Maeda T, Adachi E, Kajiyama K, Takenaka K, Sugimachi K, Tsuneyoshi M
Department of Pathology II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Cancer. 1996 Jan 1;77(1):51-7. doi: 10.1002/(SICI)1097-0142(19960101)77:1<51::AID-CNCR10>3.0.CO;2-7.
Spindle cell hepatocellular carcinoma (SpHCC) has rarely been reported, and its clinicopathologic characteristics, histogenesis, and prognosis after hepatic resection have yet to be clarified.
Fifteen cases of SpHCC, including 13 surgically resected patients and 2 autopsy cases, were studied clinicopathologically and immunohistochemically.
In 13 resected patients, all except 1 were male and the serum alpha-fetoprotein (AFP) was positive in 6 (46%). Portal venous invasion and intrahepatic metastases were frequent. In an immunohistochemical analysis of 13 SpHCC tumors, cytokeratin CAM 5.2 and AFP were positive in 8 (62%) tumors and 3 (23%) tumors in both ordinary HCC and spindle cell components, respectively. The spindle cell components, but not ordinary HCC components, revealed a positive reaction for vimentin in 8 (62%) tumors, S-100 protein and HAM-56 in 3 (23%) tumors, HHF-35 in 2 (15%) tumors, and alpha-smooth muscle actin, desmin, and KP-1 in 1 (8%) tumor, respectively. p53 overexpression was found in two SpHCC tumors. The survival curve after hepatic resection in the 13 patients with SpHCC was significantly worse than that of the 371 patients with Stage II-IV ordinary HCC (P < 0.001).
These results suggest that SpHCC represents a sarcomatous transformation of HCC. The spindle cell components revealed an immunohistochemical expression of several markers of mesenchymal cells. In addition, poor survival after hepatic resection was documented.
梭形细胞肝细胞癌（SpHCC）鲜有报道，其临床病理特征、组织发生及肝切除术后的预后尚待阐明。
对15例SpHCC进行临床病理及免疫组化研究，其中包括13例行手术切除的患者及2例尸检病例。
13例手术切除患者中，除1例为女性外其余均为男性，血清甲胎蛋白（AFP）阳性6例（46%）。门静脉侵犯及肝内转移常见。对13例SpHCC肿瘤进行免疫组化分析，细胞角蛋白CAM 5.2和AFP在8例（62%）肿瘤中呈阳性，普通肝癌成分和梭形细胞成分中分别有3例（23%）肿瘤呈阳性。梭形细胞成分而非普通肝癌成分，8例（62%）肿瘤波形蛋白呈阳性，3例（23%）肿瘤S-100蛋白和HAM-56呈阳性，2例（15%）肿瘤HHF-35呈阳性，1例（8%）肿瘤α-平滑肌肌动蛋白、结蛋白和KP-1呈阳性。2例SpHCC肿瘤发现p53过表达。13例SpHCC患者肝切除术后的生存曲线明显差于371例II-IV期普通肝癌患者（P < 0.001）。
这些结果提示SpHCC为肝癌的肉瘤样转化。梭形细胞成分显示间充质细胞多种标志物的免疫组化表达。此外，肝切除术后生存较差。
