摘要
目的:探讨胆囊罕见恶性透明细胞肿瘤的临床病理特征、免疫表型、诊断和鉴别诊断、治疗以及预后特点,以提高病理医生对其临床及病理改变的认识。方法:对收治于我院的胆囊透明细胞腺癌和胆囊转移性肾细胞癌的临床资料及病理学特征进行回顾性分析,对石蜡包埋组织切片进行HE染色和免疫组化染色,并复习相关文献进行讨论。结果:本文于国内首次报道了1例转移至双侧附件的胆囊原发性透明细胞腺癌和5例罕见胆囊转移性肾细胞癌。镜下两者形态非常相似,大部分肿瘤细胞核圆居中、深染,胞浆透亮,细胞界限清楚,形成实性巢状或腺泡状结构;但胆囊透明细胞腺癌伴有高级别上皮内瘤变和普通型腺癌的成分,而胆囊转移性肾细胞癌中不伴随其他肿瘤性成分,并且大部分胆囊转移性肾细胞癌的病例中肿瘤细胞可见嗜酸性小核仁,而胆囊透明细胞腺癌中则未见核仁。免疫组化方面,胆囊透明细胞腺癌表达CA19-9、CEA、Keratin和p53,而胆囊转移性肾细胞癌表达EMA、CD10、Keratin、RCC、Pax-2、Pax-8和Vimentin。结论:胆囊具有"透明细胞形态特征"的良恶性病变种类颇多,形态学上有所重叠,仔细观察这些透明细胞的镜下特点、排列方式、分布特点以及有无伴随其他肿瘤性成分等情况并结合免疫组化特点和特殊染色结果有助于病理医师做出正确的诊断。
Objective:To analyze and summarize the clinicopathological features,immunophenotyping,diagnosis,differential diagnosis,therapy and prognosis of rare malignant clear cell tumors in the gallbladder and enhance the knowledge level about this disease by pathologists.Methods:Cases diagnosed as clear cell carcinoma and metastatic renal cell carcinoma of the gallbladder in our hospital were analyzed retrospectively,in combined with the patients'clinicopathological data and literature review.Paraffin-embedded tissue sections were stained by HE and immunochemistry.Results:One case of gallbladder clear cell carcinoma metastasizing to bilateral ovaries and fallopian tubes was firstly reported in our country by our article,in combination with five rare cases of gallbladder metastatic renal cell carcinoma for analysis.Microscopically,there was a remarkable resemblance between the two tumors in histology.Most of the tumor cells arranged in solid nests and glandular configurations with central,deep stained nuclei and clear cytoplasm and delicate cell borders.However,the gallbladder CCG was associated with high-grade intraepithelial neoplasia and common adenocarcinoma,and gallbladder metastatic RCC with no other tumor compositions.Small eosinophilic nucleoli was found in most cases of gallbladder metastatic RCC,but which was not seen in gallbladder CCG.Immunohistochemical studies revealed that the gallbladder CCG expressed CA19-9,CEA,Keratin and p53,while gallbladder metastatic RCC expressed EMA,CD10,Keratin,RCC,Pax-2,Pax-8 and Vimentin.Conclusion:There are many kinds of benign and malignant lesions showing"clear cell histological features"in gallbladders with morphological similarities.It may help physicians make right diagnosis by observing microscopic characteristics,arrangement,distribution and concomitant of those clear cells in association with immunohistochemical characteristics and special staining results.
作者
刘坦坦
付欣
王映梅
王哲
胡沛臻
Liu Tantan;Fu Xin;Wang Yingmei;Wang Zhe;Hu Peizhen(Department of Pathology,Xijing Hospital,the Air Force Medical University(The Fourth Military Medical University),Shaanxi Xi'an 710032,China)
出处
《现代肿瘤医学》
CAS
2019年第9期1566-1570,共5页
Journal of Modern Oncology
基金
陕西省重点研发计划项目(编号:2017SF-025)
关键词
胆囊透明细胞腺癌
胆囊转移性肾细胞癌
诊断
鉴别诊断
clear cell carcinoma of the gallbladder
metastatic renal cell carcinoma of the gallbladder
diagnosis
differential diagnosis
