Sato Ryuichiro, Ando Toshinori, Tateno Hiroo, Rikiyama Toshiki, Furukawa Toru, Ebina Nobuo
Department of Surgery, Gonohe General Hospital, 17-3 Aza-Sawamukai, Sannohe-gun, Gonohe, 039-1517, Aomori, Japan.
Surgical Pathology Japan, Inc., Sendai, Japan.
Surg Case Rep. 2016 Dec;2(1):62. doi: 10.1186/s40792-016-0189-7. Epub 2016 Jun 18.
Intraepithelial neoplasias are preinvasive neoplastic lesions found throughout in the digestive system, and when such lesions are discovered in the gallbladder, they are referred to as intracystic papillary neoplasm (ICPN). In the gallbladder, mucinous adenocarcinoma is a rare histologic phenotype, and adenocarcinomas involving Rokitansky-Aschoff (RA) sinuses are uncommon, which were indeed found in a case reported here. A 64-year-old male presenting with upper abdominal pain demonstrated a spherical mass protruding outward from the gallbladder fundus in imaging studies. Laparoscopic cholecystectomy was performed, and the resected specimen revealed a subserosal cystic mass with a small communication with the gallbladder lumen. The cystic mass contained a gelatinous material without solid component. Histologically, the mass was consisted of subserosal cysts lined by atypical columnar mucinous epithelium with micropapillary growth and nuclear stratification. The neoplastic transformation was more pronounced toward the serosal side of the lesion where disruption of the cyst wall, intrastromal mucin lakes, and invasion of the neoplastic cells into surrounding stroma were observed. The epithelium was of intestinal lineage, which was supported by the positive immunoreactivity against CDX2 and MUC2. The cystic spaces were communicated with surrounding RA sinuses, which indicated that the tumor arose in the sinus. The pathological diagnosis was ICPN, intestinal type, with an associated mucinous adenocarcinoma arising in RA sinus.
上皮内瘤变是在整个消化系统中发现的侵袭前肿瘤性病变，当在胆囊中发现此类病变时，它们被称为囊内乳头状肿瘤（ICPN）。在胆囊中，黏液腺癌是一种罕见的组织学表型，累及罗-阿（Rokitansky-Aschoff，RA）窦的腺癌并不常见，本文报道的一例确实发现了这种情况。一名64岁男性因上腹部疼痛就诊，影像学检查显示胆囊底部有一个向外突出的球形肿块。行腹腔镜胆囊切除术，切除标本显示一个浆膜下囊性肿块，与胆囊腔有小的连通。囊性肿块含有胶冻样物质，无实性成分。组织学上，肿块由浆膜下囊肿组成，内衬非典型柱状黏液上皮，有微乳头生长和核分层。肿瘤性转化在病变的浆膜侧更为明显，在该处观察到囊肿壁破裂、基质内黏液湖形成以及肿瘤细胞侵入周围基质。上皮为肠型，这通过对CDX2和MUC2的阳性免疫反应得到证实。囊性间隙与周围的RA窦相通，这表明肿瘤起源于窦。病理诊断为肠型ICPN，伴发于RA窦的黏液腺癌。
