隐匿性胆囊癌的病理学分析

目的 分析隐匿性胆囊癌的病理学特点及P53、CEA和Ki67等在其鉴别诊断用的应用价值。方法 回顾性分析55例隐匿性胆囊癌的临床表现、巨检特征、组织学特点和预后等,分析肿瘤标志物P53,CEA和Ki67在鉴别诊断中的价值。结果(1) 本组隐匿性胆囊癌55例,发生率为0.40%(55/15042)。男女比例2∶3,年龄34~85岁,中位年龄65岁。(2) 肉眼观,见胆囊增大,囊壁局限性增厚,平均厚度0.9cm;或呈囊状扩张,或与正常胆囊无明显差别,亦可见孤立性息肉样病变。所有胆囊均可见黏膜粗糙,31例患者伴有胆囊结石。镜下4例为乳头状管状腺瘤癌变,肿瘤与周围组织截然分界,6例为黏膜内癌伴微浸润,3例为黏膜内癌,肿瘤与周围组织有过度并可见胆道上皮内瘤变,10例为囊内乳头状肿瘤伴浸润性癌,其余32例为浸润性癌,其中普通型腺癌28例,黏液腺癌2例,鳞状细胞癌1例,印戒细胞癌1例。(3) 本组P53和CEA在不同类型的肿瘤中具有差异性表达。P53在38.7%(12/31)的胆囊浸润性腺癌中强表达,而在形成罗-阿窦的腺体表达阴性；CEA在61.3%(19/31)的胆囊浸润性腺癌中强表达,在周围正常黏膜上皮和罗-阿窦的腺体中表达阴性；同样Ki67增殖指数在浸润性癌中明显高于黏膜内癌和囊内乳头状肿瘤。(4) 本组50例获得随访资料,随访时间1~71个月,平均随访27.4个月,6例患者出现复发和肝脏转移,14例患者死亡,中位生存时间35.6个月。结论 隐匿性胆囊癌的发病率极低,好发于老年女性患者,绝大多数伴有胆囊结石。肉眼观病变局限,腺癌是最主要的组织学类型,其次为伴有浸润的囊内乳头状肿瘤。P53,CEA和Ki67有助于评判异型腺体的浸润深度和对鉴别肿瘤性腺体浸润、罗-阿窦形成和胆囊腺肌症有重要意义。大部分IGC临床分期较早,单纯手术切除能达到预期效果,TNM分期和高Ki67增殖指数是影响其预后的主要的因素。
ObjectiveTo analyze the clinical and pathological features in incidental gallbladder cancers. detected after laparoscopic cholecystectomy. Methods In 15042 laparoscopically resected samples, preoperatively undiagnosed gallbladder cancer was detected by pathological examination in 52 cases (0.40%). The clinical and pathological features of 52 cases of incidental gallbladder carcinoma (IGC) were retrospectively analyzed. The expressions of P53, CEA and Ki67 in tissue samples were detected by immunohistochemistry EnVison method. Results Among 52 IGC cases, the male to female ratio was 2∶3 and the mean age was 65 years (34 to 85). Macroscopically, the gallbladders were enlarged with focally thicken wall or dilated with cysts with an average thickness of 0.9cm; solitary polyp was also found; gallbladder stone was detected in 31 cases. Microscopically there were 4 cases of papillary-tubular adenoma with high grade intraepithelial neoplasm and focal invasive adenocarcinoma; 3 cases of intramucosal carcinoma and 6 cases of microinvasive adenocarcinoma with biliary intraepithelial neoplasia (BiIN) adjacent the tumor; 32 cases of invasive carcinoma including invasive adenocarcinoma, mucinous carcinoma, squamous cell carcinoma and signet ring cell carcinoma. P53 was expressed in 38.7% (12/31) invasive adenocarcinoma, while it was negative expressed in R-A glands. CEA was expressed in 61.3% (19/31) invasive adenocarcinoma, while it was negative expressed in R-A glands and the adjacent mucus. Ki67 index was higher in invasive adenocarcinoma than intramucous carcinoma and intracyctic papillary neoplasm (ICPN). Among 50 patients who were followed up for 1 to 71 months, 6 patients relapsed with liver metastasis, 14 patients died during the following up. The middle