Combined hepatocellular carcinoma and cholangiocarcinoma (biphenotypic) tumors: clinical characteristics, imaging features of contrast-enhanced ultrasound and computed tomography.
Combined hepatocellular carcinoma and cholangiocarcinoma (biphenotypic) tumors: clinical characteristics, imaging features of contrast-enhanced ultrasound and computed tomography.
复制标题
DOI：
10.1186/s12885-016-2156-x
复制
发表时间：
2016-02-25
期刊：
影响因子：
3.8
通讯作者：
Yan XC
中科院分区：
文献类型：
--
作者：
Li R;Yang D;Tang CL;Cai P;Ma KS;Ding SY;Zhang XH;Guo DY;Yan XC
联合肝细胞胆管细胞癌是一种少见的原发肝脏恶性肿瘤，其临床和影像特点鲜为人知。本研究旨在通过对比增强超声(CEUS)和对比增强计算机体层摄影(CT)来明确CHCC-CC的人口学特征、影像特征。从2005年1月至2014年12月，纳入45例经手术病理证实的CHCC-CC患者，其中45例行术前CEU检查，43例同时行CT扫描。对这些患者的影像研究和临床资料进行了回顾。在本组病例中，CHCC-CC占所有原发性肝脏恶性肿瘤的1.6%。CHCC-CC患者的平均年龄为52.8岁(28-74岁)，88.9%(40/45)为男性。有肝硬化者35例(66.7%)，无肝硬化者20%(9/45)。甲胎蛋白(AFP)升高占62.2%(28/45)，糖类抗原19-9(CA19-9)升高占22.2%(10/45)。15.6%(7/45)的患者AFP和CA19-9同时升高。53.3%(24/45)的患者(CEUS)和30.2%(13/43)的CT发现类似于胆管细胞癌(CC)的强化模式。42.2%(19/45)的CEUS患者和58.1%(25/43)的CT患者的增强模式类似于肝细胞癌。在CEUS和CT上，表现为CC强化的肿瘤(27.9%，12/43)与表现为肝癌强化的肿瘤(44.2%，19/43)相似(p = 0.116)。51.1%(23/45)的患者CEUS和53.5%(23/43)的CT显示肿瘤标记物(AFP和CA19-9)同时升高或肿瘤标记物(AFP或CA19-9)升高与增强方式不一致，明显高于单独升高(p = 0.000)。CHCC-CC的临床特征与肝细胞癌相似。在CEUS和CT上，CHCC-CC肿瘤的强化模式与CC或肝细胞癌相似。肿瘤标志物(AFP和CA19-9)的同时升高和肿瘤标志物(AFP或CA19-9)的升高与CEUS或CT上假定的影像表现不一致，可能会导致更多的患者怀疑CHCC-CC的诊断。
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is an uncommon primary liver malignancy and little known about the clinical and imaging characteristics of cHCC-CC. We aim to define the demographics, imaging features of cHCC-CC on contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CT) in this study. From January 2005 to December 2014, 45 patients with pathologically proven cHCC-CC who underwent preoperative CEUS and 43 patients who had additional CT scan in our institution were included. A retrospective review of the imaging studies and clinical data in these patients was conducted. In our series, cHCC-CC accounted for 1.6 % of all primary liver malignancy. Mean age of patient with cHCC-CC was 52.8 year (range: 28–74 year) and 88.9 % (40/45) of patients were male. Thirty of forty five patients (66.7 %) had cirrhosis and 20 % (9/45) of patients had chronic hepatitis B without cirrhosis. Alpha--fetoprotein (AFP) was elevated in 62.2 % (28/45) of patients and carbohydrate antigen 19–9 (CA19-9) elevated in 22.2 % (10/45) of patients). Both AFP and CA19-9 were simultaneously elevated in 15.6 % (7/45) of patients. Enhancement pattern resembling cholangiocarcinoma (CC) was noted in 53.3 % (24/45) of patients (on CEUS and in 30.2 % (13/43) of patients at CT. Enhancement pattern resembling hepatocellular carcinoma (HCC) was observed in 42.2 % (19/45) of patients on CEUS and in 58.1 % (25/43) of patients at CT. The percentage of tumors showing CC enhancement pattern (27.9 %, 12/43) was comparable with that of tumors showing HCC enhancement pattern (44.2 %, 19/43) on both CEUS and CT (p = 0.116). Simultaneous elevation of tumor markers (AFP and CA19-9) or tumor marker elevation (AFP or CA19-9) in discordance with enhancement pattern on CEUS was demonstrated in 51.1 % (23/45) of patients and on CT in 53.5 % (23/43) of patients, which was significantly more than simultaneous elevation of tumor markers (AFP and CA19-9) alone (p = 0.000). The clinical characteristics of cHCC-CC are similar to those of HCC. The cHCC-CC tumors display enhancement patterns resembling CC or HCC in comparable proportion on both CEUS and CT. Combination of simultaneous elevation of tumor makers (AFP and CA19-9) and tumor mark elevation (AFP or CA19-9) in discordance with presumptive imaging findings on CEUS or CT may lead significantly more patients to be suspicious of the diagnosis of cHCC-CC.