Institute of Liver Studies, King's College Hospital, SE5 9RS London, United Kingdom.
Hum Pathol. 2011 Oct;42(10):1454-8. doi: 10.1016/j.humpath.2010.12.012. Epub 2011 Mar 29.
The aim of this study was to characterize the physiologic expression of "intestinal" features in gallbladders of infants and children. The study group consisted of 56 pediatric (age, 2 weeks to 7 years) and 15 adult (15-25 years) patients who underwent incidental cholecystectomy during surgery for other lesions. All gallbladders examined were histologically unremarkable without inflammation, gallstones, or neoplasia. The presence of goblet cells and the expression of cytokeratin 7, cytokeratin 20, mucin core protein 2, and caudal-related homeobox protein 2 were examined. Intestinal features were frequently detected in the pediatric gallbladders: goblet cells in 34 cases (61%), cytokeratin 20 expression in 25 (45%), mucin core protein 2 expression in 32 (57%), and caudal-related homeobox protein 2 expression in 16 (29%). In contrast, none of these features was identified in adult gallbladders. The expression of mucin core protein 2 was mostly restricted to goblet cells in pediatric gallbladders, whereas cytokeratin 20 and caudal-related homeobox protein 2 were expressed in both goblet and nongoblet cells. Cytokeratin 7 was diffusely and consistently expressed in both pediatric and adult gallbladder epithelium including goblet cells. Intestinal features became less frequent with age and were scarce in children aged 6 to 7 years. Thus, goblet cells were identified in 14 (93%) of 15 children aged <1 year, together with the common expression of cytokeratin 20 (73%), mucin core protein 2 (93%), and caudal-related homeobox protein 2 (53%). In conclusion, intestinal features are physiologically present in gallbladder epithelium of children, particularly those aged <6 years. Intestinal metaplasia, as associated with cholangiopathy or carcinogenesis in adult patients, may represent an immature phenotype of biliary epithelium.
本研究旨在描述婴儿和儿童胆囊中“肠”样特征的生理表现。研究组包括 56 例儿科（年龄 2 周至 7 岁）和 15 例成人（15-25 岁）患者，他们在因其他病变行手术时偶然行胆囊切除术。所有检查的胆囊均无组织学炎症、胆石或肿瘤。检测了杯状细胞的存在以及细胞角蛋白 7、细胞角蛋白 20、粘蛋白核心蛋白 2 和尾侧同源框蛋白 2 的表达。在儿科胆囊中经常发现肠样特征：34 例（61%）存在杯状细胞，25 例（45%）存在细胞角蛋白 20 表达，32 例（57%）存在粘蛋白核心蛋白 2 表达，16 例（29%）存在尾侧同源框蛋白 2 表达。相比之下，在成人胆囊中未发现这些特征。在儿科胆囊中，粘蛋白核心蛋白 2 的表达主要局限于杯状细胞，而细胞角蛋白 20 和尾侧同源框蛋白 2 则在杯状细胞和非杯状细胞中表达。细胞角蛋白 7 在包括杯状细胞在内的儿科和成人胆囊上皮中均广泛而一致地表达。随着年龄的增长，肠样特征变得越来越不常见，在 6 至 7 岁的儿童中很少见。因此，在 15 名<1 岁的儿童中，14 名（93%）发现有杯状细胞，共同表达细胞角蛋白 20（73%）、粘蛋白核心蛋白 2（93%）和尾侧同源框蛋白 2（53%）。总之，肠样特征在儿童胆囊上皮中普遍存在，特别是在<6 岁的儿童中。与成人患者胆管病或癌变相关的肠上皮化生可能代表胆管上皮不成熟的表型。
