Yamamoto M, Nakajo S, Tahara E, Ito M, Taniyama K, Shimamoto F, Miyoshi N, Hayashi Y, Akiyama H, Nakai S
Division of Anatomical Pathology, Hiroshima University Hospital, Japan.
Pathol Res Pract. 1991 Mar;187(2-3):241-6. doi: 10.1016/S0344-0338(11)80778-8.
Histological examination of the gallbladder mucosa was made on a total of 39 patients with anomalous union of the pancreatico-biliary duct system. The most characteristic finding was mucosal hyperplasia of the gallbladder. Measurement of the height of the mucosa revealed that 15 cases (38.5%) showed mucosal hyperplasia composed of ordinary gallbladder epithelium without any metaplastic changes, including two cases of primary mucosal hyperplasia of the gallbladder. The other finding was metaplastic changes which were observed in 26 cases in various degrees, of whom 16 cases showed only focal metaplasia. These findings indicate that metaplasia frequently occurred in the gallbladder but the distribution of metaplasia was relatively focal in anomalous union with the pancreatico-biliary duct system. In our present materials there were nine cases of gallbladder adenocarcinoma and based on our classification, they were divided into seven cases of metaplastic type and two cases of non-metaplastic type. This ratio was not different from that of usual gallbladder carcinoma not complicated by this anomaly. These results indicate that the reflux of pancreatic juice into the gallbladder by anomalous union with the pancreatico-biliary duct system may cause two different effects on the gallbladder mucosa, the first being a proliferative effect resulting in mucosal hyperplasia and the other being chronic irritation causing metaplastic changes. The relation between these changes and the pathogenesis of gallbladder carcinoma is briefly discussed.
对39例胰胆管系统异常汇合患者的胆囊黏膜进行了组织学检查。最具特征性的发现是胆囊黏膜增生。对黏膜高度的测量显示，15例（38.5%）表现为普通胆囊上皮组成的黏膜增生，无任何化生改变，其中包括2例原发性胆囊黏膜增生。另一发现是化生改变，26例有不同程度的化生，其中16例仅表现为局灶性化生。这些发现表明，化生在胆囊中频繁发生，但在胰胆管系统异常汇合时，化生的分布相对局限。在我们目前的材料中有9例胆囊腺癌，根据我们的分类，分为7例化生型和2例非化生型。该比例与未合并这种异常的普通胆囊癌的比例无差异。这些结果表明，胰胆管系统异常汇合导致胰液反流至胆囊，可能对胆囊黏膜产生两种不同的影响，第一种是增殖性影响，导致黏膜增生，另一种是慢性刺激，引起化生改变。简要讨论了这些变化与胆囊癌发病机制之间的关系。
