原发性肝癌全肝切除标本的病理解剖学特征及其启示

目的 探讨原发性肝癌的病理解剖学特征及其意义.方法 2000年8月至2007年12月共有89例肝硬化合并原发性肝癌患者接受肝移植手术,收集手术切除标本及受侵犯的邻近组织和肿大的淋巴结.将标本沿冠状切面每隔1.0 cm切开,观察肝癌的大小、数目、分布、包膜、门静脉瘤栓、卫星灶,并记录卫星灶与主瘤问的距离、受肝癌侵犯的组织、淋巴结等,然后送病理学检查,最终诊断以病理报告为准.结果 89例患者中,肝细胞肝癌86例,胆管细胞性肝癌3例;多发肿瘤53例,单发肿瘤36例;13例主瘤在右叶,但左叶存在小癌灶;14例有较完整的包膜,75例无包膜,无包膜病例中11例边界不清;术中所见侵犯邻近组织的25例患者中,8例经病理证实,16例的肿大淋巴结中7例有癌浸润;有门静脉主干或分支瘤栓者42例(47.2%),有卫星灶者39例(43.8%),瘤栓与卫星灶随肿瘤体积、数目增加而增加;卫星灶距主瘤距离多为0.5～3.0 cm,少数达5.0 cm.结论 全肝切除标本能全面地反映肝癌牛长和浸润特征.应警惕门静脉瘤栓及卫星灶的存在,特别是距主瘤较远的卫星灶及门静脉小支内的瘤栓,以及分布在另一肝叶的小癌灶.这些因素在影像学检查时容易漏诊,但会影响肝切除术或肝移植术的疗效.

The pathological feature of primary hepatic carcinoma on explanted liver and its significance

Objective To investigate the pathological feature of primary hepatic carcinoma and the clinical significance. Methods From August 2000 to December 2007, there were 89 patients with cirrhosis and carcinoma of liver who accepted whole liver resection. The whole liver was cut into 10 mm slices to examine the tumor size,number,distribution,capsule,satellite nodes,portal vein tumor thrombi(PVTT). The invaded adjacent tissue and lymph nodes were recorded, the distance from satellite to major tumor was measured, then histological examinations were carried out,and the final diagnosis was made by pathologists. Results The total of 89 cases included hepatocellular carcinoma in 86 cases and cholangiocarcinoma in 3 cases;53 cases with multiple tumors and 36 cases with solitary tumor;complete capsule only in 14 cases,no obvious margin in 11 cases, 13 cases had a major tumor in the right lobe and a small tumor in the left lobe; 8 of 25 cases with gross invaded tissue were confirmed by histological examination,? of 16 cases with swollen lymph nodes were infiltrated by cancer cells. There were 47 cases with PVTT(47. 2% ) and 39 cases with satellite nodes(43. 8% ). PVTT and satellite nodes increased with the increase of sizes and the numbers of the tumors. The distance from satellite node to major tumor mostly were 0. 5-3. 0 cm. Conclusions The whole explanted liver can completely reflect the characteristics of growth and infiltration of hepatic carcinoma. Attention must be paid to the small cancer lesions in another lobe, distal satellite nodes from major tumor,and tumor thrombi in a small branch of portal vein, which can not be found by imaging, and might influence the curative effectiveness after liver resection or transplantation.