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Cholangiolocellular carcinoma with satellite nodules showing intermediate differentiation.

Jung W, Kim BH - Clin Mol Hepatol (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

ABSTRACT

A 62-year-old male presented with abdominal pain and dyspnea. He was a chronic alcoholic and had no positive markers for hepatitis virus. On physical examination, he showed epigastric tenderness. Initial serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase levels were 48 IU/L, 19 IU/L and 167 IU/L, respectively. Serum alpha-fetoprotein, carcinoembryonic antigen and carbohydrate antigen 19-9 levels were 4.9 ng/mL, 2.2 ng/mL and 12.1 U/mL, respectively. Abdominal computed tomography and magnetic resonance imaging showed a 5 cm-sized peripheral enhancing lesion with centripetal enhancement pattern, and multiple arterial enhancing nodules in right hepatic lobe. Under the impression of intrahepatic malignant tumor, he underwent a right lobectomy of liver.

No MeSH data available.


Related in: MedlinePlus

Histologic features of combined hepatocellular-cholangiocarcinoma. (A) Typical cholangiolocellular carcinoma component with tumor cells arranged in tubular and "antler-like" pattern in a markedly fibrous stroma. (B) Satellite nodule showing intermediate differentiation. Tumor cells show more abundant cytoplasm, structural pattern of trabeculae or nest, and scant fibrous stroma (Hematoxylin and eosin, ×200).
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Figure 2: Histologic features of combined hepatocellular-cholangiocarcinoma. (A) Typical cholangiolocellular carcinoma component with tumor cells arranged in tubular and "antler-like" pattern in a markedly fibrous stroma. (B) Satellite nodule showing intermediate differentiation. Tumor cells show more abundant cytoplasm, structural pattern of trabeculae or nest, and scant fibrous stroma (Hematoxylin and eosin, ×200).

Mentions: On gross examination, liver surface showed multiple protruding nodules. On serial section of the liver, there was a 5 cm-sized whitish firm and fibrotic mass and more than 10 multiple small satellite nodules with same consistency and color of the largest mass (Fig. 1). Microscopically, the 5 cm-sized largest mass showed tumor cells arranged in tubular, cord-like and anastomosing histologic pattern, so called "antler-like" pattern with mild nuclear atypia in the marked fibrous stroma of which the typical findings of cholangiolocellular carcinoma (Fig. 2). Most of other satellite nodules showed same histologic findings. But, there were two satellite nodules which revealed different histologic findings from other nodules. Tumor cells of these nodules had more abundant cytoplasm than other nodules, showed trabecular or cluster like structural pattern rather than tubular or antler-like pattern, and had scant intervening fibrous stroma. These histologic findings were intermediate differentiation between hepatocellular carcinoma and cholangiocarcinoma. On immunohistochemical stainings, the cells of typical cholangiolocellular carcinoma nodules were positive for keratin 19, but the tumor cells showing intermediate differentiation were negative for keratin 19. Both type cells were negative for hepatocyte paraffin 1 (HepPar-1) which is relatively specific marker for hepatocellular carcinomas and positive for epithelial cell adhesion molecule (EpCAM) which is used as stem/progenitor cell marker (Fig. 3). Through these findings, the diagnosis of combined hepatocellular-cholangiocarcinoma with stem-cell features, cholangiolocellular type could be made.


Cholangiolocellular carcinoma with satellite nodules showing intermediate differentiation.

Jung W, Kim BH - Clin Mol Hepatol (2015)

Histologic features of combined hepatocellular-cholangiocarcinoma. (A) Typical cholangiolocellular carcinoma component with tumor cells arranged in tubular and "antler-like" pattern in a markedly fibrous stroma. (B) Satellite nodule showing intermediate differentiation. Tumor cells show more abundant cytoplasm, structural pattern of trabeculae or nest, and scant fibrous stroma (Hematoxylin and eosin, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493363&req=5

Figure 2: Histologic features of combined hepatocellular-cholangiocarcinoma. (A) Typical cholangiolocellular carcinoma component with tumor cells arranged in tubular and "antler-like" pattern in a markedly fibrous stroma. (B) Satellite nodule showing intermediate differentiation. Tumor cells show more abundant cytoplasm, structural pattern of trabeculae or nest, and scant fibrous stroma (Hematoxylin and eosin, ×200).
Mentions: On gross examination, liver surface showed multiple protruding nodules. On serial section of the liver, there was a 5 cm-sized whitish firm and fibrotic mass and more than 10 multiple small satellite nodules with same consistency and color of the largest mass (Fig. 1). Microscopically, the 5 cm-sized largest mass showed tumor cells arranged in tubular, cord-like and anastomosing histologic pattern, so called "antler-like" pattern with mild nuclear atypia in the marked fibrous stroma of which the typical findings of cholangiolocellular carcinoma (Fig. 2). Most of other satellite nodules showed same histologic findings. But, there were two satellite nodules which revealed different histologic findings from other nodules. Tumor cells of these nodules had more abundant cytoplasm than other nodules, showed trabecular or cluster like structural pattern rather than tubular or antler-like pattern, and had scant intervening fibrous stroma. These histologic findings were intermediate differentiation between hepatocellular carcinoma and cholangiocarcinoma. On immunohistochemical stainings, the cells of typical cholangiolocellular carcinoma nodules were positive for keratin 19, but the tumor cells showing intermediate differentiation were negative for keratin 19. Both type cells were negative for hepatocyte paraffin 1 (HepPar-1) which is relatively specific marker for hepatocellular carcinomas and positive for epithelial cell adhesion molecule (EpCAM) which is used as stem/progenitor cell marker (Fig. 3). Through these findings, the diagnosis of combined hepatocellular-cholangiocarcinoma with stem-cell features, cholangiolocellular type could be made.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

ABSTRACT

A 62-year-old male presented with abdominal pain and dyspnea. He was a chronic alcoholic and had no positive markers for hepatitis virus. On physical examination, he showed epigastric tenderness. Initial serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase levels were 48 IU/L, 19 IU/L and 167 IU/L, respectively. Serum alpha-fetoprotein, carcinoembryonic antigen and carbohydrate antigen 19-9 levels were 4.9 ng/mL, 2.2 ng/mL and 12.1 U/mL, respectively. Abdominal computed tomography and magnetic resonance imaging showed a 5 cm-sized peripheral enhancing lesion with centripetal enhancement pattern, and multiple arterial enhancing nodules in right hepatic lobe. Under the impression of intrahepatic malignant tumor, he underwent a right lobectomy of liver.

No MeSH data available.


Related in: MedlinePlus