Morinaga S, Nishiya H, Inafuku T
Department of Pathology, Saiseikai Central Hospital, Tokyo, Japan.
Arch Pathol Lab Med. 1996 Jul;120(7):687-90.
Hepatic yolk sac tumor is extremely rare, and only nine cases have been reported previously to our knowledge. We report the occurrence of a tumor combining hepatocellular carcinoma and yolk sac tumor. The clinical, pathologic, and immunohistochemical findings are presented. The patient was a 62-year-old Japanese man who died of hepatic failure and uncontrolled ascites. On autopsy, a large hepatic tumor was observed, which microscopically was composed of hepatocellular carcinoma and yolk sac tumor. The two components were intermingled, and transition zones were evident. Immunohistochemically, both components were positive for alpha-fetoprotein, but only the yolk sac tumor component was positive for carcinoembryonic antigen, epithelial membrane antigen, stage specific embryonic antigen-1, placental alkaline phosphatase, and keratin. To our knowledge, this is the first reported case of hepatic yolk sac tumor associated with hepatocellular carcinoma. The present tumor is best considered a variant of hepatocellular carcinoma showing yolk sac differentiation, and it provides another explanation for the histogenesis of extragonadal yolk sac tumor.
肝内卵黄囊瘤极为罕见，据我们所知，此前仅报道过9例。我们报告了1例合并肝细胞癌和卵黄囊瘤的肿瘤病例，并展示了其临床、病理及免疫组化结果。患者为一名62岁的日本男性，死于肝衰竭和难以控制的腹水。尸检时发现一个巨大的肝脏肿瘤，显微镜下该肿瘤由肝细胞癌和卵黄囊瘤组成。这两种成分相互交织，过渡区明显。免疫组化显示，两种成分甲胎蛋白均呈阳性，但只有卵黄囊瘤成分癌胚抗原、上皮膜抗原、阶段特异性胚胎抗原-1、胎盘碱性磷酸酶和角蛋白呈阳性。据我们所知，这是首例报道的与肝细胞癌相关的肝内卵黄囊瘤病例。目前的肿瘤最好被视为具有卵黄囊分化的肝细胞癌变体，它为性腺外卵黄囊瘤的组织发生提供了另一种解释。
