Histologic characteristics and prognostic significance in small hepatocellular carcinoma with biliary differentiation - Subdivision and comparison with ordinary hepatocellular carcinoma
Histologic characteristics and prognostic significance in small hepatocellular carcinoma with biliary differentiation - Subdivision and comparison with ordinary hepatocellular carcinoma
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DOI：
10.1097/01.pas.0000213421.53750.0a
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发表时间：
2007-05-01
影响因子：
5.6
通讯作者：
Tsuneyoshi, Masazumi
中科院分区：
文献类型：
--
作者：
Aishima, Shinichi;Nishihara, Yunosuke;Tsuneyoshi, Masazumi
肝胆道分化的小肝癌的形态学特征和生物学行为及其组织发生尚不清楚。本研究将35例胆道分化的直径小于3cm的肝细胞癌（HCC）分为3组，1组[细胞角蛋白（CK） 19阴性/粘蛋白阴性]，2组（CK 19阳性/粘蛋白阴性），3组（CK 19阳性/粘蛋白阳性）。无胆道分化的hcc 61例作为对照。我们比较了这些肿瘤的组织学特征和术后结果。40%（14/35）、60%（21/35）和42.9%（15/35）的hcc伴胆道分化的形态学特征分别为：(1)形态中等的癌细胞，(2)明显的炎性细胞浸润，(3)间质结缔组织；神经细胞粘附分子和c-kit表达分别为25.7%（9/35）和8.6%（3/35）。1组肝外肿瘤术后复发率为0%(0/16)，2组为33.3%(3/9)，3组为40.0%(4/10)，普通hcc为8.2%（5/61）。3组患者的肿瘤相关生存期较普通hcc患者差，但1组、2组患者与普通hcc患者的生存期无差异。我们的研究结果表明，即使在小的HCC中也会发生胆道分化，产生黏液的癌细胞表明肿瘤具有侵袭性行为。中间癌细胞、炎性细胞浸润、间质结缔组织增生的结合很可能与HCC的胆道分化有关。
The morphologic characteristics and biologic behavior of small liver cancers with hepatic and biliary differentiation, and their histogenesis, remain unclear. In this study, 35 cases of hepatocellular carcinoma (HCC) smaller than 3 cm in diameter with biliary differentiation were divided into 3 groups, group 1 [cytokeratin (CK) 19-negative/mucin-negative], group 2 (CK 19-positive/mucin-negative), and group 3 (CK 19-positive/mucinpositive). Sixty-one HCCs without biliary differentiation were used as controls. We compared the histologic features of these tumors and the postoperative outcomes. Three morphologic features of HCCs with biliary differentiation were respectively observed in 40% (14/35), 60% (21/35), and 42.9% (15/35) as follows: (1) cancer cells with intermediate morphology, (2) prominent inflammatory cell infiltrate, (3) desmoplastic stroma; neural cell adhesion molecule and c-kit expression were noted in 25.7%(9/35) and 8.6%(3/35), respectively. Extrahepatic tumor recurrence after surgery occurred in 0% (0/16) of group 1, 33.3% (3/9) of group 2, 40.0% (4/10) of group 3, and 8.2% (5/61) of the ordinary HCCs. The tumor-related survival of group 3 patients was worse than that of patients with ordinary HCCs, but there were no differences between the survival of group 1, or group 2 patients and those with ordinary HCCs. Our results suggest that the biliary differentiation does occur even in small HCC, and a mucin-producing cancer cells indicates aggressive tumor behavior. The combination of intermediate cancer cells, inflammatory cell infiltrate, and desmoplastic stroma is likely to be related to the biliary differentiation of HCC.