O'Hara B J, McCue P A, Miettinen M
Department of Pathology and Cell Biology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107-5098.
Am J Surg Pathol. 1992 Jan;16(1):21-5. doi: 10.1097/00000478-199201000-00003.
Bile duct adenomas are small nodules that are usually found incidentally on the liver surface at abdominal surgery or autopsy. We recently analyzed two such lesions that, in addition to the typical small caliber ducts, contained periductular nests and clusters of uniform round cells, suggestive of endocrine cell proliferation. Follow-up of these patients did not show endocrine tumors elsewhere. The lesions were studied by immunohistochemistry (avidin-biotin-peroxidase technique) and compared with conventional bile duct adenomas (seven cases). The results showed these cells to decorate with several endocrine markers, namely, neuron-specific enolase, chromogranin, synaptophysin, and Leu-7. Endocrine markers were not seen in the cells of conventional bile duct adenomas. Epithelial markers, that is, cytokeratin (CAM 5.2 antibody) and epithelial membrane antigen, were expressed by the cells composing both conventional bile duct adenomas and those with endocrine-like cells, although with less intensity in the endocrine cell clusters. We suggest that some bile duct adenomas contain endocrine cell proliferations that morphologically may resemble a small carcinoid tumor or the so-called pulmonary tumorlet. Neurosecretory granules have previously been identified in some cholangiocarcinomas and in bile duct proliferation associated with cholestasis. The endocrine clusters in biliary adenomas may constitute a diagnostic pitfall and must be separated from metastases of carcinoids or islet cell tumors.
胆管腺瘤是小结节，通常在腹部手术或尸检时于肝脏表面偶然发现。我们最近分析了两个这样的病变，除了典型的小口径导管外，还包含导管周围巢状和均匀圆形细胞簇，提示内分泌细胞增殖。对这些患者的随访未发现其他部位有内分泌肿瘤。通过免疫组织化学（抗生物素蛋白-生物素-过氧化物酶技术）对病变进行研究，并与传统胆管腺瘤（7例）进行比较。结果显示这些细胞可用几种内分泌标志物进行标记，即神经元特异性烯醇化酶、嗜铬粒蛋白、突触素和Leu-7。在传统胆管腺瘤的细胞中未见到内分泌标志物。上皮标志物，即细胞角蛋白（CAM 5.2抗体）和上皮膜抗原，由构成传统胆管腺瘤和含有内分泌样细胞的腺瘤的细胞表达，尽管在内分泌细胞簇中的表达强度较低。我们认为一些胆管腺瘤含有内分泌细胞增殖，其形态上可能类似于小类癌肿瘤或所谓的肺微小瘤。神经分泌颗粒先前已在一些胆管癌和与胆汁淤积相关的胆管增殖中被鉴定出来。胆管腺瘤中的内分泌细胞簇可能构成诊断陷阱，必须与类癌或胰岛细胞瘤的转移灶区分开来。
