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The Korean Journal of Pathology 2006;40(4): 303-305.
A Case of Combined Hepatocellular Carcinoma-Cholangiocarcinoma with Pseudosarcomatous Features.
Ok Ran Shin, Jae Young Park, Hae Kyung Lee, Young Jin Choi, Kee Hwan Kim, Young Mi Ku, Keun Woo Lim
1Department of Hospital Pathology, The Catholic University of Korea, Seoul 480-821, Korea. shinor@catholic.ac.kr
2Department of Ophthalmology, The Catholic University of Korea, Seoul 480-821, Korea.
3Department of Laboratory Medicine, The Catholic University of Korea, Seoul 480-821, Korea.
4Department of Surgery, The Catholic University of Korea, Seoul 480-821, Korea.
5Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 480-821, Korea.
ABSTRACT
Combine hepatocellular-cholangiocarcinoma with pseudosarcomatous features is a rare primary liver tumor. We report a 46-year-old man who is a carrier of HBV and has presented intermittent severe abdominal pain on right upper quadrant for 6 days. Tumor markers, alpha-fetoprotein, CEA and CA19-9 were within normal ranges. Abdominal computed tomogram revealed a large heterogeneous mass in the posteroinferior segment of right liver without associated biliary dilatation and conglomerated, enlarged portocaval and peripancreatic lymph nodes. Right hepatectomy was performed with local lymph node dissection. The tumor, measuring 7.5 x 5.5 cm showed an ill demarcated round to oval shape and a variegated whitish yellow solid cut surface with necrosis. Microscopically, the tumor consisted of three components, hepatocellular carcinoma, cholangiocarcinoma and undifferentiated sarcomatoid tumor cells. Immunohistochemically, hepatocellular carcinoma portion reacted positively with alpha-fetoprotein, cholangiocarcinoma portion reacted positively with bile duct-type cytokeratins (cytokeratin 7 and 19) and EMA. The pseudosarcomatous portion reacted with bile duct type cytokeratins and EMA. These findings suggested that pseudosarcomatous tumor cells may be with closely, associated primitive stem cells that can differentiate into the ductal epithelium.
Key Words: Carcinoma, Hepatocellular; Cholangiocarcinoma; Sarcomatoid carcioma