胆囊鳞癌和腺鳞癌25例临床病理特点分析

Clinical characteristics of squamous cell carcinoma and adenosquamous cell carcinoma of the gallbladder:An analysis of 25 cases

目的总结胆囊鳞癌(SC)和腺鳞癌(ASC)的临床表现、病理特点及诊疗方法。方法回顾性分析2003年1月至2021年12月北京协和医院收治的25例SC和ASC病例资料,包括患者基本信息、临床表现、血清学检查、影像学检查、手术方式和病理特点。结果25例中SC 5例,ASC 20例。21例(84.0%)以不特异的腹痛为首发症状。患者胆红素水平均正常,5例(20.0%)丙氨酸转氨酶(ALT)升高,9例(36.0%)γ-谷氨酰转肽酶(GGT)和碱性磷酸酶(ALP)同时升高。CT下SC和ASC主要表现为局部浸润性生长,淋巴结转移不明显。19例(76.0%)行根治性胆囊癌切除,3例(12.0%)行姑息性胆囊切除,3例(12.0%)为胆囊结石术后病理偶然发现。SC和ASC的淋巴结转移率和低分化占比比较,差异均无统计学意义(0 vs 69.2%,P=0.143;20.0%vs 45.0%,P=0.615)。结论SC和ASC属于侵袭性癌症,早期诊断困难,根治性手术切除是主要的治疗手段。

Objective To summarize the clinical manifestations,pathological characteristics and treatment of squamous cell carcinoma(SC)and adenosquamous cell carcinoma(ASC)of the gallbladder.Methods A total of 25 patients with SC/ASC in Peking Union Medical College Hospital from January 2003 to December 2021 were retrospectively analyzed.Baseline information,clinical manifestations,serology,radiological examination,surgical information and pathological characteristics were collected.Results In the 25 cases,5 were SC and 20 were ASC.21 patients(84.0%)presented with nonspecific abdominal pain as the first symptom.All patients had normal bilirubin.5 patients(20.0%)had elevated alanine aminotransferase(ALT).9 patients(36.0%)had elevated gamma-glutamyl transferase(GGT)and alkaline phosphatases(ALP).SC/ASC usually showed local invasive growth without lymph node metastasis on CT scan.19 patients(76.0%)underwent radical gallbladder resection.3 patients(12.0%)underwent palliative cholecystectomy.3 patients(12.0%)were incidentally diagnosed by postoperative pathology of gallstones.The incidence of lymph node metastasis between SC and ASC were 0 and 69.2%,respectively(P=0.143).There was no signifi cant difference in the proportion of poor differentiation between SC and ASC(20.0%vs 45.0%,P=0.615).Conclusion SC and ASC of gallbladder are invasive cancer,difficult in early diagnosis,and radical surgical resection is the preferred treatment.