胆囊良、恶性病变的组织化学和免疫组织化学研究

A HISTOCHEMICAL AND IMMUNOHISTOCHEMICAL STUDIES OF THE GALLBLADDER BENING AND MALIGNANT LESIONS

作者对正常胆囊、不同程度异型增生的胆囊,癌旁组织和胆囊癌共89例活检标本进行组织化学和免疫组织化学研究.正常胆囊只含硫酸粘液,无化生改变,而异型增生胆囊、癌旁组织和胆囊癌均见有胃肠上皮化生改变,且癌旁组织与各类异型增生的各类化生出现率间的差异无显著性(P>0.05)。在70例胆囊癌中47例有化生改变,分化程度越低,其出现率越低(P<0.01)。从轻度异型增生到癌,粘液含量逐渐减少,中性粘液和非硫酸粘液相对增多,硫酸粘液相应减少或消失,作者认为胆囊癌的发生与胆囊上皮化生有重要关系。用大分子角蛋白单克隆抗体K_(27)对部分异型增生胆囊上皮、鳞癌癌旁组织和部分鳞癌作免疫组织化学染色,显示细胞质内含有大分子角蛋增白,提示胆囊上皮的鳞状上皮化生,可能是胆囊鳞癌的组织来源。

Histochemical and immunohistochemical studies were made on 89 cases of the benign and malignant lesions of the gallbladder. Normal gallbladder epithelium showed a predominance of sulphated mucosubstance Gastric—type and intestinal —type metaplasia were demonstrated in dysplastic areas of the bordering areas of the tumor and gallbladder carcinomas. The positive rates of metaplastic changes have no significant difference (P>0.05) between dysplasias and bordering areas of the carcinoma. 47 cases of 70 gallbladder carcinoma represented metaplastic changes. The positive rate of metaplasia was lower in poor differential carcinomas (P<0.01). With gradually increasing degree of dysplastic epithilium, the quantity of mucin decreased gradually and dyspiastic epithelium contained mainly neutral mucin and nonsulphated acid mucin. This study suggested that metaplasia of gallbalder epithetium was significantly related to the development of gallbladder carcinoma. Some cases of dysplatic epithelium, bordering areas of the squamous cell carcinoma and part of squamous cell carcinoma (71.4%) represented positive reaction with monoclonal antibody K_(27) of large molecular keratin. It is suggeste that the squamous metaplastic change of gallbladder eqithelium may be the histogenesis of gallbladder squamous cell carcinoma.