- 期刊
Hepatic Sarcomatoid Carcinoma in a Patient with Recurrent Cholelithiasis and Chronic Cholangitis: Report of a Case
復發性膽道結石及慢性膽管炎合併肝臟類肉瘤性腺癌：一病例報告
摘要
類肉瘤性腺癌係指腫瘤同時表現出肉瘤及腺癌之特徵，肝臟的類肉瘤性腺癌是很少見的而且常常是由肝細胞癌或膽管癌變形而來。我們報告一位六十七歲女性因間歇性的發燒及上腹痛而住院，患者曾因膽及膽道結石在二十年前接受了膽囊切除術、膽道取石術，近幾年又因復發的瞻道結石及膽管炎接受多次的膽道鏡取石術及內視鏡取石術。住院後、超音波發現左肝及部分中肝葉有一低回音之腫瘤，腹部電腦斷層攝影發現有一低強度之腫瘤、顯影劑注射後腫瘤週邊出現顯影增強。我們實施了手術切片及腫瘤中心膿狀物引流，病理組織學上，我們發現了不規則或未分化的橫紋狀、圓形及橢圓形細胞；免疫組織染色上，細胞廣泛的對非上皮標記vimentin呈陽性反應、且其reticulin染色呈現出腺癌的形式；肉瘤及腺癌的特色皆可在切片中看到，所以我們的診斷是類肉瘤性線癌。基於其臨床、影像學及實驗室診斷學的特徵，我們推測其來源最可能是膽管癌。在本文中、我們藉此病倒來討論其臨床及免疫組織病理特色，並做一簡短之文獻回顧。
並列摘要
Sarcomatoid carcinoma is defined as a tumor having both sarcomatous and carcinoma components. Hepatic sarcomatoid carcinomas are rare and often arise from hepatocellular carcinoma or cholangiocarcinoma. We report a 67-year-old female admitted to our hospital with intermittent fever and upper abdominal pain. She had undergone cholecystectomy and choledocholithotomy 20 years previously. More recently, she had recurrent intrahepatic stones and underwent repeated choledocoscopic lithotiomy and endoscopic lithotripsy. On admission, ultrasonography showed a huge hyopechoic tumor in the left lobes of the liver Computed tomography revealed a hypoattenuating mass with peripheral enhancement. A surgical drainage of abscess was done. During the surgery, the lesion was found to be a solid tumor. A surgical wedge biopsy was done and purulent dark yellow fluid was drained from the center of the mass. Histologically, there was a solid pattern of rhabdoid and anaplastic round or oval cells haphazardly arranged with poor differentiation. Immunohistochemical staining was positive for vimentin, a mesenchymal marker; the reticulin staining was consistent with carcinoma. Given the combination of sarcomatous and carcinomatous features, the diagnosis was sarcomatioid carcinoma. The clinical presentation and immunohistochemical features were discussed and we reviewed the English literature briefly.