Extrahepatic bile duct carcinoma with extensive intraepithelial spread: a clinicopathological study of 21 cases
Extrahepatic bile duct carcinoma with extensive intraepithelial spread: a clinicopathological study of 21 cases
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DOI：
10.1038/modpathol.2008.65
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发表时间：
2008-07-01
期刊：
影响因子：
7.5
通讯作者：
Kondo, Satoshi
中科院分区：
文献类型：
--
作者：
Nakanishi, Yoshitsugu;Zen, Yoh;Kondo, Satoshi
肝外胆管癌有时表现为主瘤周围相当大范围的上皮内扩散。在这项研究中，我们比较了肝外胆管癌伴和不伴广泛上皮内扩散(距主瘤20 mm)的临床病理特征。在117例肝外胆管癌中，21例(18%)有广泛的上皮内扩散。与无上皮内扩散的病例相比，这些病例的病理特征是主瘤为乳头状或结节状，分化程度较高，深部侵袭较少，门静脉或肝脏侵袭较少。上皮内扩散区包括低乳头状生长(17例，81%)和完全平坦生长(4例，19%)。前者的组织学特征相当于肉眼可见的颗粒状粘膜，而后者的肉眼观察很难发现其生长。免疫组织化学显示，16例(76%)P53、CEA和MUC1在肿瘤主干和扩散区均有表达。有趣的是，有上皮内扩散的患者术后预后好于无上皮内扩散的患者(P=0.009)。3例术后54~130个月吻合口复发。总而言之，上皮内播散型胆管癌的特点是主要病变为乳头状或结节状，分化程度较高，侵袭性较低。上皮内扩散的存在不是预后不良的指标，但胆管残端原位癌可导致术后晚期吻合口复发。
Extrahepatic bile duct carcinoma occasionally presents with intraepithelial spread for a considerable area around the main tumor. In this study, we compared clinicopathological features of extrahepatic bile duct carcinoma with and without extensive intraepithelial spread (>= 20mm from the main tumor). Out of 117 cases of extrahepatic bile duct carcinoma, 21 (18%) were found to have extensive intraepithelial spread. Those cases were pathologically characterized by a papillary or nodular main tumor, a more differentiated histological grade, less deep invasion, and infrequent portal vein or hepatic invasion in comparison with cases without intraepithelial spread. Areas of intraepithelial spread histologically consisted of low-papillary growth (17 cases, 81%) and completely flat growth (4 cases, 19%) of carcinoma cells. The former histology corresponded to a macroscopic granular mucosa, whereas the latter growth was hardly detected by gross examination. Immunohistochemically, in 16 of 21 cases (76%), at least one of p53, CEA, and MUC1 was expressed in both the main tumor and the spreading area. Interestingly, patients with intraepithelial spread had a better postoperative prognosis than those without intraepithelial spread (P=0.009). However, three patients had anastomotic recurrence 54-130 months after surgery. In conclusion, intraepithelial-spreading bile duct carcinoma is characterized by papillary or nodular main lesions, a more differentiated histological grade, and less invasiveness. The presence of intraepithelial spread was not an indicator of a poor prognosis, but carcinoma in situ at the bile duct stump could cause late anastomotic recurrence after surgery.