가성육종성 변형을 보이는 병합형 간세포-담관암 - 1예 보고 - = A Case of Combined Hepatocellular Carcinoma-Cholangiocarcinomawith Pseudosarcomatoid Features

다국어 초록 (Multilingual 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 7.5×5.5
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.

참고문헌 (Reference)

1 "Hepatocellular carcinoma with sarcomatous change" 59 : 310-6, 1987

2 "Combined liver cell and bile duct carcinoma" 25 : 647-55, 1949

3 "Combined hepatocellular-cholangiocarcinoma:analysis of 8 cases with special reference to their growth patterns" 26 : 229-41, 1992

4 "Combined hepatocellular-cholangiocarcinoma:a case report" 58 : 1170-1173, 2004

5 "Combined hepatocellular and cholangiocarcinoma:demographic,clinical,and prognostic factors" 94 : 2040-2046, 2002

6 "An immunohistochemical study of sarcomatoid liver carcinomas" 68 : 93-7, 1991

7 "A case of combined hepatocellular and cholangiocarcinoma with neuroendocrine differentiation and sarcomatoid transformation:a case report" 39 : 125-129, 2005