case_images: PMC5779766_01
case_images: (A-B) The first case, HCC component. (A) Typical, moderately differentiated hepatocellular carcinoma, trabeculae were variable thick, the tumor shows round, oval, inconsistent cells. (HE, 200Xx). (B) Tumor cells were negative for S-100. (IHC, 200x). (C-F) The first case, CC component. (C-D) Cholangiocarcinoma component, composed of distorted tubular glands with an abundant fibrous stroma, tumor cells had vesicular nuclei, obvious nucleoli and slightly eosinophilic cytoplasm. (HE, 100x, 400x). (E-F) Tumor cells were positive for CK19, CK7. (IHC, 100x). (G-H, K) The first case, mixed area. (G-H) Sarcomatoid component mixed with cholangiocarcinoma, cholangiocarcinoma cells, and spindle cells were positive for CK19 (IHC, 200x; HE, 200x). (K) CC cells and some spindle cells secrete acid mucopolysaccharides (blue). (AB-PAS, 200x). (I:J) The first case, sarcomatoid component. (I) The sarcomatoid component was composed of short shuttle-like cells with clear nucleoli and few mitotic figures (HE, 200x). (J) Tumor cells were positive for VIM. (IHC, 200x).
case_images: medi-97-e9640-g001.jpg
case_images: PMC5779766_01_medi-97-e9640-g001.jpg
case_images: F1
case_images: The tumor showed round, oval, inconsistent cells (Fig. 1A-B). Tumor cells had nucleoli and slightly eosinophilic cytoplasm (Fig. 1C-F). In addition, some CC intermingled with spindle-shaped cells (Fig. 1G-H, K).
case_images: PMC5779766_02
case_images: (A-C) The second case, HCC component. (A) Compact trabecula was 2 to 3 thickness (HE, 200x). (B-C) tumor cells were positive for Heppar-1 and sinusoid-like blood spaces stained positive for CD34. (IHC, 200x, 100x). (D-F) The second case, pseudoglandular component. (D) Pseudoglandular admixed with the trabecular pattern, the structure is formed by a single layer of cuboidal tumor cells. (HE, 100x). (E-F) Tumor cells were positive for Heppar-1 and negative for CK7. (IHC,100x). (G-K) The second case, CC component. (I, K) Cholangiocarcinoma component consisted of a single layer of tumor cells with vesicular nuclei, obvious nucleoli (HE, 100x, 200x). (G-H, J) Tumor cells were positive for CK19, CK7, and Moc-31 (IHC, 200x). (L-M) The second case, transitional forms. (L) The tumor cells change their morphology from atypia, bizarre shape to typical spindle shape. (HE, 200x). (M) Transition zone cells were positive for CK (IHC, 200X). (N-P) The second case, sarcomatoid component. (N) Extensive spindling of neoplastic cells is obvious, whirls and bundles are irregularly arranged and contain elongated cells (HE, 200x). (O-P) Tumor cells were positive for VIM and negative for CK (IHC, 200x).
case_images: medi-97-e9640-g003.jpg
case_images: PMC5779766_02_medi-97-e9640-g003.jpg
case_images: F2
case_images: The tumor cells were positive staining for Heppar1, and negative staining for CK7, CK19, and Muc-1 (Fig. 2A-C). The CC component consisted of a single layer of tumor cells with vesicular nuclei, obvious nucleoli that expressed CK7, CK19, Muc-1, and EpCAM (Fig. 2G-K). Possible transitional forms were present, the intimate coexistence of both carcinoma and sarcomatous cells with a transitional form as well as positive staining for keratin (CK) in sarcomatous cells (Fig. 2L-M). Spindling of the neoplastic cells with bundles and whirls were observed, as typically found in sarcomas (Fig. 2N). Tumor with pseudoglandular pattern was positive for Heppar-1, GPC-3, but negative for CK7, CK19, and MUC-1 (Fig. 2D-F).