Hasebe T, Sakamoto M, Mukai K, Kawano N, Konishi M, Ryu M, Fukamachi S, Hirohashi S
Pathology Division, National Cancer Center Research Institute, Chiba, Japan.
Virchows Arch. 1995;426(2):209-13. doi: 10.1007/BF00192644.
A 59-year-old male with history of sigmoid colon cancer had a high serum-CEA level and was referred for the evaluation of metastatic liver disease. Ultrasonography and computerized tomography showed two tumours in the liver. Macroscopically, these were in segment 4 (S4) and 2 (S2). Histologically, the tumour in S4 showed a number of bile ductules with variable amounts of stroma, an appearance compatible with bile duct adenoma (BDA). There were markedly atypical ductules of various sizes, the epithelium of which had coarsely granular/hyperchromatic large nuclei, in some areas of the lesion. These atypical ductules showed invasive growth into the liver parenchyma. Some cystically dilated ductules with bile plugs resembling bile duct hamartoma (BDH) were also seen. The other tumour in S2, was a metastatic adenocarcinoma from sigmoid colon and showed strongly positive staining for CEA. Since the lesion in S4 of our case is solitary and most of histological features are similar to those of BDA with markedly atypical bile ductules, we consider that this may be the first case of cholangiocarcinoma associated with BDA with focal area of BDH. It is possible that the adenoma-carcinoma sequence occurs in biliary tumours.
一名59岁男性，有乙状结肠癌病史，血清癌胚抗原（CEA）水平较高，因转移性肝病评估前来就诊。超声检查和计算机断层扫描显示肝脏有两个肿瘤。大体上，它们位于肝段4（S4）和肝段2（S2）。组织学上，S4的肿瘤显示有许多数量不等的小胆管和间质，外观符合胆管腺瘤（BDA）。在病变的某些区域，有明显大小不一的非典型小胆管，其上皮细胞有粗大颗粒状/深染的大核。这些非典型小胆管呈浸润性生长至肝实质。还可见一些囊性扩张的小胆管，内有胆汁栓，类似胆管错构瘤（BDH）。S2的另一个肿瘤是乙状结肠转移性腺癌，CEA染色呈强阳性。由于我们病例中S4的病变是孤立的，且大多数组织学特征与BDA相似，伴有明显非典型胆管，我们认为这可能是首例与BDA相关且有局灶性BDH区域的胆管癌。胆管肿瘤可能发生腺瘤-癌序列。
