アルコール性肝障害に発生した肝細胞癌と細胆管細胞癌よりなる混合型肝癌の1切除例
症例は75歳男性．大酒家．全身倦怠感を主訴に受診．血液生化学検査で，肝機能異常を認めた．HBs抗原とHCV抗体は陰性で，飲酒歴があることより，アルコール性肝障害と考えられた．また，腹部超音波検査で，肝S6に径約20 mmの結節性病変を認め，精査が行われた．腹部血管造影，CT等の画像診断で混合型肝癌が疑われ，平成21年8月に肝S6の部分切除が施行された．切除標本の肉眼所見では同一結節に，黄白色調で被膜を有する部分と白色調で被膜はなく，浸潤性に増殖する部分を認めた．病理組織学的に被膜を有する部分は索状配列をなす中分化型肝細胞癌であり，被膜のない部分は線維性間質を有し，異型に乏しい腺管が吻合するよう...
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| Published in | 肝臓 Vol. 51; no. 11; pp. 664 - 673 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本肝臓学会
2010
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0451-4203 1881-3593 |
| DOI | 10.2957/kanzo.51.664 |
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| Abstract | 症例は75歳男性．大酒家．全身倦怠感を主訴に受診．血液生化学検査で，肝機能異常を認めた．HBs抗原とHCV抗体は陰性で，飲酒歴があることより，アルコール性肝障害と考えられた．また，腹部超音波検査で，肝S6に径約20 mmの結節性病変を認め，精査が行われた．腹部血管造影，CT等の画像診断で混合型肝癌が疑われ，平成21年8月に肝S6の部分切除が施行された．切除標本の肉眼所見では同一結節に，黄白色調で被膜を有する部分と白色調で被膜はなく，浸潤性に増殖する部分を認めた．病理組織学的に被膜を有する部分は索状配列をなす中分化型肝細胞癌であり，被膜のない部分は線維性間質を有し，異型に乏しい腺管が吻合するように増殖する細胆管癌の所見であった．細胆管癌成分には免疫組織学的にCK7，19，EMAが強陽性で，一部にHepPar1，AFPが陽性であった．本症例は肝細胞癌と細胆管癌から構成される原発性肝癌と考えられ，混合型肝癌の組織発生解明に有用な症例と思われる． |
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| AbstractList | 症例は75歳男性．大酒家．全身倦怠感を主訴に受診．血液生化学検査で，肝機能異常を認めた．HBs抗原とHCV抗体は陰性で，飲酒歴があることより，アルコール性肝障害と考えられた．また，腹部超音波検査で，肝S6に径約20 mmの結節性病変を認め，精査が行われた．腹部血管造影，CT等の画像診断で混合型肝癌が疑われ，平成21年8月に肝S6の部分切除が施行された．切除標本の肉眼所見では同一結節に，黄白色調で被膜を有する部分と白色調で被膜はなく，浸潤性に増殖する部分を認めた．病理組織学的に被膜を有する部分は索状配列をなす中分化型肝細胞癌であり，被膜のない部分は線維性間質を有し，異型に乏しい腺管が吻合するように増殖する細胆管癌の所見であった．細胆管癌成分には免疫組織学的にCK7，19，EMAが強陽性で，一部にHepPar1，AFPが陽性であった．本症例は肝細胞癌と細胆管癌から構成される原発性肝癌と考えられ，混合型肝癌の組織発生解明に有用な症例と思われる． |
| Author | 佐田, 通夫 今村, 真大 城野, 智毅 馬場, 真二 矢野, 博久 梶原, 雅彦 中島, 収 田口, 順 高木, 浩史 石井, 邦英 安倍, 弘彦 |
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| References | 10) Komuta M, Spee B, Borght SV, et al. Clinicopathological study on cholangiolocellular carcinoma suggesting hepatic progenitor cell origin. Hepatology 2008; 47: 1544-1556 2) Taguchi J, Nakashima O, Tanaka M, et al. A clinicopathological study on combined hepatocellular and cholangiocarcinoma. J Gastroenterol Hepatol 1996; 11: 758-764 12) L'Esperance E. Atypical hemorrhagic malignant hepatoma. J Med Research 1915; 32: 225-249 15) Allen RA, Lisa JR. Combined liver cell and bile duct carcinoma. Am J Patholo 1949; 25: 647-655 3) Tikoo SK, Zee SY, Obiekwe S, et al. Combined Hepatocellular-cholangiocarcinoma A histopathologic, immunohistochemical, and in situ hybridization study. Am J Surg Pathol 2002; 26: 989-997 18) Edmondson HA, Peters RL. Neoplasm of the liver. In: Disease of the liver, Edited by L Schiff, ER Schiff, 5th edn., JB Lippincott, Philadelphia, 1982, p1101-1148 8) Steiner PE, Higginson J. Cholangiolocellular carcinoma of the liver. Cancer 1959; 12: 753-759 24) Eyken PV, Sciot R, Callea F, et al. The development of the intrahepatic bile ducts in man: A keratin-immunohistochemical study. Hepatology 1988; 8: 1586-1595 16) Goodman ZD, Ishk KG, Langloss JM, et al. Combined hepatocellular cholangiocarcinoma. A histologic and immunohistochemical study. Cancer 1985; 55: 124-135 25) Aishima S, Nishihara Y, Kuroda Y, et al. Histologic characteristics and prognostic significance in small hepatocellular carcinoma with biliary differentiation. Am J Surg Pathol 2007; 31: 783-791 27) Sasaki M, Nakanuma Y, Samuel BH, et al. Cholangiocarcinomas arising in cirrhosis and combined hepatocellular-cholangiocellular carcinomas share apomucin profiles. Am J Clin Pathol 1998; 109: 302-308 4) Jarnagin WR, Weber S, Tickoo SK, et al. Combined hepatoellular and cholangiocarcinoma. Cancer 2002; 94: 2040-2046 21) Nishie A, Yoshimitsu K, Asayama Y, et al. Detection of combined hepatocellular and cholangiocarcinomas on enhanced CT: comparison with histologic findings. AJR 2005; 184: 1157-1162 9) Theise ND, Saxena R, Bernard C, et al. The canals of hering and hepatic stem cells in humans. Hepatology 1999; 30: 1425-1433 14) Gibson JB. In: Histological typing of tumors of the liver biliary tract and pancreas, World Health Organization, Geneva, 1978 26) Kozaka K, Sasaki M, Fujii T, et al. A subgroup of intrahepatic cholangiocarcinoma with an infiltrating replacement grouth pattern and resemblance to reactive proliferating bile ductules: 'bile ductular carcinoma'. Histopathology 2007; 51: 390-400 7) Zhang F, Chen X-P, Zhang W, et al. Combined hepatocellular cholangiocarcinoma originating from hepatic progenitor cells: immunohistochemical and double-fluorescence immunostaining evidence. Histopathology 2008; 52: 224-232 13) Koster H, Kasaman LP. Primary duplex liver carcinoma. Am J Surg 1932; 17: 237-241 20) Fukukura Y, Taguchi J, Nakashima O, et al. Combined hepatocellular and cholangiocarcinoma: correlation between CT findings and clinicopathological features. J Comput Assist Tomogr 1997; 21: 52-58 23) Sasaki M, Tsuneyama K, Ishikawa A, et al. Intrahepatic cholangiocarcinoma in cirrhosis presents granulocyte and granulocyte-mcrophage colony stimulating factor. Human Pathol 2003; 34: 1337-1344 28) Theise ND, Nimmakayalu M, Gardner R, et al. Liver from bone marrow in humans. Hepatology 2000; 32: 11-16 22) Motosugi U, Ichikawa T, Nakajima H, et al. Cholangiolocellular carcinoma of the liver: imaging findings. J Compute Assist Tomogr 2009; 33: 682-688 1) 日本肝癌研究会. 「臨床・病理 原発性肝癌取扱い規約第5版」 金原出版, 2008 11) Wells HG. Primary carcinoma of the liver. Am J Sci 1903; 126: 403-417 5) Ng IO, Shek TW, Nicholls J, et al. Combined hepatocellular-cholangiocarcinoma: a clinicopathological study. J Gastroenterol Hepatol 1998; 13: 34-40 6) Koh KC, Lee H, Choi MS, et al. Clinicopathologic features and prognosis of combined hepatocellular cholangiocarcinoma. Am J Surg 2005; 189: 120-125 19) Shiota K, Taguchi J, Nakasima O, et al. Clinicopathologic study on cholangiolocellular carcinoma. Oncol Rep 2001; 8: 263-268 17) 日本肝癌研究会. 第18回全国原発性肝癌追跡調査報告（2004～2005） |
| References_xml | – reference: 7) Zhang F, Chen X-P, Zhang W, et al. Combined hepatocellular cholangiocarcinoma originating from hepatic progenitor cells: immunohistochemical and double-fluorescence immunostaining evidence. Histopathology 2008; 52: 224-232 – reference: 14) Gibson JB. In: Histological typing of tumors of the liver biliary tract and pancreas, World Health Organization, Geneva, 1978 – reference: 6) Koh KC, Lee H, Choi MS, et al. Clinicopathologic features and prognosis of combined hepatocellular cholangiocarcinoma. Am J Surg 2005; 189: 120-125 – reference: 2) Taguchi J, Nakashima O, Tanaka M, et al. A clinicopathological study on combined hepatocellular and cholangiocarcinoma. J Gastroenterol Hepatol 1996; 11: 758-764 – reference: 17) 日本肝癌研究会. 第18回全国原発性肝癌追跡調査報告（2004～2005） – reference: 27) Sasaki M, Nakanuma Y, Samuel BH, et al. Cholangiocarcinomas arising in cirrhosis and combined hepatocellular-cholangiocellular carcinomas share apomucin profiles. Am J Clin Pathol 1998; 109: 302-308 – reference: 4) Jarnagin WR, Weber S, Tickoo SK, et al. Combined hepatoellular and cholangiocarcinoma. Cancer 2002; 94: 2040-2046 – reference: 12) L'Esperance E. Atypical hemorrhagic malignant hepatoma. J Med Research 1915; 32: 225-249 – reference: 18) Edmondson HA, Peters RL. Neoplasm of the liver. In: Disease of the liver, Edited by L Schiff, ER Schiff, 5th edn., JB Lippincott, Philadelphia, 1982, p1101-1148 – reference: 21) Nishie A, Yoshimitsu K, Asayama Y, et al. Detection of combined hepatocellular and cholangiocarcinomas on enhanced CT: comparison with histologic findings. AJR 2005; 184: 1157-1162 – reference: 19) Shiota K, Taguchi J, Nakasima O, et al. Clinicopathologic study on cholangiolocellular carcinoma. Oncol Rep 2001; 8: 263-268 – reference: 24) Eyken PV, Sciot R, Callea F, et al. The development of the intrahepatic bile ducts in man: A keratin-immunohistochemical study. Hepatology 1988; 8: 1586-1595 – reference: 25) Aishima S, Nishihara Y, Kuroda Y, et al. Histologic characteristics and prognostic significance in small hepatocellular carcinoma with biliary differentiation. Am J Surg Pathol 2007; 31: 783-791 – reference: 26) Kozaka K, Sasaki M, Fujii T, et al. A subgroup of intrahepatic cholangiocarcinoma with an infiltrating replacement grouth pattern and resemblance to reactive proliferating bile ductules: 'bile ductular carcinoma'. Histopathology 2007; 51: 390-400 – reference: 22) Motosugi U, Ichikawa T, Nakajima H, et al. Cholangiolocellular carcinoma of the liver: imaging findings. J Compute Assist Tomogr 2009; 33: 682-688 – reference: 10) Komuta M, Spee B, Borght SV, et al. Clinicopathological study on cholangiolocellular carcinoma suggesting hepatic progenitor cell origin. Hepatology 2008; 47: 1544-1556 – reference: 9) Theise ND, Saxena R, Bernard C, et al. The canals of hering and hepatic stem cells in humans. Hepatology 1999; 30: 1425-1433 – reference: 15) Allen RA, Lisa JR. Combined liver cell and bile duct carcinoma. Am J Patholo 1949; 25: 647-655 – reference: 8) Steiner PE, Higginson J. Cholangiolocellular carcinoma of the liver. Cancer 1959; 12: 753-759 – reference: 20) Fukukura Y, Taguchi J, Nakashima O, et al. Combined hepatocellular and cholangiocarcinoma: correlation between CT findings and clinicopathological features. J Comput Assist Tomogr 1997; 21: 52-58 – reference: 1) 日本肝癌研究会. 「臨床・病理 原発性肝癌取扱い規約第5版」 金原出版, 2008 – reference: 11) Wells HG. Primary carcinoma of the liver. Am J Sci 1903; 126: 403-417 – reference: 23) Sasaki M, Tsuneyama K, Ishikawa A, et al. Intrahepatic cholangiocarcinoma in cirrhosis presents granulocyte and granulocyte-mcrophage colony stimulating factor. Human Pathol 2003; 34: 1337-1344 – reference: 28) Theise ND, Nimmakayalu M, Gardner R, et al. Liver from bone marrow in humans. Hepatology 2000; 32: 11-16 – reference: 13) Koster H, Kasaman LP. Primary duplex liver carcinoma. Am J Surg 1932; 17: 237-241 – reference: 3) Tikoo SK, Zee SY, Obiekwe S, et al. Combined Hepatocellular-cholangiocarcinoma A histopathologic, immunohistochemical, and in situ hybridization study. Am J Surg Pathol 2002; 26: 989-997 – reference: 16) Goodman ZD, Ishk KG, Langloss JM, et al. Combined hepatocellular cholangiocarcinoma. A histologic and immunohistochemical study. Cancer 1985; 55: 124-135 – reference: 5) Ng IO, Shek TW, Nicholls J, et al. Combined hepatocellular-cholangiocarcinoma: a clinicopathological study. J Gastroenterol Hepatol 1998; 13: 34-40 |
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| SubjectTerms | 免疫染色 混合型肝癌 細胆管細胞癌 肝幹細胞 |
| Title | アルコール性肝障害に発生した肝細胞癌と細胆管細胞癌よりなる混合型肝癌の1切除例 |
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