholangiocarcinoma), 2 were diagnosed as atypical, and 1 BDB was diagnosed as negative; approximately two-thirds were found to have polysomy on fluorescence in situ hybridization. Approximately 71% of patients died of disease at a median of 3.5 months.
CONCLUSIONS
HCC may extend into the intrahepatic and/or extrahepatic biliary tree, causing masses and/or strictures that may be sampled on BDB. Although cytologically malignant, the classic features of HCC are uncommon, which can cause misdiagnosis. Cytopathologists should be mindful of this differential when evaluating BDBs, particularly when concomitant liver masses and/or HCC risk factors are present. Because of the associated high mortality and rapid rate of death, its presence should be conveyed clearly in pathology reports.
背景
肝细胞癌（HCC）很少累及胆道，可能会意外地在胆管刷片中采样到。
方法
对 5 家机构的病理学档案进行了搜索，以获取涉及 HCC 的胆管刷片。
结果
共获得 14 名患者的 17 份胆管刷片，男女比例为 6:1；患者中位年龄为 59.5 岁（范围 22-80 岁）。肝肿瘤的中位大小为 6.2cm（范围 2.2-13.0cm）。HCC 的危险因素包括病毒性肝炎（5 例）、肝硬化（5 例）、血色病（1 例）和酒精性脂肪性肝炎（1 例）。常见的表现为黄疸、胆红素、肝酶和甲胎蛋白升高。内镜逆行胰胆管造影显示胆管扩张、胆管内息肉样肿块（5 例）、血栓/碎片（2 例）或狭窄（4 例）。所有胆管刷片均显示单个或簇状的大细胞，细胞核呈裸核样，核仁明显，细胞质颗粒状，核浆比高。不常见的发现包括透明/微泡状细胞质（35%）、乳头上皮（29%）和核大小不均（35%）。经典 HCC 特征（宽小梁[35%]、内皮包裹[24%]、多核[24%]和细胞质胆汁色素[35%]）并不常见。共有 11 份胆管刷片诊断为恶性（10 份为 HCC，1 份为胆管癌），2 份为不典型，1 份为阴性；大约三分之二的病例通过荧光原位杂交发现了多倍体。大约 71%的患者在中位 3.5 个月时因疾病死亡。
结论
HCC 可能延伸至肝内和/或肝外胆道，导致肿块和/或狭窄，这些可能会在胆管刷片中采样到。尽管细胞学上是恶性的，但 HCC 的典型特征并不常见，这可能导致误诊。当评估胆管刷片时，细胞病理学家应该注意到这一差异，特别是当存在同时性肝内肿块和/或 HCC 危险因素时。由于其相关的高死亡率和快速死亡速度，应在病理报告中明确告知其存在。
Zotero 插件