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目的:探讨胆囊癌肉瘤(carcinosacoma of gallbladder)的临床表现、影像特征、病理特点及治疗方法,提高对本病的认识。方法:回顾性分析经手术病理证实的5例胆囊癌肉瘤患者的CT表现及临床资料,并结合文献进行总结。结果:临床症状有右上腹疼痛、轻压痛,腹部肿块等;CT平扫5例均见胆囊内有结节状或菜花状软组织影突入、胆囊体积增大、胆囊壁增厚,可伴有肝内侵润、淋巴结及远处转移;增强的3例中,增厚的胆囊壁、腔内软组织肿块有轻中度不均匀强化;镜下均可见癌和肉瘤两种成分,免疫组化波形蛋白(Vim)、抗胰蛋白酶(AAT)、抗胰糜蛋白酶(AACT)等表现阳性;5例均经手术切除,短期内均有复发或转移。结论:胆囊癌肉瘤是一种罕见的高恶性肿瘤;临床表现无特异性;CT检查能为其诊断及鉴别诊断提供有用的参考价值;确诊依靠病理及免疫组化;治疗方式主要以手术为主,预后差。
Objective: To investigate the clinical manifestations, imaging features, pathological features and treatment of carcinosacoma of gallbladder and to raise awareness of the disease. Methods: The CT findings and clinical data of 5 cases of gallbladder carcinosarcoma confirmed by surgery and pathology were retrospectively analyzed, and the results were summarized with the literature. Results: The clinical symptoms of right upper quadrant pain, mild tenderness, abdominal mass, etc .; CT scan in 5 cases were seen within the gallbladder nodular or cauliflower-like soft tissue projection, gallbladder volume increased gallbladder wall thickening, may be associated with liver Intrinsic invasion, lymph node and distant metastasis; enhanced in 3 cases, thickening of the gallbladder wall, intracavitary soft tissue mass with mild to moderate enhancement; microscope can be seen both cancer and sarcoma, immunohistochemical vimentin (Vim), antitrypsin (AAT), anti-chymotrypsin (AACT) were all positive. All of the 5 cases were surgically removed and had recurrence or metastasis in a short period of time. Conclusion: Gallbladder carcinosarcoma is a rare malignant tumor with no specific clinical manifestations. CT examination can provide valuable reference for its diagnosis and differential diagnosis. Diagnosis depends on pathology and immunohistochemistry. The main treatment is mainly surgery Poor prognosis.