CLINICOPATHOLOGIC FEATURES AND DIAGNOSIS OF COMBINED HEPATOCELLULAR AND CHOLANGIOCARCINOMA

Hepatoma cases (N=130) were analyzed through histochemical and immunohistochemical staining. There were 99 cases of hepatocellular carcinoma (HCC), 15 cholangiocarcinoma (CC), and 16 combined HCC and CC (HCC+CC). The clinical features and the cases accompanied with hepatitis and/or liver cirrhosis in the non-tumor liver tissue of HCC+CC Group were between HCC Group and CC Group. Histologically,there were 4 cases with trabecular, 4 with pseudoglandula, 3 with solid type in HCC+CC Group. In these 11 cases, the CC area was less than 10% of the neoplasm. The cases were classified as HCC+CC type I. There was no obvious stroma fibrosis. The rest 5 cases of HCC+CC showed tubular carcinoma. The CC area took up over 10% of the tumor. These cases were designed as HCC+CC type II. There was significant fibrosis in the stroma so that its CC area is indistinguishable from that of CC cases. The CC area of all HCC+CC cases was positive to mucin and EMA staining, the same to that of CC cases. Near 70% of the H(~C+CC cases had intracytoplasmic glycogen in the HCC area. The HCC area was mucin and EMA negative, similar to that of HCC cases. We also observed transition areas between HCC and CC in both of the type I and type II HCC+CC cases. The areas were mucin negative but EMA positive. We concluded that HCC+ CC had HCC and CC area, with the characteristics of HCC of CC respectively. Histochemical mucin staining and immunohistochemical EMA staining were valuable in detection and diagnosis of the HCC+CC.