Takei K, Watanabe H, Itoi T, Saito T
First Department of Pathology, Niigata University School of Medicine, Japan.
Pathol Int. 1996 Nov;46(11):908-17. doi: 10.1111/j.1440-1827.1996.tb03569.x.
Twenty intramucosal tumors of "carcinoma-in-adenoma' and 43 adenomas (39 pyloric gland type, 4 intestinal type) of the gall-bladder were studied to establish more precise histological criteria of carcinoma or adenoma in cases of "carcinoma in pyloric gland type adenoma', to compare carcinoma in adenoma with pure, that is, without adenomatous components, carcinoma, and to confirm the benign nature of spindle cell foci in the adenomas. Ki-67 and p53 immunostaining and nuclear morphometry were used. Eight pure intramucosal cancers were used as controls. The formalin-fixed, paraffin-embedded sections were stained with p53 and Ki-67 antibodies. Spindle cell foci were observed only in the adenoma area of the pyloric gland type, with a frequency of 23% in 39 adenomas, and of 45% in 20 tumors of carcinoma-in-adenoma. Ki-67 staining was negative in 129 of 130 spindle cell foci examined, regardless of their size, and positive in only one focus (550 microns in size, Ki-67 index 0.2%). All of the spindle cell foci were negative for p53 stain. The Ki-67 positive index was 36.6 +/- 5.6% in the 8 pure carcinomas, and 12.5 +/- 1.9% in the cancer areas of 16 tumors with carcinoma-in-adenoma, while it was 7.9 +/- 1.7% in the adenoma areas of 16 tumors with carcinoma-in-adenoma and 4.9 +/- 0.5% in the 32 pure pyloric gland adenomas. The p53-protein over-expression was found in seven of eight pure intramucosal cancers, and in one of 16 cancer components of carcinoma-in-adenoma. However, it was not found in any of 16 adenoma components of carcinoma-in-adenoma, and 35 adenomas. Cells of the cancer tissue of carcinoma-in-adenoma showed a significantly larger nuclear area and a larger nuclear minor axis than those of the pyloric gland type adenomas, as well as other architectural and cytologic abnormalities differing from the features of adenomas. These results suggest that clustered spindle cells do not indicate a malignant transformation of adenoma cells and that carcinomas in carcinoma-in-adenoma are different from pyloric gland type adenomas in terms of morphology and proliferative activity. Moreover, the results of the present study indicate that carcinomas in carcinoma-in-adenoma are lower in malignancy than pure carcinomas, and that their genetic abnormality may differ from that of pure carcinomas.
对20例“腺瘤内癌”的黏膜内肿瘤和43例胆囊腺瘤（39例幽门腺型，4例肠型）进行研究，以确立“幽门腺型腺瘤内癌”病例中癌或腺瘤更精确的组织学标准，比较腺瘤内癌与单纯癌（即无腺瘤成分的癌），并确认腺瘤中梭形细胞灶的良性性质。采用Ki-67和p53免疫染色及核形态计量学方法。8例单纯黏膜内癌用作对照。用p53和Ki-67抗体对福尔马林固定、石蜡包埋的切片进行染色。仅在幽门腺型腺瘤区域观察到梭形细胞灶，在39例腺瘤中的出现频率为23%，在20例腺瘤内癌肿瘤中的出现频率为45%。在所检查的130个梭形细胞灶中，129个Ki-67染色为阴性，无论其大小如何，仅1个灶（大小为550微米，Ki-67指数0.2%）为阳性。所有梭形细胞灶p53染色均为阴性。8例单纯癌的Ki-67阳性指数为36.6±5.6%，16例腺瘤内癌肿瘤的癌区域为12.5±1.9%，16例腺瘤内癌肿瘤的腺瘤区域为7.9±1.7%，32例单纯幽门腺腺瘤为4.9±0.5%。8例单纯黏膜内癌中有7例发现p53蛋白过度表达，16例腺瘤内癌的癌成分中有1例发现。然而，16例腺瘤内癌的腺瘤成分及35例腺瘤中均未发现。腺瘤内癌的癌组织细胞的核面积和核短轴明显大于幽门腺型腺瘤的细胞，以及存在与腺瘤特征不同的其他结构和细胞学异常。这些结果表明，聚集的梭形细胞并不表明腺瘤细胞发生恶性转化，腺瘤内癌的癌在形态和增殖活性方面与幽门腺型腺瘤不同。此外，本研究结果表明，腺瘤内癌的恶性程度低于单纯癌，其基因异常可能与单纯癌不同。
