胆囊肝样腺癌的临床影像病理分析

Clinical imaging and pathological analysis of hepatoid adenocarcinoma of gallbladder

目的总结胆囊肝样腺癌临床病理学特征及影像学表现。方法回顾性分析2010年1月至2019年10月海军军医大学第三附属医院收治的经手术病理诊断的6例胆囊肝样腺癌患者的临床资料、病理检查结果、影像学资料及术后随访资料。结果本组6例胆囊肝样腺癌患者的发病年龄为49~69岁,男女发病率为2∶1,3例发生于肝脏或淋巴结转移。6例患者血清甲胎蛋白(AFP)水平均升高、肝细胞抗原(Hep-1)染色均呈阳性。1例患者MRI和CT表现动脉期呈中度-明显强化,门静脉期及延迟期强化减退,1例为轻度强化;1例为不均匀明显强化。6例患者中2例患者失访;2例患者术后5年未见复发,存活至今;1例患者术后2年发现肝转移,治疗后存活至今;1例患者术后1年复发,治疗6个月后死亡。结论胆囊肝样腺癌好发于中老年男性,且容易发生肝脏或淋巴结转移,并通常伴有血清AFP水平升高,预后差,结合临床和影像学特征可提高对该病的诊断准确率。

Objective To summarize the clinicopathological features and imaging findings of hepatoid adenocarcinoma of gallbladder.MethodsThe clinical data,pathological examination results,imaging data and postoperative follow-up data of 6 patients with hepatoid adenocarcinoma of gallbladder diagnosed by surgery and pathology admitted to the Third Affiliated Hospital of Naval Medical University from January 2010 to October 2019 were retrospectively analyzed.ResultsThe onset ages of the 6 patients with hepatoid adenocarcinoma of gallbladder ranged from 49 to 69 years,the incidence rate of male and female was 2∶1,and 3 cases had liver or lymph node metastasis.The serum alpha fetoprotein(AFP)level was increased and hepatocyte paraffin-1(Hep-1)staining was positive in all 6 patients.MRI and CT showed moderate to significant enhancement in arterial phase,decreased enhancement in portal vein phase and delayed phase in 1 patient,and mild enhancement in 1 patient.Uneven enhancement was observed in 1 patient.Of the 6 patients,2 patients were lost to follow-up;2 patients survived 5 years after surgery without recurrence;1 patient was found to have liver metastasis 2 years after operation and survived to date after treatment;1 patient relapsed 1 year after operation and died 6 months after treatment.ConclusionHepatoid adenocarcinoma of gallbladder is more likely to occur in middle-aged and elderly men,and is prone to liver or lymph node metastasis,and usually accompanied by elevated serum AFP level,poor prognosis,combined with clinical and imaging features can improve the diagnostic accuracy of this disease.