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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

Immunohistochemical findings of typical cholangiolocellular carcinoma component (left column) and intermediate differentiation component (right column). Typical cholangiolocellular carcinoma component shows negativity for HepPar-1 (A) and positive reactivity for keratin 19 (B) and EpCAM (C). Intermediate differentiation component shows negative reactivity for HepPar-1 (D) and keratin 19 (E), and weak positive reactivity for Ep-CAM (F). EpCAM, epithelial cell adhesion molecule; HepPar-1, hepatocyte paraffin 1.
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Figure 3: Immunohistochemical findings of typical cholangiolocellular carcinoma component (left column) and intermediate differentiation component (right column). Typical cholangiolocellular carcinoma component shows negativity for HepPar-1 (A) and positive reactivity for keratin 19 (B) and EpCAM (C). Intermediate differentiation component shows negative reactivity for HepPar-1 (D) and keratin 19 (E), and weak positive reactivity for Ep-CAM (F). EpCAM, epithelial cell adhesion molecule; HepPar-1, hepatocyte paraffin 1.

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)

Immunohistochemical findings of typical cholangiolocellular carcinoma component (left column) and intermediate differentiation component (right column). Typical cholangiolocellular carcinoma component shows negativity for HepPar-1 (A) and positive reactivity for keratin 19 (B) and EpCAM (C). Intermediate differentiation component shows negative reactivity for HepPar-1 (D) and keratin 19 (E), and weak positive reactivity for Ep-CAM (F). EpCAM, epithelial cell adhesion molecule; HepPar-1, hepatocyte paraffin 1.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Immunohistochemical findings of typical cholangiolocellular carcinoma component (left column) and intermediate differentiation component (right column). Typical cholangiolocellular carcinoma component shows negativity for HepPar-1 (A) and positive reactivity for keratin 19 (B) and EpCAM (C). Intermediate differentiation component shows negative reactivity for HepPar-1 (D) and keratin 19 (E), and weak positive reactivity for Ep-CAM (F). EpCAM, epithelial cell adhesion molecule; HepPar-1, hepatocyte paraffin 1.
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