原发性胆囊鳞癌和腺鳞癌临床病理学分析

Clinicopathological analysis of primary gallbladder squamous and adenosquamous carcinoma

目的 探讨原发性胆囊鳞癌(SCC)、腺鳞癌(ASC)的临床病理特征、诊断、治疗及预后。方法 对13例原发性胆囊SCC、ASC行HE和免疫组化SP法染色,分析其临床病理学特征并复习文献。结果 原发性胆囊SCC 7例,原发性胆囊ASC 6例,其中男3例,女10例,主要发生于老年患者,中位年龄为67岁。病理学分期T4期8例,T3期4例,T1b期1例。肿瘤部位:弥漫分布4例,胆囊底部5例,胆囊底部及体部3例,胆囊体部1例。其中9例非弥漫肿物最大径2.0~6.0 cm。合并胆囊结石12例。手术方式:行开腹手术7例,腹腔镜手术6例。截至2022年4月1日,11例患者获得随访,中位随访时间14个月(6~110个月),死亡7例,生存4例。6例行术后化疗或放化疗(化疗用药包括吉西他滨、吉西他滨+顺铂、替加氟),其中3例死亡,3例生存;5例未行放化疗患者中4例死亡,1例生存。结论 原发性胆囊癌以腺癌多见,而SCC、ASC少见。胆囊SCC、ASC肿物体积较大,预后较腺癌差,治疗以手术切除为主,术后放化疗疗效尚不明确。

objective To investigate the clinicopathological characteristics, diagnosis, treatment and prognosis of primary gallbladder squamous carcinoma(SCC) and adenosquamous carcinoma(ASC). Methods hematoxylin-eosin(HE) staining and immunohistochemical streptavidin-perosidase(SP) were performed on tumor tissues of 13 cases of primary gallbladder SCC and ASC to analyze their clinicopathological features, followed by a review of relevant literature. Results A total of 7 cases of primary gallbladder SCC and 6 cases of primary gallbladder ASC, including 3 males and 10 females, were included. The patients were mainly elderly with a median age of 67 years. Pathological stage: 8 cases were T4 stage, 4 cases were T3 stage, and 1 case was T1b stage. Tumor sites: 4 cases were diffusely distributed, 5 cases were located at the base of the gallbladder, 3 cases were located at the base and body of the gallbladder, and 1 case was located at the body of the gallbladder. The maximum diameters of 9 non-diffuse mass ranged from 2.0 to 6.0 cm. Gallstones were found in 12 cases. Surgery: open surgery was performed in 7 cases and laparoscopic surgery in 6 cases. As of April 1, 2022, 11 patients were followed up with a median follow-up time of 14 months(6-110 months), with 7 deaths and 4 survivals. Six patients were treated with postoperative chemotherapy or radiotherapy(chemotherapy agents included gemcitabine, gemcitabine+cisplatin, and tegafur), of which three died and three survived;four of the five patients who did not receive radiotherapy died and one survived. Conclusion Adenocarcinoma is the main histological subtype of gallbladder carcinoma, while SCC and ASC are rare. The SCC and ASC of gallbladder have larger tumor size and worse prognosis than that of adenocarcinoma. Surgical resection is the main treatment, and the effect of postoperative radiotherapy and chemotherapy is unclear.