肝肉瘤样癌手术切除1例并文献复习

Surgical Resection of One Case of Hepatic Sarcomatoid Carcinoma with Literature Review

摘要: 肝肉瘤样癌(Hepatic Sarcomatoid Carcinoma, HSC)是一种极为罕见且高度恶性的原发性肝脏肿瘤，约占切除肝标本的2%。其发病机制尚未完全阐明，目前认为可能与上皮–间质转化(epithelial-mesenchymal transition, EMT)密切相关。该肿瘤的病理学核心特征为在同一病灶中同时存在上皮源性癌成分(如肝细胞癌或胆管细胞癌样结构)和化生形成的间叶源性肉瘤样成分，二者之间常可见过渡形态，构成典型的“双相性”组织学表现。由于HSC发病率极低，临床表现缺乏特异性，实验室检查及影像学特征多与常见原发性肝癌相似，术前诊断困难，极易误诊为普通肝细胞癌、胆管细胞癌或转移性肿瘤。确诊仍依赖术后组织病理学检查结合免疫组化分析。本文报道1例经手术切除并经病理证实的HSC病例，系统回顾其临床资料、影像学表现、病理特征及治疗经过，并结合国内外相关文献进行综合分析，旨在加深临床及影像科医师对该病的认识，提高早期诊断率，探索合理治疗策略，改善患者预后。

Abstract: Hepatic Sarcomatoid Carcinoma (HSC) is an extremely rare and highly malignant primary hepatic tumor, accounting for approximately 2% of resected liver specimens. Its pathogenesis has not been fully elucidated, and current evidence suggests that it may be closely associated with epithelial-mesenchymal transition (EMT). The core pathological feature of this tumor is the coexistence of epithelial-derived carcinomatous components (such as hepatocellular carcinoma or cholangiocarcinoma-like structures) and metaplastic mesenchymal-derived sarcomatoid components within the same lesion, with transitional morphologies often observed between the two, forming a typical biphasic histological pattern. Due to the extremely low incidence of HSC, its clinical manifestations are non-specific, and the features of laboratory examinations and imaging findings are mostly similar to those of common primary liver cancer, resulting in great difficulty in preoperative diagnosis and a high risk of misdiagnosis as conventional hepatocellular carcinoma, cholangiocarcinoma, or metastatic tumors. A definitive diagnosis still relies on postoperative histopathological examination combined with immunohistochemical analysis. This paper reports a case of HSC confirmed by surgical resection and pathological examination, systematically reviews its clinical data, imaging manifestations, pathological features, and treatment process, and conducts a comprehensive analysis by integrating relevant domestic and international literature. The aim is to deepen the understanding of this disease among clinicians and radiologists, improve the rate of early diagnosis, explore reasonable treatment strategies, and enhance patient prognosis.