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目的探讨混合型肝癌的临床病理特征,以提高其诊断的准确性。方法分析2002—2012年间本院收治的12例混合型肝癌的临床表现、病理形态、免疫组化标记结果。结果本组12例患者,男性8例,女性4例,年龄36～77岁(平均53.9岁)。10例伴有病毒性肝炎,8例合并肝硬化和脉管侵犯。肿瘤组织内可见不同比例的肝细胞癌和胆管细胞癌存在于同一肿块内或不同部位,肝细胞性肝癌样区域可呈小梁状结构、假腺样型、腺泡型和实性型结构,癌细胞有丰富的嗜酸性胞质,胞核圆形,核仁易见;移行区癌细胞体积较小呈卵圆形,核深染而胞质较少,排列呈梁状、实性巢团或束状,间质纤维化明显。肝内胆管细胞癌(ICC)癌细胞胞质淡染或伊红染,有/无黏液分泌,排列成大小不等的腺管或实性条索状结构,间质内纤维组织增生明显。结论混合型肝癌是一种同时包含肝细胞癌和胆管细胞癌病理组织特征的少见肝原发性恶性肿瘤,术前诊断比较困难,要结合患者病史、血清AFP、CA19-9水平和影像学资料,确诊主要依靠病理检查。治疗以完整手术切除为主。
Objective To investigate the clinicopathological features of hepatocellular carcinoma (HCC) in order to improve the diagnostic accuracy. Methods The clinical manifestations, pathomorphology and immunohistochemical results of 12 HCC patients admitted to our hospital from 2002 to 2012 were analyzed. Results The group of 12 patients, 8 males and 4 females, aged 36 to 77 years (mean 53.9 years). 10 patients with viral hepatitis, 8 patients with cirrhosis and vascular invasion. HCC and cholangiocarcinoma can be seen in tumor tissue in the same mass or in different sites. HCC hepatoma-like area can have trabecular structure, pseudohypoglactoid type, acinar and solid type structure, Cancer cells are rich in eosinophilic cytoplasm, round nucleus, nucleolus easy to see; transitional zone smaller cancer cells were oval, dark stained nuclear and less cytoplasmic, arranged in a beam-like, solid nest Or bundle, interstitial fibrosis significantly. Intrahepatic cholangiocarcinoma (ICC) cancer cell cytoplasm stained or Iraqi red dye, with / without mucus secretion arranged in different sizes of the duct or solid cord-like structure, interstitial fibrosis significantly. Conclusions Hepatocellular carcinoma (HCC) is a rare malignant primary liver tumor characterized by both hepatocellular carcinoma (HCC) and cholangiocarcinoma (HCC). Preoperative diagnosis is difficult. Combined with the patient’s history, serum AFP, CA19-9 levels and imaging data The diagnosis mainly depends on the pathological examination. Treatment is based on complete surgical resection.