胆囊腺癌：免疫组织化学特征及与胆管癌的比较。

Adenocarcinoma of gallbladder: an immunohistochemical profile and comparison with cholangiocarcinoma.

机构信息

Department of Pathology, The University of Melbourne, Melbourne, Victoria, Australia.

出版信息

J Clin Pathol. 2013 Mar;66(3):212-7. doi: 10.1136/jclinpath-2012-201146. Epub 2012 Dec 25.

DOI:10.1136/jclinpath-2012-201146

PMID:23268317

Abstract

AIM

Cholangiocarcinomas display intestinal and pyloric gland metaplasia-cell phenotypes. Those that arise in chronically inflamed (fluke infested) bile ducts more frequently express the intestinal metaplasia-cell phenotype and p53 than sporadic cholangiocarcinomas. We wished to determine if adenocarcinomas of the gallbladder display a similar profile.

METHODS

Adenocarcinoma, adenoma, and dysplastic and metaplastic epithelia were studied in 55 gallbladders. Serial paraffin sections were stained for five foregut antigens characteristically present in pyloric gland metaplasia, three intestinal-specific antigens and p53. Antigen expression was compared with that shown by 65 fluke-associated and 47 sporadic cholangiocarcinomas.

RESULTS

Pyloric gland metaplasia in gallbladders with chronic cholecystitis invariably displayed the five foregut antigens. The frequency of expression of these five antigens by the gallbladder cancers and cholangiocarcinomas did not differ significantly. An intestinal goblet-cell marker and p53 were more frequently expressed by gallbladder carcinoma (59% and 45%, respectively) and fluke-associated cholangiocarcinoma (45% and 46%) than by sporadic cholangiocarcinoma (17% and 23%). K20 was more frequently expressed by gallbladder carcinoma (52%) than either fluke-associated (21%) or sporadic (17%) cholangiocarcinoma. Dysplastic epithelium and adenomas also displayed the pyloric gland and intestinal metaplasia-cell phenotypes. Cells staining for pyloric gland metaplasia-cell phenotypes were distinct from the intestinal metaplasia-cell phenotypes when present together in a gallbladder carcinoma, cholangiocarcinoma, dysplastic epithelium or adenoma.

CONCLUSIONS

Adenocarcinomas of gallbladder generally arise from a foregut cell lineage via a metaplasia-dysplasia-carcinoma sequence. A background of chronic inflammation increases the frequency of expression of an intestinal goblet-cell phenotype and p53 in the cancers.

摘要

目的

胆管癌表现出肠和幽门腺化生-细胞表型。那些在慢性炎症（吸虫感染）的胆管中发生的胆管癌比散发的胆管癌更频繁地表达肠化生-细胞表型和 p53。我们希望确定胆囊腺癌是否显示出类似的特征。

方法

研究了 55 个胆囊中的腺癌、腺瘤、发育不良和化生上皮。对 5 种特征性存在于幽门腺化生中的前肠抗原、3 种肠特异性抗原和 p53，对连续石蜡切片进行染色。将抗原表达与 65 例吸虫相关和 47 例散发的胆管癌进行比较。

结果

慢性胆囊炎胆囊中的幽门腺化生始终显示出 5 种前肠抗原。这些抗原在胆囊癌和胆管癌中的表达频率没有显著差异。肠杯状细胞标记物和 p53 在胆囊癌（分别为 59%和 45%）和吸虫相关的胆管癌（分别为 45%和 46%）中比散发的胆管癌（分别为 17%和 23%）更频繁地表达。K20 在胆囊癌（52%）中比吸虫相关（21%）或散发（17%）的胆管癌更频繁地表达。发育不良上皮和腺瘤也显示出幽门腺和肠化生-细胞表型。当在胆囊癌、胆管癌、发育不良上皮或腺瘤中同时存在时，幽门腺化生-细胞表型的细胞与肠化生-细胞表型明显不同。