Yamamoto M, Takasaki K, Nakano M, Saito A
Institute of Gastroenterology, Tokyo Women's Medical College, Japan.
Hepatogastroenterology. 1996 Jul-Aug;43(10):1046-50.
We present a rare case of hepatic recurrence of cholangiolocellular carcinoma in a 61-year-old woman. The patient's past history included a right hepatic lobectomy and a hepatic hilar resection with hepaticojejunostomy for cholangiolocelluar carcinoma in 1990. After the diagnosis of hepatic recurrence in 1993, a partial hepatic resection was performed. The gross specimen showed an irregularly shaped white nodular tumor 2.5 cm in size without liver cirrhosis. The histopathological findings revealed small cuboidal cells resembling cholangiole forming acinar structures with fibrotic stroma, these findings were the same as those in the previously resected tumor. An immunohistochemical examination showed a positive reaction to carcinoembryonic antigen and keratin. The ultrastructural features revealed small round nuclei, flat contact of the cell membranes without interdigitation resembling that of hepatocytes, relatively numerous intracytoplasmic filaments, few organelae and a basement membrane resembling those of the bile duct epithelium. No recurrence has been observed during a one-year follow up. On the basis of the characteristic clinical and histopathological features of this case, we therefore consider that cholangiolocellular carcinoma should be recognized as an intermediate type somewhere between hepatocellular and cholangiocellular carcinoma.
我们报告一例61岁女性胆管细胞癌肝复发的罕见病例。患者既往史包括1990年因胆管细胞癌行右肝叶切除术及肝门部切除术并肝空肠吻合术。1993年诊断为肝复发后，行部分肝切除术。大体标本显示一个大小为2.5 cm的不规则形白色结节状肿瘤，无肝硬化。组织病理学检查发现小立方形细胞，类似胆小管，形成腺泡结构，伴有纤维性间质，这些表现与先前切除的肿瘤相同。免疫组化检查显示癌胚抗原和角蛋白呈阳性反应。超微结构特征显示细胞核小而圆，细胞膜扁平接触，无指状交叉，类似肝细胞，胞质内细丝相对较多，细胞器较少，基底膜类似胆管上皮。随访一年未观察到复发。基于该病例的特征性临床和组织病理学表现，我们认为胆管细胞癌应被视为肝细胞癌和胆管细胞癌之间的一种中间类型。
