Adenomas of the gallbladder. Morphologic features, expression of gastric and intestinal mucins, and incidence of high-grade dysplasia/carcinoma in situ and invasive carcinoma
Adenomas of the gallbladder. Morphologic features, expression of gastric and intestinal mucins, and incidence of high-grade dysplasia/carcinoma in situ and invasive carcinoma
复制标题
DOI：
10.1016/j.humpath.2011.11.011
复制
发表时间：
2012-09-01
期刊：
影响因子：
3.3
通讯作者：
Henson, Donald E.
中科院分区：
文献类型：
--
作者：
Albores-Saavedra, Jorge;Chable-Montero, Fredy;Henson, Donald E.
我们报告来自91例患者的201例胆囊腺瘤，其中大多数为成年女性。53例（58%）患者有胆结石。83例（91%）患者为单发腺瘤。一个胆囊有102个腺瘤。组织学上，201例腺瘤中有165例（82%）为幽门腺瘤，28例（14%）为肠腺瘤，5例（2.4%）为小凹腺瘤，3例（1.4%）为胆道腺瘤。2例肠型腺瘤合并胆道乳头状瘤病。28%的幽门腺腺瘤含有鳞状细胞。两个幽门腺腺瘤主要由柱状氧嗜细胞组成。165例幽门腺腺瘤中有44例（27%）鉴定为高级别发育不良/原位癌，165例中有25例（15%）鉴定为低级别发育不良。然而，只有2例（1%）浸润性腺癌出现在幽门腺腺瘤中，均为肠型。两例患者均存活5年以上。肠型腺瘤分为管状、乳头状和管状乳头状。28例肠腺瘤中有13例（46%）发现高级别非典型增生/原位癌。然而，只有1例（3.5%）具有胆道表型的浸润性腺癌出现在肠型腺瘤中。小窝腺瘤表现为低度发育不良，胆道腺瘤由类似于正常胆囊胆道细胞的柱状细胞组成。这些肿瘤均未发展为腺癌。46例幽门腺腺瘤中44例（95%）为MUC5AC和MUC6标记，18例肠腺瘤中14例（78%）为CDX2阳性，18例肠腺瘤中6例（33%）为MUC2阳性。MUC5AC和MUC6标记2个小凹腺瘤，2个胆道腺瘤仅表达CK7。胆囊腺瘤的免疫表型证明其分为幽门、肠、小窝和胆道。我们的研究结果表明，胆囊腺瘤在胆囊癌变途径中起次要作用。(C) 2012爱思唯尔公司版权所有。
We report 201 gallbladder adenomas from 91 patients most of whom were adult females. Fifty-three (58%) patients had gallstones. In 83 (91%) patients the adenomas were single. One gallbladder had 102 adenomas. Histologically, 165 (82%) of 201 adenomas were classified as pyloric, 28 (14%) as intestinal, 5 (2.4%) as foveolar, and 3 (1.4%) as biliary. Two patients had intestinal-type adenomas coexisting with biliary papillomatosis. Twenty-eight percent of pyloric gland adenomas contained squamoid mondes. Two pyloric gland adenomas were composed predominantly of columnar oxyphil cells. High-grade dysplasia/carcinoma in situ was identified in 44 (27%) of 165 pyloric gland adenomas and low-grade dysplasia in 25 (15%) of 165. However, only 2 (1%) invasive adenocarcinomas, both of intestinal type, arose in pyloric gland adenomas. Both patients survived more than 5 years. Intestinal-type adenomas were classified as tubular, papillary, and tubulopapillary. High-grade dysplasia/carcinoma in situ was recognized in 13 (46%) of 28 intestinal adenomas. However, only 1 (3.5%) invasive adenocarcinoma with biliary phenotype arose in an intestinal-type adenoma. Foveolar adenomas showed low-grade dysplasia, and biliary adenomas were composed of columnar cells similar to the normal biliary cells of the gallbladder. None of these tumors progressed to adenocarcinoma. MUC5AC and MUC6 labeled 44 (95%) of 46 pyloric gland adenomas, whereas CDX2 was positive in 14 (78%) of 18 intestinal adenomas and MUC2 in 6 (33%) of 18. MUC5AC and MUC6 labeled 2 foveolar adenomas, and 2 biliary adenomas expressed only CK7. The immunophenotype of gallbladder adenomas justifies their classification into pyloric, intestinal, foveolar, and biliary. Our results indicate that adenomas of the gallbladder play a minor role in the pathway of gallbladder carcinogenesis. (C) 2012 Elsevier Inc. All rights reserved.