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Primary hepatic tumors with myxoid change: morphologically unique hepatic adenomas and hepatocellular carcinomas.

具有黏液变的原发性肝脏肿瘤:独特形态的肝腺瘤和肝细胞癌

Salaria SN,Graham RP,Aishima S,Mounajjed T,Yeh MM,Torbenson MS

Abstract

Mucin production in primary liver neoplasms is typically interpreted as evidence for biliary differentiation. However, we have observed benign and malignant liver tumors that have abundant extracellular myxoid/mucinous material, yet have only evidence of hepatocellular differentiation. To further characterize these unusual findings, 9 cases were identified and further studied. Four cases were hepatic adenomas, whereas 5 were hepatocellular carcinomas. Extracellular myxoid/mucinous material was diffuse in 7 cases and patchy in 2 cases. The extracellular myxoid/mucinous material was typically weakly mucicarmine positive (N=6) and Alcian blue positive (N=8). All tumors were well differentiated, and none had evidence for biliary differentiation by morphology or immunohistochemistry. The hepatic adenomas arose in nondiabetic and nonobese patients. Both the hepatic adenomas and the hepatocellular carcinomas were strongly and diffusely HepPar1 positive, CK19 negative, and showed loss of LFABP protein expression. These findings indicate that extracellular myxoid/mucinous material in isolation should not be interpreted as cholangiocarcinoma. Furthermore, the unique morphology, the clinical characteristics, and the immunophenotype results suggest that myxoid hepatic adenomas and hepatocellular carcinoma may be unique tumor variants.

摘要

黏液产生在原发性肝脏肿瘤中通常被认为是向胆管分化的证据,但是,我们在良性和恶性肝脏肿瘤中发现有丰富的细胞外黏液样/黏液物质,但仅具有向肝细胞分化的证据。为了进一步寻找这些病变的特征,我们对9个病例进行了深入研究。4例肝腺瘤,5例肝细胞癌。细胞外黏液/黏液样物质在7例中弥漫分布,2例灶状分布。细胞外黏液/黏液样物质黏液卡红弱阳性(N=6),阿尔辛蓝阳性(N=8)。所有9例肿瘤分化好,形态学以及免疫组织化学没有胆管分化证据。肝腺瘤发生于非糖尿病非肥胖患者。肝腺瘤和肝细胞癌免疫组织化学均呈现HepPar1弥漫强阳性,CK19阴性,LFABP蛋白表达缺失。这些发现表明细胞外黏液/黏液样物质不应该被诠释为胆管癌。而且,独特的形态、临床特点和免疫表型均提示黏液性肝腺瘤和肝细胞癌可能为一种独特的肿瘤亚型。

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