胆囊原发性腺鳞癌一例临床病理分析并文献复习

Primary adenosquamous carcinoma of gallbladder: clinicopathological feature and review of literature

目的:分析胆囊原发性腺鳞癌的临床病理特点、鉴别诊断及治疗预后。方法:对1例胆囊腺鳞癌的临床资料进行分析,并复习相关文献。结果:本病早期无特异临床表现,主要表现为右上腹疼痛合并胆囊内结石。组织学特点:肿瘤由鳞癌及腺癌两种成分构成。以鳞癌成分为主呈巢状结构,鳞癌细胞大小不等,异型性明显,胞浆丰富,边界清楚,核仁较明显,核分裂像可见,可见角化珠、单个细胞内角化及细胞间桥。腺癌成分较少,肿瘤细胞排列成不规则的腺体,异型性较明显.间质中淋巴细胞较丰富,部分腺癌与鳞癌间质有移行。免疫组化染色显示:部分癌细胞34βE12(++),部分癌细胞CK7(++)、CEA(+)、CA19-9(++)、ki-67(+)、p53(+)、CK20(-)。结论:胆囊腺鳞癌是一种少见的胆囊肿瘤,其诊断主要依靠组织病理学和免疫组化标记。

Objective：To explore the clinicopathological features,diagnosis,differential diagnosis and prognosis of adenosquamous carcinoma of gallbladder.Methods：One case of adenosquamous carcinoma of gallbladder was observed and analyzed.In addition,the related literature was reviewed.Results：The clinical manifestation of primary adenosquamous carcinoma of gallbladder was atypical in the early stage,manifested right upper abdominal pain and gallstone.Histological feature：the tumor composed of squanmous cell carcinoma and adenocarcinoma.Squanmous cell carcinoma was the more ingredient with hyperchromatic nuclei and abound cytoplasm that were arranged in nest,cytologic atypia and mitotic figures were obvious.Squamous cell features with keratinization,squamous pearls and intercellular bridges can be observed.The adenocarcinoma ingredient was less,arranged in irregular,atypical glands,with many lymphocytes in stroma.Partly,the two kind of carcinoma stroma demonstrated an infiltrative growth pattern.Immunohistochemical staining showed：34βE12（＋ ＋）,CK7（＋ ＋）,CEA（＋）,CA19-9（＋ ＋）,ki-67（＋）,p53（＋）,CK20（-）.Conclusion：Primary adenosquamous carcinoma of gallbladder was a rare tumor.The disgnosis of this tumor mainly depends on Histological feature and immunohistochemical staining.