Departments of Pathology, Kurume University School of Medicine, Kurume 830-0011, Japan.
World J Gastroenterol. 2012 Jul 28;18(28):3673-80. doi: 10.3748/wjg.v18.i28.3673.
To investigate the clinicopathological features of intraductal neoplasm of the intrahepatic bile duct (INihB).
Clinicopathological features of 24 cases of INihB, which were previously diagnosed as biliary papillomatosis or intraductal growth of intrahepatic biliary neoplasm, were reviewed. Mucin immunohistochemistry was performed for mucin (MUC)1, MUC2, MUC5AC and MUC6. Ki-67, P53 and β-catenin immunoreactivity were also examined. We categorized each tumor as adenoma (low grade), borderline (intermediate grade), and malignant (carcinoma in situ, high grade including tumors with microinvasion).
Among 24 cases of INihB, we identified 24 tumors. Twenty of 24 tumors (83%) were composed of a papillary structure; the same feature observed in intraductal papillary neoplasm of the bile duct (IPNB). In contrast, the remaining four tumors (17%) showed both tubular and papillary structures. In three of the four tumors (75%), macroscopic mucin secretion was limited but microscopic intracellular mucin was evident. Histologically, 16 tumors (67%) were malignant, three (12%) were borderline, and five (21%) were adenoma. Microinvasion was found in four cases (17%). Immunohistochemical analysis revealed that MUC1 was not expressed in the borderline/adenoma group but was expressed only in malignant lesions (P = 0.0095). Ki-67 labeling index (LI) was significantly higher in the malignant group than in the borderline/adenoma group (22.2 ± 15.5 vs 7.5 ± 6.3, P < 0.01). In the 16 malignant cases, expression of MUC5AC showed borderline significant association with high Ki-67 LI (P = 0.0622). Nuclear expression of β-catenin was observed in two (8%) of the 24 tumors, and these two tumors also showed MUC1 expression. P53 was negative in all tumors.
Some cases of INihB have a tubular structure, and are subcategorized as IPNB with tubular structure. MUC1 expression in INihB correlates positively with degree of malignancy.
探讨肝内胆管内肿瘤（INihB）的临床病理特征。
回顾性分析 24 例曾被诊断为胆管内乳头状瘤或肝内胆管内肿瘤的 INihB 患者的临床病理特征。对黏蛋白（MUC）1、MUC2、MUC5AC 和 MUC6 进行黏蛋白免疫组织化学染色。还检测了 Ki-67、P53 和β-连环蛋白的免疫反应性。我们将每个肿瘤分为腺瘤（低级别）、交界性（中级别）和恶性（原位癌，包括有微浸润的高级别肿瘤）。
在 24 例 INihB 中，我们共发现 24 个肿瘤。24 个肿瘤中有 20 个（83%）由乳头状结构组成；与胆管内乳头状瘤（IPNB）相同。相比之下，其余 4 个肿瘤（17%）表现为管状和乳头状结构。在 4 个肿瘤中有 3 个（75%），肉眼可见的黏液分泌有限，但镜下可见细胞内黏液。组织学上，16 个肿瘤（67%）为恶性，3 个（12%）为交界性，5 个（21%）为腺瘤。4 例有微浸润。免疫组化分析显示，MUC1 在交界性/腺瘤组不表达，仅在恶性病变中表达（P = 0.0095）。Ki-67 标记指数（LI）在恶性组显著高于交界性/腺瘤组（22.2 ± 15.5 比 7.5 ± 6.3，P < 0.01）。在 16 例恶性病例中，MUC5AC 的表达与高 Ki-67 LI 呈显著相关（P = 0.0622）。24 例肿瘤中有 2 例（8%）有β-连环蛋白核表达，这 2 例肿瘤也有 MUC1 表达。所有肿瘤 P53 均为阴性。
部分 INihB 病例有管状结构，被归类为具有管状结构的 IPNB。INihB 中 MUC1 的表达与恶性程度呈正相关。
