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目的 观察胆囊鳞癌、腺鳞癌 ,探讨其组织起源及发病机制。方法 全部病例做常规石蜡切片、HE染色及CEA、EMA、AFP、ER、AE1、AE3 、CA19 9、Ki 6 7免疫组化染色。结果 7例中鳞癌 2例、腺鳞癌 5例。肿瘤均浸润性生长 ,累及邻近器官 ,伴有明显坏死、炎症及结石。癌旁上皮增生、化生、不典型增生、原位癌改变 ,并与浸润性癌有过渡或移行关系。免疫组化示 7例EMA、AE1、AE3 强阳性 ,CEA胆囊上皮及腺鳞癌强阳性而鳞癌弱表达。ER腺鳞癌、鳞癌均表达。CA19 9胆囊上皮及腺鳞癌强阳性而鳞癌阴性。Ki 6 7在中—低分化癌中阳性 ,而高分化癌中阴性。结论 本癌好发于女性。慢性炎症及胆石症在胆囊癌发生上起到一定的作用。癌旁上皮不典型增生、原位癌及与浸润癌有移行 ,提示癌旁上皮增生或化生亦为发生胆囊癌的重要因素。CA19 9在鉴别腺鳞癌与鳞癌有意义 ,Ki 6 7、ER、AFP对预测细胞增殖、分化程度、恶性程度及预后有一定帮助
Objective To observe the squamous cell carcinoma and adenosquamous carcinoma of the gallbladder and explore its origin and pathogenesis. Methods All cases were performed routine paraffin sections, HE staining and immunohistochemical staining for CEA, EMA, AFP, ER, AE1, AE3, CA19 9, and Ki 67. Results There were 2 cases of squamous cell carcinoma and 5 cases of adenosquamous carcinoma in 7 cases. The tumors were infiltrating, involving adjacent organs, with obvious necrosis, inflammation, and stones. Adjacent epithelial hyperplasia, metaplasia, atypical hyperplasia, and carcinoma in situ, and there is a transitional or migratory relationship with invasive carcinoma. Immunohistochemistry showed that 7 cases of EMA, AE1, AE3 strong positive, CEA gallbladder epithelial and adenosquamous carcinoma strong positive and weak expression of squamous cell carcinoma. ER adenosquamous carcinoma and squamous cell carcinoma are all expressed. CA19 9 gallbladder epithelium and adenosquamous carcinoma are strongly positive and squamous cell carcinoma is negative. Ki67 is positive in moderately-differentiated carcinomas and negative in well-differentiated carcinomas. Conclusion The cancer occurs in women. Chronic inflammation and cholelithiasis play a role in gallbladder cancer. Adjacent epithelial dysplasia, carcinoma in situ, and invasive carcinoma have transitions, suggesting that epithelial hyperplasia or metaplasia is also an important factor in the development of gallbladder cancer. CA19 9 is of significance in identifying adenosquamous carcinoma and squamous cell carcinoma. Ki 67, ER and AFP are helpful in predicting cell proliferation, differentiation, malignancy and prognosis.