Pathologies of Precursor Lesions of Biliary Tract Carcinoma.
Pathologies of Precursor Lesions of Biliary Tract Carcinoma.
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胆道癌和前驱病变属于胰胆系肿瘤，具有共同的组织学和细胞谱系。高级别胆管上皮内肿瘤(高级别BLIN)、胆管内乳头状肿瘤(IPNB)和胆囊内乳头状肿瘤(ICPN)是胆道的主要前体。高级别胆汁是显微镜下可识别的上皮内肿瘤，而IPNB和ICPN分别是胆管和胆囊腔内或腔内侵袭前肿瘤。这些肿瘤根据细胞谱系和两级分级的四种亚型表现出特征性的组织学特征，并且在手术切除时与间质侵袭的病灶并不少见。此外，这些前体，特别是高级别的胆蛋白，经常在胆道癌(BTC)周围的胆管黏膜中被发现。综上所述，这些前体向浸润性癌的进展可能是胆道癌发生的主要过程。胆道癌和前驱病变属于胰胆系肿瘤，具有共同的组织学和细胞谱系。在过去的二十年里，已经发现了胆道癌(BTC)的前侵袭前体，如高级别胆管上皮内肿瘤(高级别BLIN)、胆管内乳头状肿瘤(IPNB)和胆囊内乳头状肿瘤(ICPN)。虽然这些前体大部分可能来自胆道粘膜，但也有一些起源于胆管壁的胆周腺和Rokitansky-Aschoff窦。高级别胆管上皮内肿瘤是一种显微镜下可识别的胆道上皮内肿瘤，而IPNB和ICPN分别是胆管和胆囊腔内或腔内侵袭前肿瘤。根据四种细胞系和两级分级，这些肿瘤具有特征性的组织学特征，表现为上皮内扩散到周围粘膜，并累及胆管壁的非肿瘤性腺体。这些前体并不少见与间质侵袭有关，尤其是高级别的胆红素，经常在BTCs周围的粘膜中发现。综上所述，从这些先兆到浸润性癌的进展似乎是胆道癌发生的一个主要过程。
Carcinomas and precursor lesions of the biliary tract belong to a spectrum of pancreatobiliary neoplasms that share common histology and cell lineages. High-grade biliary intraepithelial neoplasm (high-grade BilIN), intraductal papillary neoplasm of bile duct (IPNB), and intracholecystic papillary neoplasm of the gallbladder (ICPN) are the main biliary tract precursors. High-grade BilINs are microscopically identifiable intraepithelial neoplastic lesions, whereas IPNB and ICPN are grossly visible intraductal or intraluminal preinvasive neoplasms in the bile duct and gallbladder, respectively. These neoplasms show characteristic histologic features according to the four subtypes based on cell lineages and two-tiered grading, and they are not infrequently associated with foci of stromal invasion at the time of surgical resection. In addition, these precursors, particularly high-grade BilINs, are frequently identified in the biliary mucosa surrounding biliary tract carcinomas (BTCs). Taken together, the progression of these precursors to invasive carcinoma may be a major process in biliary carcinogenesis. Carcinomas and precursor lesions of the biliary tract belong to a spectrum of pancreatobiliary neoplasms that share common histology and cell lineages. Over the past two decades, preinvasive precursors to biliary tract carcinomas (BTCs) have been identified such as high-grade biliary intraepithelial neoplasm (high-grade BilIN), intraductal papillary neoplasm of bile duct (IPNB) and intracholecystic papillary neoplasm of the gallbladder (ICPN). While a majority of these precursors may arise from the biliary tract mucosa, some originate from the peribiliary glands and Rokitansky-Aschoff sinuses in the walls of the biliary tract. High-grade BilIN is a microscopically identifiable intraepithelial neoplasm of the biliary tract, whereas IPNB and ICPN are grossly visible intraductal or intraluminal preinvasive neoplasms in the bile duct and gallbladder, respectively. These neoplasms show characteristic histologic features according to four cell lineages and two-tiered grading, and show intraepithelial spreading to the surrounding mucosa and involve non-neoplastic glands in the walls of the biliary tract. These precursors are not infrequently associated with stromal invasion, and high-grade BilIN, in particular, are frequently identified in the surrounding mucosa of BTCs. Taken together, it seems likely that progression from these precursors to invasive carcinoma is a major process in biliary carcinogenesis.
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