Shiraishi M, Takushi Y, Simoji H, Oshiro T, Shinzato S, Tanigawa N, Kusano T, Muto Y
First Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
J Gastroenterol. 1998 Aug;33(4):593-6. doi: 10.1007/s005350050140.
Combined hepatocellular (HCC) and cholangiocellular carcinoma (CCC) (mixed carcinoma) is a rare subtype of primary hepatic carcinoma. We report a case of mixed carcinoma that developed in a non-cirrhotic liver, in a patient who was serologically negative for both hepatitis B and C viruses. A 65-year-old Japanese woman with a 25-year history of chronic rheumatoid arthritis had been treated with steroids and anti-inflammatory drugs, and was diagnosed by ultrasonography with an asymptomatic solitary tumor in the right lobe of the liver. On computed tomography scan and hepatic arteriography, the tumor was well enhanced by contrast medium in the early phase. Based on the findings of elevated serum alpha-feto protein (AFP, 245 ng/ml) and normal carcino-embryonic antigen (CEA, 2.6 ng/ml) levels, a preoperative diagnosis of hepatocellular carcinoma was made. Right lobectomy of the liver was performed on January 7, 1997. Histological examination showed that the resected tumor consisted of combined CCC cells and HCC cells in an intermingled form, with CCC being far more dominant than HCC. The tumor was therefore determined to be a combined carcinoma, subclassified as intermingled type. This case appears to indicate that mixed type carcinoma developed in a non-cirrhotic liver, with CCC being dominant; such a finding is extremely unusual, based on previously published reports.
肝细胞癌（HCC）和胆管细胞癌（CCC）合并存在（混合性癌）是原发性肝癌中一种罕见的亚型。我们报告一例在非肝硬化肝脏中发生的混合性癌病例，该患者乙肝和丙肝病毒血清学检测均为阴性。一名65岁的日本女性，有25年慢性类风湿关节炎病史，一直在接受类固醇和抗炎药物治疗，经超声检查诊断为肝脏右叶有一个无症状的孤立性肿瘤。在计算机断层扫描和肝动脉造影检查中，肿瘤在早期造影剂增强明显。根据血清甲胎蛋白（AFP，245 ng/ml）升高和癌胚抗原（CEA，2.6 ng/ml）水平正常的检查结果，术前诊断为肝细胞癌。1997年1月7日进行了肝脏右叶切除术。组织学检查显示，切除的肿瘤由CCC细胞和HCC细胞混合组成，其中CCC远比HCC占优势。因此，该肿瘤被确定为混合性癌，归类为混合型。根据以往发表的报告，该病例似乎表明混合型癌在非肝硬化肝脏中发生，且CCC占主导；这样的发现极为罕见。
