Combined Hepatocellular-Cholangiocarcinoma: Report of Two Cases

肝細胞癌合併膽管癌：兩病例報告

林育民(Yu-Min Lin) ； 許銘仁(Ming-Jen Sheu) ； 林勤益(Ching-Yih Lin) ； 郭行道(Hsing-Tao Kuo) ； 陳明鎮(Ming-Jenn Chen) ； 孫定平(Ding-Ping Sun) ； 吳仁宏(Reng-Hong Wu) ； 曾慶誠(Ching-Cherng Tzeng) ； 蔡順隆(Sun-Lung Tsai)

《臺灣消化醫學雜誌》 28卷2期 (2011/06) Pp. 212-219

https://doi.org/10.6557/GJT.201106_28(2).0003

摘要

肝細胞癌合併膽管癌(cHCC-CC)是一種同時具有肝細胞和膽管上皮細胞分化的原發性肝惡性腫瘤。臨床上少見。其發生率據文獻記載佔原發性肝惡性腫瘤的0.54%至14.2%不等。其臨床表徵可以是類似於肝細胞癌(hepatocellular carcinoma)或肝內膽管癌(intrahepatic cholangiocarcinoma)，並可能有較高的腫瘤多發性，門靜脈或肝靜脈侵犯和淋巴結轉移。因此，準確的術前診斷十分重要。但是術前的非侵入性血清學和放射學檢查，甚至是侵入性的穿刺活檢仍經常出現誤診。目前的證據顯示腫瘤完全切除合併肝門部淋巴結廓清術可能提供患者最佳的治癒機會。肝移植的角色仍尚待確立。在此，我們報告兩例肝細胞癌合併膽管癌分別以雙原發癌型和混合型表現，並強調在術前使用非侵入性的診斷工具產生合理臨床懷疑的重要性。

關鍵字

肝細胞癌合併膽管癌 ； 雙原發性肝惡性腫瘤

並列摘要

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is an uncommon primary liver cancer composed of cells with both hepatocellular and biliary epithelial differentiation. The incidence has been reported to be 0.54% to 14.2% of primary liver cancers. The clinical and demographic features may be similar to either hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC), with a high prevalence of multiplicity, portal vein or hepatic vein invasion and lymph node metastasis. Accurate preoperative diagnosis is important; however, misdiagnosis frequently occurs with noninvasive serological and radiological studies and even invasive percutaneous biopsy. Complete tumor resection with hilar lymph node dissection may provide the best chance of cure in patients with compensated liver reserve. The role of liver transplantation is yet to be determined. Herein, we report two cases of cHCC-CC, a double-cancer type and a mixed-type, and focus on the importance of preoperative clinical suspicion using noninvasive diagnostic tools.

並列關鍵字

combined hepatocellular-cholangiocarcinoma ； double primary liver cancer