In situ and invasive adenocarcinomas of the gallbladder extending into or arising from Rokitansky-Aschoff sinuses - A clinicopathologic study of 49 cases
In situ and invasive adenocarcinomas of the gallbladder extending into or arising from Rokitansky-Aschoff sinuses - A clinicopathologic study of 49 cases
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DOI：
10.1097/00000478-200405000-00009
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发表时间：
2004-05-01
影响因子：
5.6
通讯作者：
Henson, DE
中科院分区：
文献类型：
--
作者：
Albores-Saavedra, J;Shukla, D;Henson, DE
我们报告49例胆囊癌侵犯或起源于Rokitansky-Aschoff窦（RAS），所有病例均经腹腔镜胆囊切除术切除。21例肿瘤为沿沿着RAS延伸的原位癌，6例原位癌发生于腺肌瘤样增生，22例为浸润性腺癌并延伸至RAS。37名患者为女性，12名男性。胆石症40例。年龄55 ~ 84岁，平均67岁。所有原位癌均为因胆石症和/或胆囊炎而切除的胆囊中的偶然显微镜发现。无原位癌患者因肿瘤死亡，包括2例起源于腺肌瘤样增生并显示微浸润的原位癌。与此相反，15例浸润性高至中分化腺癌患者中，有8例患者在手术后2 - 4年死亡，这些患者浸润RAS并侵犯肌肉层或浆膜下结缔组织。7例患者术后生存1 ~ 8年。将RAS与原位癌和管状肿瘤浸润性腺体分开的有用线索如下：上皮内陷与表面上皮的连接，识别正常胆管上皮与肿瘤上皮的混合，在长的扩张空间中存在胆固醇化的胆汁，以及缺乏对平滑肌束的浸润。原位癌沿着RAS扩散，由长管状结构组成，通常扩张，延伸穿过肌间结缔组织，而肿瘤腺体通常较小或中等大小，侵入平滑肌束或肌间结缔组织。神经浸润仅见于浆膜下结缔组织的浸润性腺体。两例原位癌发生在腺肌瘤样增生和三个浸润性腺癌，主要由高柱状粘蛋白含有细胞类似于胃小凹细胞与不同程度的degenia和细胞与胆表型承担一些相似的导管内乳头状粘液癌的胰腺或粘液囊性胰腺肿瘤。化生性幽门腺常见于肌层和浆膜下结缔组织，保持其小叶形态，不应与浸润性腺体混淆。我们的研究结果表明，在这组胆囊癌患者中，从浸润性腺癌的管状肿瘤腺体扩散到RAS的原位癌的区别是决定预后的关键。
We report 49 cases of gallbladder carcinomas that extended into or originated from Rokitansky-Aschoff sinuses (RAS), all of which were resected by laparoscopic cholecystectomy. Twenty-one tumors were in situ carcinomas that extended along RAS; six in situ carcinomas arose in adenomyomatous hyperplasia and 22 were invasive adenocarcinomas with extension into RAS. Thirty-seven patients were women and 12 men. Forty patients had cholelithiasis. The age of the patients ranged from 55 to 84 years (mean 67 years). All in situ carcinomas were incidental microscopic findings in gallbladders removed for cholelithiasis and/or cholecystitis. No patient with in situ carcinoma died as a result of the tumor, including two with in situ carcinoma that originated in adenomyomatous hyperplasia and showed microinvasion. In contrast, of 15 patients with invasive well to moderately differentiated adenocarcinoma extending into RAS and invading the muscle layer or subserosal connective tissue, 8 died 2 to 4 years after surgery. Seven patients survived I to 8 years after cholecystectomy. Useful clues to separate RAS with in situ carcinoma from tubular neoplastic invasive glands were the following: connection of the epithelial invaginations to the surface epithelium, recognition of normal biliary epithelium admixed with neoplastic epithelium, presence of inspissated bile in long dilated spaces, and lack of invasion to the smooth muscle bundles. In situ carcinoma spreading along RAS consisted of long tubular often dilated structures extending through the intermuscular connective tissue, whereas neoplastic glands were usually small or of medium size that invaded smooth muscle bundles or intermuscular connective tissue. Perineural invasion was seen only in invasive glands located in the subserosal connective tissue. Two cases of in situ carcinoma that arose in adenomyomatous hyperplasia and three invasive adenocarcinomas that were composed predominantly of tall columnar mucin containing cells similar to gastric foveolar cells with varying degrees of atypia and cells with biliary phenotype bear some resemblance to intraductal papillary mucinous carcinoma of the pancreas or to mucinous cystic pancreatic neoplasm. Metaplastic pyloric glands often seen in the muscle layer and subserosal connective tissue maintain their lobular pattern and should not be confused with invasive glands. Our findings indicate that distinction of in situ carcinoma spreading into RAS from tubular neoplastic glands of invasive adenocarcinomas is crucial to determine prognosis in this group of patients with gallbladder carcinoma.