Akiyama T, Sahara H, Seto K, Saitou H, Kiriyama M, Tomita F, Kosaka T, Kita I, Takashima S, Matsunou H
Second Department of Surgery, Kanazawa Medical University, Ishikawa, Japan.
J Gastroenterol. 1996 Jun;31(3):470-4. doi: 10.1007/BF02355043.
We report herein two cases of carcinoma in situ of the gallbladder associated with cholesterosis. The patient in case 1 was an 81-year-old man who underwent a cholecystectomy for cholelithiasis. The resected specimens revealed gallbladder cancer in the fundus which was diagnosed histologically as mucinous carcinoma. Other findings included 13-mm, 12-mm, and 5-mm polypoid lesions in the neck of the gallbladder which macroscopically appeared to be cholesterol polyps, but histologically demonstrated carcinoma in situ with cholesterosis. The patient in case 2 was a 76-year-old man in whom ultrasonography revealed a highly echogenic, elevated lesion in the gallbladder. Cholecystectomy was performed, and a 33 x 28-mm papillary, elevated lesion with cholesterosis was resected from the neck of the gallbladder. Histologically, this was demonstrated to be papillary adenocarcinoma in situ with cholesterosis surrounded by glandular dysplasia. The distribution of the carcinomas and cholesterosis in both of these patients suggests that the adenoma or carcinoma of the gallbladder had occurred first. Then, the tumor epithelium absorbed cholesterol from the bile, and foamy cells were produced. Thus, when treating cholesterol polyps, it should be remembered that it is often difficult to distinguish between cholesterol polyp and gallbladder cancer with cholesterosis.
我们在此报告两例与胆囊胆固醇沉着症相关的胆囊原位癌。病例1的患者为一名81岁男性，因胆结石接受了胆囊切除术。切除的标本显示胆囊底部有胆囊癌，组织学诊断为黏液癌。其他发现包括胆囊颈部有13毫米、12毫米和5毫米的息肉样病变，肉眼看来似乎是胆固醇息肉，但组织学显示为伴有胆固醇沉着症的原位癌。病例2的患者是一名76岁男性，超声检查发现胆囊内有一个高回声的隆起病变。进行了胆囊切除术，从胆囊颈部切除了一个33×28毫米的有胆固醇沉着症的乳头状隆起病变。组织学上，这被证实为伴有胆固醇沉着症的原位乳头状腺癌，周围有腺体发育异常。这两名患者中癌和胆固醇沉着症的分布表明，胆囊腺瘤或癌首先发生。然后，肿瘤上皮从胆汁中吸收胆固醇，并产生泡沫细胞。因此，在治疗胆固醇息肉时，应记住区分胆固醇息肉和伴有胆固醇沉着症的胆囊癌往往很困难。
