title: Clinicopathologic study on combined hepatocellular carcinoma and cholangiocarcinoma: with emphasis on the intermediate cell morphology.
abstract: Combined hepatocellular carcinoma and cholangiocarcinoma (combined HCC-CC) is a rare subtype of primary liver cancer. We investigated the histopathologic features of transitional or intermediate areas in 21 combined HCC-CCs and immunophenotypes using different hepatic progenitor cell markers (CK7, CK19, c-kit, NCAM, and EpCAM). Major histologic findings of transitional or intermediate areas of 21 combined HCC-CCs included strands/trabeculae of small, uniform, oval-shaped cells with scant cytoplasm and hyperchromatic nuclei embedded within an abundant stroma, small cells with an antler-like anastomosing pattern, and solid nests of intermediate hepatocyte-like cells surrounded by small cells in periphery, in order of frequency. The intermediate area of one tumor was composed predominantly of spindle cells arranged in short fascicles. Immunophenotype of tumor cells with intermediate morphology suggested a progenitor cell origin for this tumor. Clinical findings of combined HCC-CC showed a closer resemblance with those of HCC than those of CC. In univariate analysis, tumor size, TNM stage, and serum alpha-fetoprotein levels showed a significant association with poor patient survival. Serum alpha-fetoprotein level was an independent prognostic indicator in multivariate analysis. In conclusion, an awareness of the clinicopathologic features, specifically the various morphologic features of intermediate areas in this tumor, is essential for prevention of potential misdiagnosis as another tumor.
authors.affiliation: Department of Pathology, Chonbuk National University Medical School, Institute for Medical Sciences, Research Institute of Clinical Medicine, Jeonju, Korea.
authors.forename: Ho Sung
authors.initials: HS
authors.lastname: Park
authors.forename: Jun Sang
authors.initials: JS
authors.lastname: Bae
authors.forename: Kyu Yun
authors.initials: KY
authors.lastname: Jang
authors.forename: Ju Hyung
authors.initials: JH
authors.lastname: Lee
authors.forename: Hee Chul
authors.initials: HC
authors.lastname: Yu
authors.forename: Ji Hyeon
authors.initials: JH
authors.lastname: Jung
authors.forename: Baik Hwan
authors.initials: BH
authors.lastname: Cho
authors.forename: Myoung Ja
authors.initials: MJ
authors.lastname: Chung
authors.forename: Woo Sung
authors.initials: WS
authors.lastname: Moon
mesh_terms: D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D015815:Cell Adhesion Molecules / Q000378:metabolism; D018281:Cholangiocarcinoma / Q000473:pathology*; D000071858:Epithelial Cell Adhesion Molecule; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D053539:Keratin-19 / Q000378:metabolism; D053552:Keratin-7 / Q000378:metabolism; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D019006:Neural Cell Adhesion Molecules / Q000378:metabolism; D011379:Prognosis; D019009:Proto-Oncogene Proteins c-kit / Q000378:metabolism; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000951:Antigens, Neoplasm; D015815:Cell Adhesion Molecules; D000071858:Epithelial Cell Adhesion Molecule; D053539:Keratin-19; D053552:Keratin-7; D019006:Neural Cell Adhesion Molecules; D000509:alpha-Fetoproteins; D019009:Proto-Oncogene Proteins c-kit