胆囊癌肉瘤的临床及病理学观察

Carcinosarcoma of gallbladder: a clinicopathologic analysis

目的通过观察3例胆囊癌肉瘤的临床病理学特点及免疫组化表型,结合文献探讨胆囊癌肉瘤的发生、组织学特点、鉴别诊断及预后。方法采用光镜及免疫组化LSAB法对3例胆囊癌肉瘤标本进行观察分析。结果3例胆囊癌肉瘤患者均为成年女性。肿瘤呈菜花状或息肉状突入腔内,表面有坏死出血,肿瘤平均直径为55cm。光镜下胆囊癌肉瘤由上皮源性恶性肿瘤及间叶源性恶性肿瘤混合组成,上皮成分多表现为腺癌或鳞状细胞癌,间叶成分则表现多样。免疫组化显示上皮源性恶性成分表达上皮细胞标记(如CK),而不表达间叶组织标记(如vimentin、SMA、CD68),间叶成分根据构成不同而表达不同的间叶组织标记,但不表达上皮细胞标记。术后随访,2例复发,3例存活时间分别为20天、8个月和9个月。结论胆囊癌肉瘤是一罕见的高恶性肿瘤,多发生于中、老年女性,由癌和肉瘤两种成分混合组成,需要与肉瘤样癌及癌伴间叶成分化生鉴别,其预后主要与肿瘤分期有关。

Objective To study the clinicopathological and immunohistochemical features of carcinosarcoma arising from the gallbladder with emphasis on its histiogenesis and differential diagnosis. Methods Three cases of carcinosarcoma of the gallbladder were investigated with light microscopy and immunohistochemistry. Results Three cases occurred in female adults. All the three cases were polypoid patterns, protruding into the lumen of gallbladder with focal necrosis and hemorrhages. The epithelial component consisted of adenocarcinoma and squamous cell carcinoma or both, the mesenchymal component included fibrosarcoma, leiomyosarcoma, osteosarcoma or chondrosarcoma. Immunohistochemically, the malignant epithelial component expressed pan-cytokeratin and the sarcomatous component expressed vimentin, SMA or CD68. Follow-up information in three cases showed local recurrence in two cases. Survival time of three patients were twenty days, eight months and nine months, respectively. Conclusions Carcinosarcoma is a rare, high malignant neoplasm of gallbladder and often occurs in middle-aged female. Histologically, it shows intimate admixture of carcinoma and sarcoma,which need to make differential diagnosis from several similar diseases. The poor prognosis is correlated with stage of the tumor.