肉瘤样肝细胞癌:12例临床及病理分析

目的研究肉瘤样肝细胞癌的临床及病理特点，探讨其组织来源及预后。方法结合临床病史及实验室检查，分析12例肉瘤样肝细胞癌的病理及免疫组化。结果11例（91．7％）血液乙肝表面抗原阳性，血清AFP升高9例（75％），10例病理切片中有典型肝细胞癌和肉瘤样组织，另外2例仅有肉瘤样成分，肉瘤样组织可分为梭形细胞、多形细胞及巨细胞三部分。肉瘤样组织中免疫组化标记Vimentin阳性12例（100％）、Hepa阳性7例（58．3％）、AFP阳性4例（33．3％）、AE1／AE3阳性4例（33．3％）。结论肉瘤样肝细胞癌是一种特殊类型的肝细胞癌，在我国同样与乙肝病毒密切相关，尽管本质上是上皮性癌，但其也有部分肉瘤的特性，如体积大，易侵犯肝包膜及周围组织，预后较若。

Sarcomatoid hepatocellular carcinoma:a clinical and pathological analysis of 12 cases

Objective To investigate the clinical and pathological features of sarcomatoid hepa-tocellular carcinoma (HCC) and study its histological origin and prognosis. Methods Twelve cases of sarcomatoid HCC were analyzed clinicopathologically and immunohistochemically after hepatectomy. Meanwhile, their clinical data and laboratory results were analyzed. Results HBsAg was positive in 11 patients (91. 7%) and serum AFP rose in 9 (75%). The tumors showed ordinary HCC and sarcomatoid components in 10 patients and only sarcomatoid components in other 2. Sarcomatoid components included spindle cells, pleopmorphic cells and giant cells. The sarcomatoid components showed positive reaction for vimentin in 12 patients (100%), Hepa in 7 (58. 3%), AFP in 4 (33. 3%) and AE1/AE3 in 4 (33. 3%). Conclusions The sarcomatoid HCC is a special type of HCC and it is closely related to HBV in China. Though it is a kind of epithelial carcinoma, it shows some sarcomatoid traits such as huge size and tendency being apt to invading hepatic capsule and adjacent organs. It usually has poor prognosis.