Dusenbery D
Department of Pathology, University of Pittsburgh Medical Center, Pennsylvania 15213-2582, USA.
Acta Cytol. 1997 May-Jun;41(3):903-9. doi: 10.1159/000332726.
Rarely do primary hepatic tumors show mixed hepatocellular carcinoma (HCC) and cholangiocarcinoma differentiation. Histologic criteria for these combined hepatocellular-cholangiocarcinomas (CHCC-C) are not universally agreed upon. Cytologic descriptions of CHCC-C are scarce, yet recognition of this tumor type may have some prognostic significance.
The clinical and cytohistologic findings, including histochemical and immunohistochemical studies, in four cases of CHCC-C were reviewed. The specimens consisted of three needle biopsies of the liver and one bile duct brushing specimen. In all cases the diagnosis of CHCC-C was confirmed by histologic, histochemical and immunohistochemical study.
The reliable diagnosis of CHCC-C on cytologic preparations alone is fraught with difficulty. However, the addition of cell block or core biopsy histologic material, which may serve as a substrate for histochemical and immunohistochemical studies, may permit the diagnosis to be made. Serum markers of HCC, when elevated, may raise the suspicion of hepatocellular differentiation even when it is not suspected based on examination of the cytologic and/or histologic biopsy specimen.
原发性肝肿瘤很少表现出肝细胞癌（HCC）和胆管癌的混合分化。对于这些联合性肝细胞-胆管癌（CHCC-C）的组织学标准尚未达成普遍共识。CHCC-C的细胞学描述很少见，然而，识别这种肿瘤类型可能具有一定的预后意义。
回顾了4例CHCC-C的临床及细胞组织学检查结果，包括组织化学和免疫组织化学研究。标本包括3例肝脏穿刺活检和1例胆管刷检标本。所有病例均经组织学、组织化学和免疫组织化学研究确诊为CHCC-C。
仅依靠细胞学涂片可靠诊断CHCC-C存在困难。然而，增加细胞块或芯针活检组织学材料，可作为组织化学和免疫组织化学研究的底物，有助于做出诊断。HCC的血清标志物升高时，即使根据细胞学和/或组织学活检标本检查未怀疑有肝细胞分化，也可能增加对肝细胞分化的怀疑。
