KL-6 mucin is a useful immunohistochemical marker for cholangiocarcinoma

This study aimed to clarify the clinical significance of the expression of KL-6 mucin, a type of MUC1, in primary liver cancer. Tissue specimens were collected from 21 patients with cholangiocarcinoma (CC), 78 with hepatocellular carcinoma (HCC), and 12 with combined hepatocellular and cholangiocarcinoma (cHCC-CC). Immunohistochemical analysis was done using a monoclonal antibody for KL-6 mucin as well as antibodies for Hep1 or CK7. KL-6 staining was positive in all the CC tissues examined, while it was not positive in any of the HCC tissues. Similar selectivity of KL-6 staining was also observed in the cHCC-CC specimens, and the cholangiocellular tissue could be clearly delineated by KL-6 staining. In contrast, 79.5% of HCC specimens and 25.0% of cHCC-CC specimens were positive for Hep1 in the hepatocellular tissues, while none of the CC or cHCC-CC specimens were positive in the cholangiocellular tissues. Staining for CK7 was positive in 95.2% of CC and 35.9% of HCC specimens, while 58.3 and 25.0% of cHCC-CC specimens displayed positivity for CK7 in the cholangiocellular and hepatocellular tissues, respectively. These results suggest that KL-6 may be a useful tumor marker for distinguishing CC from HCC. In addition, the high selectivity of KL-6 for cholangiocallular tissue may help to provide information for deciding the clinical strategy in cHCC-CC patients.     

Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors

BACKGROUND: Tumors with combined hepatocellular and cholangiocellular features are well known histopathologically but their clinical behavior is poorly understood. The objectives of the current study were to define the demographic profile of the patients in whom these uncommon tumors occur and to evaluate treatment outcome in comparison with that in patients with either hepatocellular carcinoma (HCC) or peripheral cholangiocarcinoma (CC) alone. METHODS: Twenty-seven patients with combined tumors were identified from a prospective database. Pathologic specimens were analyzed to confirm the diagnosis. Demographics, clinical data, and survival were analyzed. Outcome after resection was compared with that of patients with CC and with a matched group of patients with HCC. RESULTS: The gender distribution of the combined tumors (52% men and 48% women) was intermediate between HCC (67% men and 33% women) and CC (30% men and 70% women) (P = 0.03). The incidence of positive hepatitis B or C serology and cirrhosis was similar in patients with combined tumors and those with CC (15% and 0% vs. 13% and 4%, respectively); similarly, patients of Asian heritage constituted 7% and 9%, respectively, of the patients with these tumors. By contrast, cirrhosis (41%) and positive hepatitis serology (56%) were far more common in patients with HCC, and 19% of these patients were of Asian heritage. Twenty-one of 27 patients with combined tumors (78%) underwent resection. All 6 patients with combined tumors that were not amenable to resection died of disease within 18 months. After resection, the 5-year survival was lowest in patients with combined tumors (24%) but was not significantly different from that in patients with CC (33%) or HCC (37%). The liver was the most common site of recurrence in all three groups. CONCLUSIONS: The demographic and clinical features of patients with combined tumors were most similar to those of patients with CC. Most important, combined tumors were not found to be associated with chronic liver disease; consequently, the resectability rate was higher for these tumors than typically is reported for HCC. Resection was associated with long-term survival in some patients, but recurrent hepatic disease was common. The presence of cholangiocellular differentiation appeared to worsen the prognosis when compared with pure HCC, although this difference did not reach statistical significance.     

CLINICOPATHOLOGIC FEATURES AND DIAGNOSISOF COMBINED HEPATOCELLULAR ANDCHOLANGIOCARCINOMA

ＣＬＩＮＩＣＯＰＡＴＨＯＬＯＧＩＣＦＥＡＴＵＲＥＳＡＮＤＤＩＡＧＮＯＳＩＳＯＦＣＯＭＢＩＮＥＤＨＥＰＡＴＯＣＥＬＬＵＬＡＲＡＮＤＣＨＯＬＡＮＧＩＯＣＡＲＣＩＮＯＭＡＬｕＪｉａｎｐｉｎｇ路建平；ＣａｉＷｅｉｍｉｎ蔡为民；ＨａｙａｓｈｉＫｅｉｋｉ１林肇辉...     

Clinical characteristics of hepatocellular carcinoma in elderly patients

The incidence of hepatocellular carcinoma (HCC) in elderly patients in Japan has been on the increase. The aim of the present study was to evaluate the impact of aging on the clinicopathological findings and the survival of HCC patients. A total of 624 patients with HCC were examined in this study. The patients were classified according to their age at the time of diagnosis: one group comprised younger patients (<75 years; n=544) and the second comprised elderly patients [(≥75 years; n=80, (12%)]. Results showed that there were significantly more female patients (younger:elderly, 22:36; p=0.005), normal livers (younger:elderly, 0.3:6%; p=0.0002), non-viral HCC (younger:elderly, 11:31%; p<0.001) and solitary tumors (younger:elderly, 53:76%; p=0.0008) in the elderly group. Five out of seven (71%) non-B non-C (NBNC) HCC patients who developed HCC in the normal liver were elderly patients. Survival between the younger and elderly HCC groups was not significantly different (younger:elderly, 4.38:3.45 years; p=0.665). Additionally, elderly HCC patients had fewer tumors, more mild underlying liver damage, and more frequent NBNC HCC. Their prognosis was not necessarily poorer than that of the younger HCC patients. Additionally, it appears that elderly patients develop HCC even without fibrosis. Therefore, aging may be a factor affecting hepatocarcinogenesis.     

Diagnostic utility of the HepPar1 antibody to differentiate hepatocellular carcinoma from metastatic carcinoma in fine-needle aspiration samples

BACKGROUND: The cytopathologic distinction between hepatocellular carcinoma (HCC) and metastatic carcinoma (MC) in the liver can be problematic, especially in patients with poorly differentiated HCC, in whom a trabecular pattern, bile production, and Mallory bodies may not be apparent on small fine-needle aspiration (FNA) samples. HepPar1 (OCH1E5) is a monoclonal antibody specifically developed to react with hepatocytes. It rarely reacts with bile duct and nonparenchymal liver cells. METHODS: FNA samples (cell blocks) from 75 liver tumors were selected. These included 50 moderate to poorly differentiated HCC cases, 5 cholangiocarcinoma (CC) cases, and 20 MC cases (4 from the breast, 4 from the stomach, 4 from the pancreas, and 8 from the colon). Immunohistochemical staining for HepPar1 was performed to differentiate HCC from MC. RESULTS: The HepPar1 antibody was positive in 50 of 50 HCC cases (100%). The positivity was cytoplasmic, diffuse, and granular. All 5 cases of CC were found to be negative (0%). Although focal positivity within tumor cells was noted in one case, cytologically these were entrapped normal hepatocytes between the tumor cells. In addition, 3 of 20 MC cases (15%) also were positive for HepPar1. All three cases originated from gastric primary tumors and exhibited diffuse, granular cytoplasmic staining. CONCLUSIONS: The results of the current study demonstrate that HepPar1 is an effective marker with which to differentiate between HCC and CC and/or MC. HepPar1 was found to demonstrate 100% positivity in HCC cases, compared with 0% and 15% positivity, respectively, in CC and MC cases. In addition, HepPar1 is extremely helpful in limited tissue samples from FNA. Although 15% of the MC cases in the current study were found to be positive, with the help of clinical correlation and other immunohistochemical stains a definite diagnosis could be rendered. Potential pitfalls include residual benign hepatocyte staining within a non-HCC malignancy, as was observed in one of the CC cases in the current study.     

乙酰肝素酶mRNA在肝癌组织中的表达及其临床意义

目的　探讨乙酰肝素酶 (HPSE)mRNA在肝癌组织中的表达及其与肝癌临床病理特征和血管生成的关系。方法　以逆转录 -聚合酶链反应 (RT PCR)检测HPSEmRNA在 5 1例原发性肝细胞癌组织中的表达 ,以Ⅷ因子抗体免疫组织化学染色检测肝癌组织的微血管密度 (MVD)。结果　 5 1例肝癌组织中有 2 5例 (4 9.0 % )HPSEmRNA表达阳性。直径≥ 3cm的肝癌组织中 ,HPSE的表达阳性率(6 3.6 % ,2 1/33)明显高于直径 <3cm的肝癌组织 (2 2 .2 % ,4 /18) ,差异有非常显著性 (P <0 .0 1)。高侵袭性肝癌组织中 ,HPSE表达阳性率 (70 .0 % ,14 /2 0 )明显高于中等侵袭性 (4 6 .7% ,7/15 )和低侵袭性肝癌组织 (2 5 .0 % ,4 /16 ;P <0 .0 5 )。微血管密度高的肝癌组织中HPSE表达阳性率 (6 2 .5 % ,2 0 /32 )明显高于微血管密度低的肝癌组织 (2 6 .3% ,5 /19;P <0 .0 5 )。结论　HPSEmRNA表达对肝癌的生长、侵袭和血管生成具有重要作用。     

Application of Joint Detection of AFP,CA19-9, CA125 and CEA in Identification and Diagnosis of Cholangiocarcinoma

Objective: To explore the application of joint detection of serum AFP, CA19-9, CA125 and CEA in identificationand diagnosis of cholangiocarcinoma (CC). Materials and Methods: The levels of serum AFP, CA19-9, CA125and CEA of both 30 patients with CC and 30 patients with hepatocellular carcinoma (HCC) were assessed.Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic effects of single and jointdetection of those 4 kinds of tumor markers for CC. Results: The levels of serum CA19-9, CA125 and CEAin CC patients were higher than that in HCC patients,whereas that of serum AFP was significantly lower s.The area under ROC curve of single detection of serum AFP, CA19-9, CA125 and CEA were 0.05, 0.86, 0.84and 0.83, with the optimal cutoff values of 15.4 ng/ml, 125.1 U/ml, 95.7 U/ml and 25.9 ng/ml, correspondingly,and the percentage correct single diagnosis was <79%. With joint detection, the diagnostic effect of combinedAFP, CA19-9, CA125 and CEA was the highest, with an area under the ROC curve of 0.94 (95%CI 0.88~0.99).Conclusions: Single detection of serum CA19-9, CA125 and EA is not meaningful. The sensitivity, specificity,the rate of correct diagnosis and the area under ROC curve of joint detection of AFP, CA19-9, CA125 and CEAare highest, indicating that the joint detection of these 4 tumor markers is of great importance in the diagnosisof CC.     

Clinicopathological significance of loss of heterozygosity on chromosome 13q in hepatocellular carcinoma.

PURPOSE: Allelic loss is the most frequently genetic alteration found in hepatocellular carcinoma (HCC). Previous genome-wide studies have indicated that chromosome 13q is one of the most frequently affected chromosomes. However, reports on detailed deletion mapping as well as detailed clinicopathological correlation are scanty. EXPERIMENTAL DESIGN: We performed high-density allelotyping on chromosome 13q in HCC from 60 patients and investigated the correlation between allelic losses on chromosome 13q and the clinicopathological features. RESULTS: Allelic loss at one or more of the 29 microsatellite markers was found in 28 (47%) of the 60 HCCs. Allelic losses were more frequently found in tumors with larger size or in tumors at more advanced tumor stages (P = 0.015 and 0.012, respectively). These two clinicopathological features were also significantly associated with the accumulation of allelic losses in terms of fractional allelic loss index (P = 0.028 and 0.018, respectively). In addition, subchromosomal regions located at 13q12.3-14.1 and 13q32 were found to be significantly associated with advanced tumor stages and larger tumor size, respectively (P = 0.008 and 0.007). CONCLUSIONS: The overall findings suggested that allelic losses on 13q might play an important role in contributing to a more aggressive tumor behavior. Putative tumor suppressor genes might be harbored at 13q12.3-14.1 and 13q32, and inactivation of these genes via allelic losses might enhance tumor progression in HCC.     

肝细胞癌8号染色体微卫星变异的研究(英文)

目的探讨肝细胞癌(HCC)8号染色体微卫星变异的特点及其与临床病理的相关性。方法采用 MegaBACE 500型自动化 DNA 分析系统,对56例 HCC 中8号染色体上10个微卫星的杂合性缺失(LOH)、微卫旱不稳定性(MSI)和等位基因失衡(AI)3种变异特征进行检测。结果 56例 HCC 在8号染色体上10个基因座发生 LOH 的总频率为66.1%(37/56),MSI 的频率为12.5%(7/56),AI 的频率为19.6%(11/56)。LOH 以 D8S261最高为53.5%(23/43),其次为 D8S1721(52.5%)和 D8S1771(52.5%)。D8S277基因座,血清HBsAg 阳性患者的 LOH 频率显著高于 HBsAg 阴性者(P<0.01),D8S261、D8S298和 D8S1733基因座,血清 HBsAg 阴性患者的 LOH频率显著高于 HBsAg 阳性者(P<0.01);D8S298和 D8S1771基因座.肿瘤直径>3cm 的 LOH 率明显高于≤3cm 组(P<0.05和 P<0.01);在 D8S1721基因座,无包膜或包膜不完整的肿瘤的 LOH 显著高于包膜完整的肿瘤(P<0.01);D8S298和 D8S1771基因座,肝内转移者的 LOH 明显高于无肝内转移者(P<0.05)。MSI 和 AI 与 HCC 临床病理学特点无明显相关性。结论 HCC 的8号染色体上存在广泛的微卫星变异,其中以代表肿瘤抑制基因路径的 LOH 方式在 HCC 的发生和发展过程中起重要作用,代表错配修复基因路径的 MSI 的作用次之。特定基因座的 LOH 与临床和病理学参数有一定的相关性。     

Clinicopathologic features of poorly differentiated hepatocellular carcinoma

BACKGROUND AND OBJECTIVES: Clinicopathologic features of poorly differentiated hepatocellular carcinoma (HCC) have not been elucidated. The purpose of this study was to clarify the characteristics of poorly differentiated HCC in hepatectomized patients. METHODS: From 1986 to 2001, 354 HCC patients underwent curative hepatectomy in our institution and were prospectively followed. Histological examinations revealed 43 well-differentiated HCC tumors, 273 moderately differentiated HCC tumors, and 38 poorly differentiated HCC tumors. Clinicopathologic factors and outcomes after hepatectomy were compared statistically. RESULTS: Only serum alpha-fetoprotein level was significantly different in the poorly differentiated HCC group from that in the moderately differentiated HCC group preoperatively (P=0.0001). Although there were no significant differences between overall survival rates or between disease-free survival rates in the three groups, distant metastasis within 2 years after hepatectomy occurred more frequently in the poorly differentiated HCC group (21%) than in the well-differentiated HCC group (2%) (P=0.011) or moderately differentiated HCC group (8%) (P=0.018). Distant metastasis occurred in about 40% of patients in the poorly differentiated HCC group with tumor size greater than 3 cm. CONCLUSIONS: Poorly differentiated HCC tumors larger than 3 cm are already of advanced stage representing distant metastasis in the early period after hepatectomy.     

Hepatocellular carcinoma and liver tumors in South African children: a case for increased prevalence

BACKGROUND: The high regional incidence of hepatocellular carcinoma (HCC) in South Africa also may be present in children of the region, although the link to hepatitis B (HBV) appears less clear. The objective of this study was to assess the incidence and probable causes of HCC in South African children. METHODS: Data were obtained from seven participating pediatric oncology units and from the tumor registry to review hepatic tumors in children in South Africa. RESULTS: One hundred ninety-four children (ages 0-14 years) presented with malignant primary hepatic tumors (1988-2003). One hundred twelve tumors (57%) were hepatoblastoma (HB), 68 tumors (35%) were hepatocellular carcinoma (HCC) (including 9 patients with the fibrolamellar variant, 6 of which occurred in black children), 10 tumors (5%) were sarcoma of the liver, and 4 tumors were lymphoma. The ratio of HB to HCC (1.67) was markedly lower compared with other reports, suggesting a greater prevalence of HCC. Correlation with population statistics indicated an incidence of 1.066 malignant liver tumors per year per 10(6) children age < 14 years (HB, 0.61 per 10(6) children; HCC, 0.39 per 10(6)). Two-thirds of patients with HCC were positive for HBV surface antigen (HBsAg), and HCC occurred mostly in black African patients (93%). The mean age of onset was 1.47 years for HB and 10.48 years for HCC. A preponderance of males (3.5:1.0) was noted in the HBsAg-positive group that was not reflected elsewhere. Serum alpha-fetoprotein (AFP) levels were raised both in patients with HB (100%; most AFP levels were very high) and in patients with HCC (69%), although 15% of patients with HCC had low or normal AFP levels. CONCLUSIONS: It appeared from the current results that HCC is more prevalent among children in South Africa compared with the children in more developed countries, although their rates were lower that the rates noted in adults. A collaborative approach will be required to improve their diagnosis and management.     

Tumeurs des voies biliaires: difficultés et pièges diagnostiques en anatomie pathologique

Malignant tumors of the biliary tree or cholangiocarcinoma (CC) are tumors developed at the expense of the normal epithelial cells of the biliary tract. They are the second primary malignant tumors after liver hepatocellular carcinoma (HCC). OMS classification 2010 defines two groups of CC according to their anatomical location in the biliary tree: intrahepatic CC or peripheral CC, which develop from small intrahepatic biliary duct beyond the second segmentation, and extrahepatic CC comprising hilar CC and tumors from common hepatic duct. In 1992, amacroscopic classification of CC was elaborated by the ??Liver Study Group of Japan?? based on tumor growth criteria. It defines three types: the ??massforming type??, the ??periductal infiltrating type?? and the ??intraductal growth?? type. The ??massforming?? type is most often represented by peripheral CC in which main differential diagnoses are HCC, metastases of adenocarcinoma and hepatocholangiocarcinoma. The extrahepatic CC is most often represented by the ??periductalinfiltrating?? type and is clinically revealed by an obstruction in the bile ducts. Themain role of the pathologist in this case is to establish the malignant nature of the stenosis. Biliary cytology plays an important role in the differential diagnosis but remains a very low sensitive technique withmany false-negative cases.     

双表型肝细胞癌新亚型的临床病理学研究进展

双表型肝细胞癌（dual-phenotype hepatocellular carcinoma，DPHCC）是近年报道的肝细胞癌（hepatocellular carcinoma，HCC）的一种新亚型，以组织学上为典型的肝细胞癌但同时表达肝细胞癌和肝内胆管癌（intrahepatic cholangiocarcinoma，ICC）的基因标志物为特征，因其具有HCC和ICC的双重生物学行为，恶性程度更高，临床预后差，因而正确诊断十分重要。CK19是DPHCC诊断的重要标志物之一，可以通过多种途径参与DPHCC的发生和恶性生物学行为的调控。本文拟从DPHCC的临床病理特点、免疫组织化学标记、组织起源发生等方面对DPHCC的研究进展进行综述。      

Combined hepatocellular andcholangiocarcinoma originating fromthe same clone：a pathomolecular evidence-based study

Background:Combined hepatocellular and cholangiocarcinoma (CHC) is a unique subtype of liver cancer com?prising both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC); however, its cellular origin remains unclear. The purpose of this study was to investigate the clinicopathologic features and the clonal relation?ship between HCC and ICC in 34 patients with CHC. Methods:The clinicopathologic features and prognosis of the 34 CHC patients were compared with those of 29 patients with separated HCC and ICC (SHC). Loss of heterozygosity (LOH) at 10 highly polymorphic microsatellite markers was detected in 16 CHC and 10 SHC tissues for determination of the clonal origin of CHC. Expression of hepatocyte markers [hepatocyte paraffn 1 (Hep Par 1) and glypican 3 (GPC3)] and cholangiocyte markers [cytokeratin (CK)7 and 19] in tumor tissues was examined by immuno histochemical analysis. Results:In the 16 CHC specimens, the difference in LOH patterns between HCC and ICC was less than 30%, suggest?ing the same clonal origin of HCC and ICC. Consistent with this ifnding, immunohistochemical analysis revealed that hepatocyte markers (Hep Par 1 and GPC3) and cholangiocyte markers (CK7 and CK19) were simultaneously expressed in both the HCC and ICC components in 52.9% of CHC specimens, suggesting that the two components shared a similar phenotype with hepatic progenitor cells (HPCs). On the contrary, in all 10 SHC cases, the difference in LOH patterns between the HCC and ICC components was greater than 30%, suggesting different clonal origins of HCC and ICC. Overall survival and disease?free survival were shorter for patients with CHC than for patients with SHC (P<0.05). Conclusions:Our results suggest that the HCC and ICC components of CHC may originate from the same clone, hav?ing the potential for dual?directional differentiation similar to HPCs. CHC tended to exhibit the biological behaviors of both HCC and ICC, which may enhance the inifltrative capacity of tumor cells, leading to poor clinical outcomes for patients with CHC.     

肝细胞癌患者血清脂肪酸合成酶的表达水平及其临床意义

目的:分析脂肪酸合成酶(fatty acid synthase，FASN)在肝细胞癌患者血清中的表达情况及与肿瘤病理特征的关系，以探讨FASN在肝癌诊断及治疗中的意义。方法:选取经过临床病理检查证实诊断的60例肝细胞癌患者为研究组，另选30名健康志愿者为对照组。采用酶联免疫吸附法(enzyme-linked immunosorbent assay，ELISA)检测血清FASN水平，分析肝细胞癌患者血清FASN表达情况与其临床病理特征的关系。结果:ELISA结果显示FASN在肝细胞癌患者血清中的表达均明显上调，研究组FASN水平为（36.83±10.52）mg/L，对照组FASN水平为（11.37±7.21）mg/L，差异有统计学意义(P<0.05)；FASN表达水平与肝癌患者临床病理特征的关系分析显示FASN在血清中高表达可能与肝癌的转移有关；FASN和AFP联合检测有可能提高肝癌的早期诊断率。结论:FASN有可能作为新的生物标志物应用于肝癌的预测转移和早期诊断，并可能作为防治肝癌的分子标靶之一。     

去唾液酸糖蛋白受体 2 基因在肝细胞性肝癌中的表达及意义

目的检测去唾液酸糖蛋白受体2（asialoglycoprotein receptor 2,ASGR2）基因在肝细胞性肝癌（hepatocellular carcinoma,HCC）中的表达水平,探讨ASGR2在HCC发生、发展中的作用和意义。方法以RT-PCR法检测55例HCC患者、55例非肝癌的其他肿瘤患者和33例非肿瘤的其他疾病对照患者外周血液中ASGR2基因的表达水平,并分析其意义。结果肝癌组和非肝癌的其他肿瘤组患者血液中ASGR2基因阳性表达率分别为85．5％、65．5％,两组差异有统计学意义（P〈0．05）,肝癌组和非肿瘤的其他疾病对照组ASGR2基因阳性表达率分别为85．5％、78．8％,两组差异无统计学意义（P〉0．05）,ASGR2基因在3组患者外周血液中的表达水平有明显差异（P〈0．05）。ASGR2基因的表达与HCC患者的性别、年龄、AFP、肝硬化、肿瘤家族史等临床病理特征均无统计学意义（P〉0．05）。结论ASGR2基因的表达水平可能与HCC发生、发展有关,检测ASGR2的水平有望作为HCC早期发病的预测指标。     

跨膜4超家族成员1在原发性肝细胞癌组织中的表达及其对患者预后的影响

目的：探讨跨膜4超家族成员1（TM4SF1）在原发性肝细胞癌（HCC）组织中的表达及其与HCC患者预后的关系。方法：用免疫组织化学方法检测TM4SF1在120例HCC组织和相应癌旁组织,以及30例非恶性肿瘤患者正常肝组织（正常对照组）中的表达,并分析其与HCC患者临床病理指标及预后的关系。结果：TM4SF1在肝癌组织中的表达明显高于癌旁组织及正常对照肝组织（P均 < 0.01）。TM4SF1在甲胎蛋白（AFP）高水平组、有淋巴结转移组、有门静脉癌栓（PVTT）组、临床TNM分期Ⅲ-Ⅳ期组、分化程度低-未分化组、术后转移组、复发组的表达分别高于AFP低水平组、无淋巴结转移组、无PVTT组、Ⅰ-Ⅱ期组、高-中分化组、术后无转移组、无复发组（P均 < 0.05）。TM4SF1高表达组的无瘤生存期和总生存期明显短于低表达组（P均 < 0.01）。TM4SF1高表达、PVTT、TNM分期Ⅲ-Ⅳ期是无瘤生存期和总生存期的独立风险因素（P均 < 0.05）。结论：TM4SF1在HCC中高表达,并参与HCC发生、发展过程。TM4SF1的表达水平可能作为判断HCC预后的指标。     

Clinicopathological characteristics of patients with hepatocellular carcinoma after hepatectomy: relationship with status of viral hepatitis

BACKGROUND AND OBJECTIVES: Viral hepatitis may modulate the status of liver dysfunction, tumor biology, and postoperative course in patients with hepatocellular carcinoma (HCC). METHODS: To determine the characteristics of HCC in different types of viral hepatitis, we conducted a comparative analysis of clinicopathological features and outcomes in 243 Japanese HCC patients following hepatic resection. Patients were divided into four groups; non-B-non-C group, hepatitis B (HBV) group, hepatitis C (HCV) group, and co-infection with HB, and HC (HBCV) group. RESULTS: Liver function was worst and prevalence of cirrhosis was highest in HBCV group than in compare to HBV and non-B-non-C group. The prevalence rates of intrahepatic metastasis, tumor vascular involvement, and low curability in HBCV group were higher than in the other groups. Uncontrolled ascites and hepatic failure were significantly more common in HBCV group than other groups. The disease-free and overall survival rates of non-B-non-C group were better than those of the other groups; both survival rates were the worst in HBCV group than the other groups. CONCLUSIONS: HCC patients with co-infection of HBV and HCV had poorer liver function and more advanced tumors compared with the other groups. This might explain the poor prognosis of such patients.     

硬化型肝细胞癌临床病理特征分析

目的:探讨硬化型肝细胞癌的临床病理学特征。方法:收集2例硬化型肝细胞癌患者的临床资料,结合文献复习硬化型肝细胞癌的诊断和鉴别诊断要点及发病机制。结果:2例患者,1例男性,64岁,因反复上腹部疼痛1月余就诊;1例女性,52岁,因体检发现右肝占位就诊。大体可见2例肿物均位于肝外周区,呈结节状,与周围境界尚清。镜下示肿瘤组织内含有丰富的纤维性间质,肿瘤细胞呈梁状、条索状及巢状分布其中,瘤细胞胞浆嗜酸性,部分透明,核呈圆形及卵圆形,可见核仁及病理性核分裂象。免疫组化检测结果显示肿瘤细胞弥漫表达CK8、CK18、Ep-CAM,部分表达GPC3、Arginase-1、CK7、CK19、HepPar1,而CA19-9、CD10、CK20、CEA均为阴性,周围肝细胞HBsAg部分阳性,Ki-67增殖指数约10%。结论:硬化型肝细胞癌是一种罕见的肝细胞癌亚型,具有较独特的病理形态学特征及分子遗传学机制,需与纤维板层型肝细胞癌、肝内胆管细胞癌、转移癌等相鉴别。