Duarte I, Llanos O, Domke H, Harz C, Valdivieso V
Department of Pathology, Pontificia Universidad Catolica de Chile, Santiago.
Cancer. 1993 Sep 15;72(6):1878-84. doi: 10.1002/1097-0142(19930915)72:6<1878::aid-cncr2820720615>3.0.co;2-2.
Gallbladder diseases, especially cholelithiasis, are extremely frequent in Chile, and an increasing frequency of gallbladder carcinoma has been observed during the last decades. Hyperplastic and atypical epithelial lesions of gallbladder epithelium have been considered potential precursors of invasive carcinoma. The current study was designed to study the frequency, distribution, extension, and probability of routine detection of potentially preneoplastic changes of gallbladder epithelium.
Epithelial changes were histologically studied by mapping gallbladders obtained at elective cholecystectomy for lithiasis in 162 Chilean patients.
Antral-type metaplasia was found in 95.1% of the cases, intestinal metaplasia in 58.1%, hyperplasia in 46.9%, dysplasia in 16%, and carcinoma in situ in 2.5%. A significant association of intestinal metaplasia with hyperplasia, intestinal metaplasia with dysplasia, and hyperplasia with dysplasia was found. Hyperplasia and dysplasia were also present in four cases with carcinoma in situ. Mean extension of the lesions (percentages of the sections in which the change was observed) was antral-type metaplasia (62.7%), intestinal metaplasia (25.3%), hyperplasia (24.1%), dysplasia (15.5%), and carcinoma in situ (9.7%). Antral-type and intestinal metaplasia were more extensive and more severe in patients older than 50 years of age. Hyperplasia was more extensive in cases in which it was associated with dysplasia and carcinoma in situ.
The extension of metaplasia seems to depend in part on the age of the patients. The association of intestinal metaplasia with hyperplasia and dysplasia agrees with the findings of other authors that relate metaplasia to gallbladder cancer. The epithelial lesions are focal or partially confluent, thus a single random histologic section will detect less than one third of the hyperplasias, dysplasias, and carcinomas in situ.
胆囊疾病，尤其是胆石症，在智利极为常见，并且在过去几十年中观察到胆囊癌的发病率呈上升趋势。胆囊上皮的增生性和非典型上皮病变被认为是浸润性癌的潜在前体。本研究旨在探讨胆囊上皮潜在癌前病变的发生率、分布、范围及常规检测的可能性。
对162例因结石行择期胆囊切除术获取的胆囊进行组织学绘图，研究上皮变化。
95.1%的病例发现胃窦型化生，58.1%发现肠化生，46.9%发现增生，16%发现发育异常，2.5%发现原位癌。发现肠化生与增生、肠化生与发育异常、增生与发育异常之间存在显著关联。4例原位癌病例中也存在增生和发育异常。病变的平均范围（观察到变化的切片百分比）为胃窦型化生（62.7%）、肠化生（25.3%）、增生（24.1%）、发育异常（15.5%）和原位癌（9.7%）。50岁以上患者的胃窦型和肠化生范围更广、程度更重。增生在与发育异常和原位癌相关的病例中范围更广。
化生的范围似乎部分取决于患者年龄。肠化生与增生和发育异常的关联与其他作者将化生与胆囊癌相关联的研究结果一致。上皮病变为局灶性或部分融合性，因此单个随机组织学切片检测到的增生、发育异常和原位癌不到三分之一。
