Ma Qing-Jun, Wang Fu-Hai, Yang Ning-Ning, Wei Hong-Long, Liu Feng
Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong Province, China.
Department of Respiratory and Critical Care Medicine, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan 250013, Shandong Province, China.
World J Clin Oncol. 2024 Jul 24;15(7):936-944. doi: 10.5306/wjco.v15.i7.936.
Cholangiocarcinoma is the most common malignancy of the biliary tree and has a poor prognosis. Adenocarcinoma is the most common pathological type of cholangiocarcinomas, but rare squamous, adenosquamous, and mucinous variants have been reported without adequate clinical data.
This report describes a rare case of primary squamous cell carcinoma (SCC) of the intrahepatic bile duct. The patient was admitted with a tumor in the hepatic caudate lobe with no obvious clinical symptoms. Examination revealed hepatitis B surface antigen positivity, a slight increase in alfa-fetoprotein to 16.34 ng/mL, and an irregular slightly heterogeneous enhancing lesion in the hepatic caudate lobe, which was initially thought to be hepatocellular carcinoma. Laparoscopic resection was performed, and the final pathology suggested a rare primary SCC of the intrahepatic bile duct. Immunohistochemistry indicated positivity for villin, partial positivity for p63, and negativity for hepatocyte, CK7, CK8, CK19, and CK20. The Ki-67 index was approximately 60%. The patient received six cycles of Tegio chemotherapy. A new lesion was detected in the liver after 15 months. The surgery was performed, and the patient was followed-up at a local hospital. To date, no new lesions have been observed.
Surgery is the first choice for resectable lesions, and combined chemotherapy based on pathology is essential for increasing overall survival.
胆管癌是胆管最常见的恶性肿瘤，预后较差。腺癌是胆管癌最常见的病理类型，但也有罕见的鳞状细胞癌、腺鳞癌和黏液性变体的报道，且缺乏充分的临床资料。
本报告描述了1例罕见的肝内胆管原发性鳞状细胞癌（SCC）病例。患者因肝尾状叶肿瘤入院，无明显临床症状。检查发现乙肝表面抗原阳性，甲胎蛋白轻度升高至16.34 ng/mL，肝尾状叶有一不规则的稍不均匀强化病灶，最初考虑为肝细胞癌。行腹腔镜切除术，最终病理提示为罕见的肝内胆管原发性SCC。免疫组化显示维林蛋白阳性，p63部分阳性，肝细胞、细胞角蛋白7（CK7）、细胞角蛋白8（CK8）、细胞角蛋白19（CK19）和细胞角蛋白20（CK20）阴性。Ki-67指数约为60%。患者接受了6个周期的替吉奥化疗。15个月后肝脏发现新病灶，行手术治疗，患者在当地医院接受随访。迄今为止，未观察到新病灶。
手术是可切除病灶的首选治疗方法，基于病理结果的联合化疗对提高总生存率至关重要。
