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Dual-phenotype hepatocellular carcinoma presenting as cholangiocarcinoma on imaging: A case report
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摘要: <正>1病例资料患者男性,63岁,因体检发现上腹部肝左叶占位,考虑恶性肿瘤,于2018年10月23日收入南通大学附属医院肝胆外科。患者自诉有慢性HBV病史30余年,未正规治疗,否认家族性肝癌病史。查体:全腹未及肿块,肝区无叩痛,肝脾肋下未触及。肿瘤指标:癌胚抗原16. 7 ng/ml,血清铁蛋白> 2000 ng/ml,CA19-9 7289. 8 U/ml,AFP 3. 57 ng/ml,CA72-4 1. 10 U/ml。异常凝血酶原（PIVKA-Ⅱ） 46. 00 mA U/ml。HBV核酸定量<1000拷贝/ml。HBsA g阳性（48. 80 ng/ml）,抗-HBe阳性（>6. 00 PEIU/ml）,抗-HBc阳性（6. 52 PEIU/ml）。胸苷激酶1测定:细胞质胸苷激酶0. 49 PM。上腹部增强CT示:肝占位,考虑肝内胆管细胞癌（图1）。
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Key words:
- carcinoma,hepatocellular /
- cholangiocarcinoma /
- diagnosis,differential
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[1] WANG Y,YANG Q,LI S,et al. Imaging features of combined hepatocellular and cholangiocarcinoma compared with those of hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma in a Chinese population[J]. Clin Radiol,2019,74(5):407. [2] WANG H,CONG WM. Progress in clinical pathology of new subtypes of bicotypic hepatocellular carcinoma[J]. Chin J Clin Oncol,2017,44(12):616-619.(in Chinese)王瀚，丛文铭．双表型肝细胞癌新亚型的临床病理学研究进展[J]．中国肿瘤临床，2017,44(12):616-619. [3] LU XY,XI T,LAU WY,et al. Hepatocellular carcinoma expressing cholangiocyte phenotype is a novel subtype with highly aggressive behavior[J]. Ann Surg Oncol,2011,18(8):2210-2217. [4] LIU M,SHI Y,ZHANG W,et al. Expression of CK19 andβ-catenin in primary hepatocellular carcinoma and its clinical significance[J]. J Xinjiang Med Univ,2016,39(8):1004-1008,1011.(in Chinese)刘铭，师艺，张巍，等．CK19及β-catenin在原发性肝细胞肝癌中的表达及其临床意义[J]．新疆医科大学学报，2016,39(8):1004-1008,1011. [5] WAKIZAKA K,YOKOO H,KAMIYAMA T,et al. Clinical and pathological features of combined hepatocellular-cholangiocarcinoma compared with other liver cancers[J]. J Gastroenterol Hepatol,2019,34(6):1074-1080. [6] LI AM,ZHU YZ. Advances in imaging diagnosis of primary intrahepatic cholangiocarcinoma[J]. Milit Med J Southeast China,2019,21(5):517-520.(in Chinese)李艾梅，朱友志．原发肝内胆管细胞癌的影像学诊断进展[J]．东南国防医药，2019,21(5):517-520. -
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