胆管腺瘤癌变的临床与病理特点研究

Clincopathological features of Intrahepatic cholangiocarcinoma arising in the bile duct adenoma

目的本研究通过对胆管腺瘤(bile duct adenoma,BDA)癌变病例的分析,对其诊断和临床病理特点及预后进行了探讨。方法搜集3例胆管腺瘤癌变病例,观察其胆管腺瘤区域和癌变区域的免疫组化抗体表达,并对相关文献进行回顾。结果 3例主诉均为腹胀、腹痛,均无肝炎病史,血清检查AFP、CEA、CA199等指标正常或稍高。镜下显示:肿瘤由大致正常的小胆管构成,胆管间质组织增生显著,并见淋巴细胞增生。肿瘤区域,腺上皮呈非典型增生,细胞异型性明显,核分裂像可见,并浸润至周边肝实质内。胆管腺瘤区域和癌变区域移行明显。其中1例肿瘤局部可见胆管囊性扩张及胆栓形成,形态与胆管错构瘤(bile duct hamartoma,BDH)相似。免疫组化染色,胆管腺瘤区域及癌变区域CK19均为阳性,而Her-2只在癌变区域表达。结论胆管腺瘤可以发生癌变,说明其具有一定的恶性潜能。

Objective Bile duct adenoma（BDA） is a very rare form of benign bile duct lesion.This study aimed to evaluate the potential malignant transformation of BDA in the liver in order to improve the diagnosis and predicting the prognosis of BDA.Methods Three cases of intrahepatic cholangiocarcinoma arising from BDA were clinicopathologically evaluated and subjected to immunohistochemical examination by a panel of antibodies using the EnVision system.Relevant literature about BDA was reviewed.Results Three females were enrolled in this study.Their chief complaints were Abdominal swelling and pain.Microscopic findings indicated the tumors were composed of many normal looking bile ductules with a scanty to moderate amount of surrounding connective tissue.The stroma showed mild inflammation with predominant lymphocytes.The lumen of the ductules were narrow or slightly dilated.In addition,markedly atypical and irregularly shaped bile ductules of various sizes were noted and some of them invaded the stroma and extended into the adjacent liver parenchyma.The transitional zone from the apparently benign bile ductules to markedly atypical bile ductules was present.Mitotic figures were occasionally seen.In one tumor,areas,of cystically dilated ductules with brown bile plugs were observed,which simulate the bile duct hamartoma（BDH）.Immunohistochemical analysis showed positive cytokeratin 19 staining in the neoplastic epithelium and positive Her-2 staining in cholangiocarcinoma area.Conclusion Cholangiocarcinoma can develove from BDA indicating that BDA may be a precancerous lesion with the potential of malignant transformation.