Department of Pathology, Universidad de La Frontera, Temuco, Chile.
Mod Pathol. 2011 Aug;24(8):1069-78. doi: 10.1038/modpathol.2011.68. Epub 2011 Apr 29.
The information in the literature on squamous cell and adenosquamous carcinomas of the gallbladder is highly limited. In this study, 606 resected invasive gallbladder carcinoma cases were analyzed. Squamous differentiation was identified in 41 cases (7%). Those without any identifiable glandular-type invasive component were classified as pure squamous cell carcinomas (8 cases) and those with the squamous component constituting 25-99% of the tumors were classified as adenosquamous carcinomas (26 cases) and included into the analysis. The remaining 7 that had <25% squamous component were classified as adenocarcinoma with focal squamous change and excluded. The clinicopathological characteristics of adenosquamous carcinoma/squamous cell carcinomas were documented and contrasted with that of ordinary gallbladder adenocarcinomas. The average patient age was 65 years (range 26-81); female/male ratio, 3.8. In only 13%, there was a preoperative clinical suspicion of malignancy. Grossly, 58% presented as thickening and hardening of the wall and 6% were polypoid. In 12%, mucosa adjacent to the tumor revealed squamous metaplasia. All pure squamous cell carcinomas had prominent keratinization. Giant cells and tumor-infiltrating eosinophils were observed in 29 and 51% of the squamous cell carcinomas/adenosquamous carcinomas versus 10% (P=0.02) and 6% (P=0.001) in gallbladder adenocarcinomas, respectively. All but three cases had 'advanced' (pT2 and above) carcinomas. Follow-up was available in 31 patients: 25 died of disease (median=5 months, range 0-20), and 6 were alive (median=64 months, range 5-112.5). The survival of patients with squamous cell carcinomas/adenosquamous carcinomas was significantly worse than that of gallbladder adenocarcinomas (P=0.003), and this adverse prognosis persisted when compared with stage-matched advanced gallbladder adenocarcinoma cases (median=11.4 months, P=0.01). In conclusion, squamous differentiation was noted in 7% of gallbladder carcinomas. The incidence of adenosquamous carcinoma (defined as 25-99% of the tumor being squamous) was 4%, and that of pure squamous cell carcinoma (without any documented invasive glandular component) was 1%. Pure squamous cell carcinomas often showed prominent keratinization. The overall prognosis of adenosquamous carcinoma/squamous cell carcinoma appears to be even worse than that of ordinary adenocarcinomas. Most patients died within a few months; however, those few who were alive beyond 2 years in this cohort experienced long-term survival.
胆囊的鳞状细胞癌和腺鳞癌的文献资料非常有限。在这项研究中，分析了 606 例经手术切除的浸润性胆囊癌病例。在 41 例（7％）中发现了鳞状分化。那些没有任何可识别的腺体型浸润成分的被归类为单纯的鳞状细胞癌（8 例），而那些鳞状成分构成肿瘤的 25-99％的被归类为腺鳞癌（26 例）并纳入分析。其余 7 例的鳞状成分<25％，被归类为具有局灶性鳞状化生的腺癌，并排除在外。记录了腺鳞癌/鳞状细胞癌的临床病理特征，并与普通胆囊腺癌进行了对比。平均患者年龄为 65 岁（范围 26-81）；女性/男性比例为 3.8。只有 13％的患者术前有恶性肿瘤的临床怀疑。大体上，58％表现为壁增厚和硬化，6％呈息肉样。在 12％的病例中，肿瘤附近的粘膜显示出鳞状化生。所有的单纯鳞状细胞癌均有明显的角化。在鳞状细胞癌/腺鳞癌中观察到巨细胞和肿瘤浸润性嗜酸性粒细胞分别为 29％和 51％，而在胆囊腺癌中分别为 10％（P=0.02）和 6％（P=0.001）。除了 3 例以外，所有病例均为“晚期”（pT2 及以上）癌。31 例患者可获得随访：25 例死于疾病（中位 5 个月，范围 0-20），6 例存活（中位 64 个月，范围 5-112.5）。鳞状细胞癌/腺鳞癌患者的生存率明显低于胆囊腺癌（P=0.003），与分期匹配的晚期胆囊腺癌病例相比，这种不良预后仍然存在（中位 11.4 个月，P=0.01）。总之，在 7％的胆囊癌中发现了鳞状分化。腺鳞癌（定义为肿瘤的 25-99％为鳞状）的发生率为 4％，单纯的鳞状细胞癌（无任何有记录的浸润性腺型成分）的发生率为 1％。单纯的鳞状细胞癌通常表现出明显的角化。腺鳞癌/鳞状细胞癌的总体预后似乎比普通腺癌更差。大多数患者在几个月内死亡；然而，在本队列中，少数存活超过 2 年的患者经历了长期生存。
