Terada Tadashi
Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan.
Case Rep Gastroenterol. 2010 Sep 18;4(3):374-380. doi: 10.1159/000320674.
The author reports a very rare case of spindle cell carcinoma of the common bile duct with an emphasis on immunohistochemical features. A 65-year-old man was admitted to our hospital because of jaundice. Imaging modalities revealed a tumor of the common bile duct, and bile cytology demonstrated malignant cells. A pancreatico-duodenectomy was performed. Grossly, an elevated tumor (15 × 10 × 3 mm) was present in the middle portion of the common bile duct. Microscopically, the tumor consisted of well-differentiated adenocarcinoma (20% in area) and spindle cell carcinoma (80% in area). There were gradual transitions between the two. The tumor cells invaded into the serosa. Immunohistochemically, the spindle cell carcinoma element was positive for four types of pancytokeratins, cytokeratin 7 (CK7), CK8, CK18, CK19, CK20, epithelial membrane antigen, vimentin, p53 protein, Ki-67 (labeling = 52%), and CEA. It was negative for high-molecular-weight CK, CK5/6, CK14, p63, neuron-specific enolase chromogranin, synaptophysin, CD56, CA19-9, CD34, desmin, S100 protein, myoglobin, a-smooth muscle antigen, CD34, CD68 and KIT. The adenocarcinoma element showed similar immunoreactivity except for negative vimentin, and positive CA19-9. The present case is the first report of spindle cell carcinoma of the common bile duct demonstrating an extensive immunohistochemistry. The spindle cell carcinoma in the present case may be derived from sarcomatous transformation of the adenocarcinoma element. CK20 newly emerges in the development of spindle cell carcinoma of the common bile duct.
作者报告了一例非常罕见的胆总管梭形细胞癌病例，并重点阐述了其免疫组化特征。一名65岁男性因黄疸入住我院。影像学检查显示胆总管有肿瘤，胆汁细胞学检查发现恶性细胞。遂行胰十二指肠切除术。大体上，胆总管中部有一隆起性肿瘤（15×10×3mm）。显微镜下，肿瘤由高分化腺癌（面积占20%）和梭形细胞癌（面积占80%）组成。两者之间有逐渐过渡。肿瘤细胞侵犯至浆膜层。免疫组化方面，梭形细胞癌成分对四种全细胞角蛋白、细胞角蛋白7（CK7）、CK8、CK18、CK19、CK20、上皮膜抗原、波形蛋白、p53蛋白、Ki-67（标记指数=52%）和癌胚抗原呈阳性。对高分子量CK、CK5/6、CK14、p63、神经元特异性烯醇化酶、嗜铬粒蛋白、突触素、CD56、CA19-9、CD34、结蛋白、S100蛋白、肌红蛋白、α平滑肌抗原、CD34、CD68和KIT呈阴性。腺癌成分除波形蛋白阴性和CA19-9阳性外，显示出相似的免疫反应性。本病例是首例对胆总管梭形细胞癌进行广泛免疫组化分析的报告。本病例中的梭形细胞癌可能源自腺癌成分的肉瘤样转化。CK20在胆总管梭形细胞癌的发生过程中首次出现。
