胆囊胃型黏膜腺上皮腺瘤的病理特征与胆囊内乳头状肿瘤胃型的比较。

Pathological features of pyloric gland adenoma of the gallbladder in comparison with gastric subtype of intracholecystic papillary neoplasm.

机构信息

Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan; Department of Diagnostic Pathology, Fukui Prefecture Saiseikai Hospital, Fukui, Japan.

Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan.

出版信息

Ann Diagn Pathol. 2022 Feb;56:151879. doi: 10.1016/j.anndiagpath.2021.151879. Epub 2021 Dec 16.

DOI:10.1016/j.anndiagpath.2021.151879

PMID:34933153

Abstract

BACKGROUND AND AIMS

Pyloric gland adenoma (PGA) of the gallbladder is a polypoid, preinvasive epithelial neoplasm composed of uniform back-to-back, pyloric glands in a tubular configuration. Intracholecystic papillary neoplasm (ICPN), another preinvasive grossly visible neoplasm of the gallbladder, is subdividable into four subtypes, including gastric subtype. In this study, PGA was reappraised referring to gastric subtype of ICPN (gICPN).

MATERIALS AND METHODS

PGA and gICPN pathologically defined by WHO 2019 classification were surveyed in a total of 104 cases of gallbladder epithelial neoplasms of our Hospital (2002 January to 2021 May) and were pathologically and immunohistochemically compared.

RESULTS

PGA (7 cases) was characterized by i) a well-demarcated, polypoid lesion and ii) packed tubular components resembling pyloric glands. gICPNs (14 cases) were subdivided into i) pyloric gland predominant (2 cases), ii) foveola predominant (6 cases) and iii) mixed foveola and pyloric gland type (6 cases). gICPNs were also divided into a solitary, polypoid lesion with well demarcation from the surrounding mucosa (5 cases) and a conglomerated polypoid and granular lesions with poor demarcation (9 cases). PGA shared gross and histologic features with solitary, polypoid gICPNs, and PGA could be regarded as solitary gICPN predominantly composed of pyloric glands. Nuclear expression of β-catenin was found in 6 of 7 PGA, but absent in gICPN, including solitary, polypoid gICPN.

CONCLUSION

PGA could correspond to a solitary gICPN mainly composed of pyloric glands, but may undergo a different molecular pathway from gICPN.

摘要

背景与目的

胆囊的胃泌素瘤性腺瘤（PGA）是一种息肉样、黏膜内的上皮性肿瘤，由前后相连的、呈管状排列的胃泌素瘤组成。胆囊的另一种黏膜内可见的、具有侵袭性的肿瘤——腔内乳头状肿瘤（ICPN），可进一步分为四个亚型，包括胃型。本研究通过参考胃型 ICPN（gICPN）对 PGA 进行了再评估。

材料和方法

在我院（2002 年 1 月至 2021 年 5 月）的总共 104 例胆囊上皮性肿瘤中，对经 2019 年 WHO 分类定义的 PGA 和 gICPN 进行了调查，并对其进行了病理和免疫组化比较。

结果

PGA（7 例）的特征为：i）界限清楚的息肉样病变；ii）排列紧密的管状结构，类似于胃泌素瘤。gICPN（14 例）进一步分为：i）胃泌素瘤占优势（2 例）；ii）凹窝占优势（6 例）；iii）凹窝和胃泌素瘤混合占优势（6 例）。gICPN 还分为孤立性、界限清楚的息肉样病变（5 例）和多发性息肉样和颗粒状病变，界限不清（9 例）。PGA 与孤立性、息肉样 gICPN 具有大体和组织学特征，PGA 可被视为主要由胃泌素瘤组成的孤立性 gICPN。7 例 PGA 中有 6 例β-连环蛋白核表达，而 gICPN 包括孤立性、息肉样 gICPN 均无表达。