- 期刊
- OpenAccess
一罕見之肝外膽管腺鱗狀上皮癌－病例報告及文獻回顧
Adenosquamous Carcinoma of the Extra-Hepatic Bile Duct: Report of a Case and Review of Literatures
摘要
原發性膽管系統之腫瘤為屬少見之病變，多數為分化良好之腺癌，而發生於肝外膽管系統之惡性腫瘤更是罕見。此類腫瘤常因無特殊臨床症狀，早期診斷較困難且極易侵犯鄰近組織，於外科手術時無法行腫瘤完全摘除，而導致預後不良之腫瘤。本病例報告為一58歲已婚女性，於十四年前因膽囊結石而接受膽囊切除術，今因總膽管遠端腫瘤，總膽管、左、右枝肝管及多發性肝內膽管結石而經外科手術行腫瘤及結石摘除術。病理學檢查確定為總擔管遠端鱗狀上皮細胞癌，顯微鏡下腫瘤細胞呈腺樣結構並嵌併入實質性叢狀結構之鱗狀上皮細胞分化，而腫瘤附近可見由增生性併有中度到重度細胞之異常變化，局部之鱗狀上皮細胞之化生現象所構造之乳頭狀腺瘤。組織化學染色法中，呈腺樣結構之腫瘤細胞對mucincarmine 及periodic acid- Schiff（PAS）呈陽性反應，而鱗狀上皮分化細胞對CK呈陽性反應，對CEA則呈局部陽性反應。肝外膽管腺鱗狀上皮癌之病因及組織成因仍不清楚，故提出討論與相關性文獻之回顧並對其病因及組織成因可能性之探討。
並列摘要
Adenosquamous carcinoma (ASC) of the extrahepatic biliary tract, is an extremely uncommon neoplasm. Not only are these lesions freguently small, slow-growing, asymptomatic and difficult to diagnosis with a poor prognosis, they are often invasion of adjacent vascular structures, and their tendency to spread along bile ducts make surgical unresectable. We, herein ,reported a case of 57-year-old married women with common bile ductal neoplasm with multiple intrahepatic stones and common bile duct stones under the roentgenographic evaluations. A complete workup was performed and followed the exploratory and radical en bloc resection of the tumor with patent Y-tube implantation. She has received the cholecy-stectomy due to gall-stones 14 years ago.Microscopically, the tumor revealed neoplastic glandular structures merged with solid nests of epidermoid. While the presence of the papillary adenoma with dysplastic epithelium in adjacent to the neoplasm was noted. Histochemical, the tumor cells showed positive staining for the PAS and mucincarmine of the neoplastic glandular architectures. Immunohistochemically, these dysplastic adenoma and neoplastic glandular epithelium demonstrated immunoreactivity staining for the cytokeration (CK) and carcinoembryonic antigen (CEA), but focal positive immunostaining to the epidermoid nests. We reported this case and suggested that the nature of extrahepatic adenosquamous carcinoma may be related to the epithelial hyperplasia, squamous metaplasia and dysplasia of the lining epithelium of the bile ducts occuring to the multiple cholelithiasis and hepatolithiasis. The literature regarding the morpholgy and histopathogensis of this tumor was also reviewed.
延伸閱讀
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