Ohta T, Nagakawa T, Ueda N, Nakamura T, Akiyama T, Ueno K, Miyazaki I
Second Department of Surgery, School of Medicine, Kanazawa University, Japan.
Cancer. 1991 Nov 15;68(10):2217-23. doi: 10.1002/1097-0142(19911115)68:10<2217::aid-cncr2820681021>3.0.co;2-v.
Four cases are reported of the intraductal variant of peripheral cholangiocarcinoma among surgical specimens from 32 cases of hepatolithiasis. The cancers arose from the periphery of the stone-containing bile duct and spread chiefly along the luminal surface. Microscopically, these tumors showed papillary proliferation and therefore were diagnosed as the intraductal spreading type of peripheral cholangiocarcinoma. Mucosal dysplasia also was noticed in the vicinity of the tumors. In six other cases, mucosal dysplasia was observed in the periphery of the stone. Immunohistochemically, anti-CA 19-9 staining was observed diffusely in the cytoplasm of dysplastic lesions and carcinomas. Anti-carcinoembryonic antigen staining was restricted to the luminal surface and/or the supranuclear region of the cytoplasm in carcinomas. It was not identified in dysplastic cells. These results suggest that the mucosal dysplasia occasionally observed near stones is a precursor of the intraductal spreading type of peripheral cholangiocarcinoma in the presence of hepatolithiasis. The authors hypothesize that the lining epithelium of the large bile duct, when persistently exposed to biochemically altered bile, may undergo a carcinomatous transformation through a stage of mucosal dysplasia.
在32例肝内胆管结石手术标本中，报告了4例周围型胆管癌的导管内变异型。这些癌症起源于含结石胆管的周边，主要沿管腔表面扩散。显微镜下，这些肿瘤表现为乳头样增生，因此被诊断为周围型胆管癌的导管内扩散型。在肿瘤附近也观察到黏膜发育异常。在另外6例中，在结石周边观察到黏膜发育异常。免疫组化显示，抗CA 19-9染色在发育异常病变和癌的细胞质中弥漫性观察到。抗癌胚抗原染色局限于癌的管腔表面和/或细胞质的核上区。在发育异常细胞中未发现。这些结果表明，在肝内胆管结石存在的情况下，偶尔在结石附近观察到的黏膜发育异常是周围型胆管癌导管内扩散型的前驱病变。作者推测，大胆管的内衬上皮在持续暴露于生化改变的胆汁时，可能通过黏膜发育异常阶段发生癌变。
