结石性胆囊炎患者胆囊粘膜病变分析

目的　探讨结石性胆囊炎患者胆囊粘膜病变与临床的关系。方法　应用组织化学技术 ,对连续收集的 1 0 0例结石性胆囊炎患者的胆囊标本进行观察。按年龄和结石病史不同进行分组比较。结果　 53例粘膜上皮出现化生 ,1 9例出现不典型增生 ,其中重度不典型增生 2例。化生和不典型增生的发生率与患者的年龄、结石病史呈正相关。年龄大于 50岁、结石病史超过 5年 ,胆囊粘膜上皮化生和不典型增生的发生率明显增高。结论　结石是引起胆囊粘膜上皮化生和不典型增生的主要原因。年龄大于 50岁、结石病史超过 5年是胆囊癌发生的高危因素     

胆结石对胆囊粘膜的病理损害及其与胆囊癌关系的研究

研究结石对胆囊粘膜的病理损害及这一过程中细胞DNA和AgNOR含量的改变,以探讨各型病理改变在胆囊癌发病中的作用。方法:对165例连续切除的胆囊标本进行病理及组化研究。结果:合并结石时胆囊粘膜的单纯增生、不典型增生、胆囊癌发生率分别为75.2％、19.33％和5.4％;结石引起的化生率为38.8％;胆囊粘膜从单纯增生到轻、中、重度不典型增生及胆囊癌的AgNOR颗粒及面积与DNA倍体含量逐步增高;50岁以上结石患者的化生、不典型增生、DNA及AgNOR含量均明显增加。结论:胆囊结石病例的不典型增生明显增多,推测不典型增生是胆囊癌的重要癌前病变,50岁以上的结石患者胆囊癌风险明显增加。     

胆囊上皮癌变病理形态学与CD44基因蛋白表达

目的: 研究慢性胆囊炎、胆囊腺上皮异型增生到癌变过程中形态及其与CD44基因表达的关系. 方法: 采用病理组织学和免疫组织化学S-P法检测95例慢性胆囊炎、慢性胆囊炎壁肥厚伴腺上皮异型增生和胆囊炎后壁肥厚型腺癌的CD44基因表达. 结果: 胆囊壁增厚者粘膜上皮部分或大部分脱失,形成代偿性区域性增生集中,伴有不同程度的异型性.CD44基因蛋白在慢性胆囊炎中均为阴性表达,胆囊壁肥厚伴腺上皮异型增生Ⅰ级、Ⅱ级和Ⅲ级的表达分别为18.8%、21.4%和27.3%,结果显示:胆囊炎壁肥厚随着腺上皮异型增生程度加重,而CD44基因蛋白阳性表达率随之递增.慢性胆囊炎后壁肥厚型腺癌CD44阳性表达为57.1%,阳性强度增加,阳性细胞数增多. 结论: 胆囊壁肥厚是重要的癌前病变,胆囊壁肥厚或增厚的结节在1.5 cm以上者应采取手术切除.     

胆囊病变时bcl-2和p16蛋白产物的表达和意义

以２５例胆囊粘膜异型增生和４０例胆囊腺癌标本用免疫组化方法观察ｂｃｌ－２和ｐ１６蛋白的表达,并与正常胆囊粘膜比较。结果;在正常胆囊粘膜中均未ｂｃｌ－２和ｐ１６表达,而胆囊粘膜上皮导型增生及胆囊腺癌组织中,两者的表达阳性率较正常组织明显增高,且ｂｃｌ－２和ｐ１６蛋白的阳笥率随着异型增生程度的增高而增加;ｐ１６的表达还与胆囊腺癌之浸润程度及淋巴结转移有关。     

胆囊癌和癌前病变的细胞凋亡研究

我们采用免疫组化ＳＡＢＣ法和原位细胞凋亡 (ＴＵＮＥＬ)技术 ,对胆囊良、恶性病变进行检测 ,探讨胆囊腺上皮异型增生和胆囊癌的发生、发展及其预后情况 ,为外科治疗提供病理学依据。材料与方法1.研究对象 :本组 2 7例慢性胆囊炎伴腺上皮异型增生 ,其中胆囊腺瘤伴腺上皮异型增生 18例和胆囊壁弥漫性或结节状增厚 9例。组织学所见胆囊乳头状腺瘤和管状腺瘤均伴有Ⅰ～Ⅲ级异型增生。胆囊壁增厚的病例可见粘膜上皮部分或大部分脱失 ,大量纤维组织增生 ,伴有以淋巴细胞、浆细胞为主的炎细胞浸润 ,淋巴滤泡形成 ;罗阿窦下延 ,可深达肌层或穿过肌…     

胆囊结石时胆囊粘膜的病理损害及其与胆囊癌的关系

目的 研究胆囊结石时胆囊粘膜的病理损害过程中细胞ＤＮＡ及核仁形成体区嗜银蛋白（Ａｇｎｏｒ）含量的改变,探讨各型病理改变在胆囊癌发病中的位置。方法 应用免疫组织化学方法对１５６例胆囊结石及９例合并结石的胆囊癌标本进行对照研究。结果 胆结石引起胆囊粘膜典型增生、非典型增生及胆囊癌的发生率分别为７５．１５％、１９．３９％、５．４５％。引起粘膜的肠上皮化生发生率为３８．７８％。从单纯增生、非典型增生到胆囊癌细胞Ａｇｎｏｒ蛋白及ＤＮＡ含量逐级增高。结论 胆囊结石可引起不同程度的粘损伤,粘膜的非典型增生为胆囊癌的癌前病变。     

肝内结石时胆囊的改变及作用

采用粘液组织化学及凝集素免疫组织化学的方法对15例肝内结石病人(其中5例伴有胆囊结石)及4例正常人的肝内胆管和胆囊进行了研究。结果表明肝内结石病人肝内胆管壁内粘液腺大量增生,浆液腺及胆管上皮出现粘液化改变。胆囊粘膜在不伴有胆囊结石时结构完整,上皮粘液化程度轻,壁内腺体增生不明显;伴有胆囊结石时可出现部分破坏脱落,上皮粘液化程度重,壁内粘液腺轻度增生。肝内胆管与胆囊在凝集素受体类型表达上存在一致性,阳性范围与粘液组织化学染色阳性范围相对应,均以岩藻糖及半乳糖含量最丰富。故认为肝内结石成因在肝内,胆囊主动参与了所伴胆囊结石的形成。但肝内结石手术时不存在一律行胆囊切除的形态学基础。     

酒精性肝硬变病人的胆石病的自然过程

酒精中毒性肝硬变病人的胆石病的处理是普通外科医生面临的一个难题。为了探讨肝硬变病人的胆石病自然发展过程,作者从1865例肝硬变病人中发现32例具有肝硬变和胆石病,其中29例做了肝活体组织检查,证明有肝硬变,另3例虽无活体组织检查,但有静脉曲张、脑病或腹水。诊断胆石病时的平均年龄为50岁(19～67岁)。女性14例(44%),男性18例(56%),男:女=1:3。胆石病的诊断主要根据 B 型超声断层(28例),ERCP(2例),口服胆囊造影(1例)和手术检查(1例)。病人的主要症状和体征有肝脏肿大(78%),腹水(59%),脾肿大(69%),黄疸(69%),脑病,静脉曲张(47%)急性胰腺炎(25%)。     

胆囊癌与胆囊节段型腺肌病的关系

作者于6年间研究了3197例切除的胆囊标本,其中279例标本有腺肌病,发生率为8.7%(其它报道为0.8～33.3%)。胆囊腺肌病的病变特征是:胆囊壁增厚,壁内有增生、扩张的胆囊粘膜窦,窦的周围有增生而排列混杂的纤维肌肉组织。根据标本的肉眼所见特征,作者把腺肌病分成三种类型:(1)节段型—在增厚的胆囊中段常出现一个环状狭缩,以致胆囊形似葫芦,从而把胆囊腔分隔成互相连通的两个小腔(即狭缩远端的基底腔和狭缩近端的颈腔);(2)基底型—在胆囊顶端的粘膜上有一半球状隆起,其中央有一酒窝状小凹;(3)弥散型—整个胆囊壁呈弥漫性增厚。本文分析的279例腺肌病中,男性居多,有154例,平均年龄为55.8岁。其中,节段型188例(67%),基底型82例(30%),弥散型9例(3%)。人们一直认为腺肌病与胆囊癌共存的情况极为少见,仅有少数报道,故认为是偶发现象。而且文献上     

胆囊结石病人胆囊颈和胆囊管的组织学和组织化学研究

采用组织化学及组织学的方法对15例胆囊结石病人和5例正常人的胆囊颈和胆囊管进行了研究。结果表明正常胆囊颈和胆囊管壁内也存在腺体和平滑肌。胆囊结石时胆囊颈和胆囊管壁增厚,管腔变窄,粘膜上皮呈现粘液分泌改变;壁内粘液腺增生,粘液(包括中性、硫酸和羧酸粘液)细胞数增多,但以硫酸粘液细胞增多更明显;平滑肌纤维有退化变性,胶原纤维数量增多,弹力纤维数量减少。作者推测,胆囊结石时胆囊颈和胆囊管的改变可能对结石的形成及胆囊的排空产生一定影响。     

Prevalence and risk factors for gallbladder neoplasia in patients with primary sclerosing cholangitis: evidence for a metaplasia-dysplasia-carcinoma sequence

Primary sclerosing cholangitis (PSC) carries an increased risk (10% to 20%) of hepatobiliary malignancy, especially cholangiocarcinoma (CC). Dysplasia, adenomas, and carcinomas of the gallbladder have been described in PSC but are less common than bile duct carcinomas. However, the prevalence and risk factors for gallbladder neoplasia among patients with PSC undergoing orthotopic liver transplantation (OLT) have not been well studied. We evaluated 72 gallbladders from 100 consecutive liver explants for PSC, including 66 cholecystectomies performed at the time of OLT and 6 performed before OLT. All specimens were totally embedded for histologic examination. We evaluated the following histologic features: presence of diffuse lymphoplasmacytic chronic cholecystitis, pyloric metaplasia, intestinal metaplasia, dysplasia (low-grade or high-grade), and adenocarcinoma. Gallbladder dysplasia and adenocarcinoma were correlated with several clinicopathologic parameters using Fisher exact test and t test, including: (1) sex, (2) age, (3) PSC duration, (4) inflammatory bowel disease (IBD) at time of OLT, and (5) concomitant bile duct dysplasia or carcinoma. Lymphoplasmacytic chronic cholecystitis was present in 35 (49%), pyloric metaplasia in 69 (96%), intestinal metaplasia in 36 (50%), dysplasia in 27 (37%; low-grade in 12 and high-grade in 15), and adenocarcinoma in 10 (14%; 2 with lamina propria invasion and 8 with invasion into muscularis or adventitia). Gallbladder carcinoma was associated with intrahepatic bile duct dysplasia (P=0.001), CC (P=0.023), and IBD (P=0.03). Gallbladder dysplasia was associated with hilar/intrahepatic bile duct dysplasia (P=0.0006), CC (P=0.028), IBD (P=0.0014), and older age at OLT (P=0.007). Neither gallbladder carcinoma nor dysplasia had a significant association with sex or PSC duration. These results indicate that complete histologic evaluation of gallbladders in patients undergoing transplantation for PSC yields high frequencies of inflammatory, metaplastic, and neoplastic changes. The strong correlation between gallbladder dysplasia/adenocarcinoma and bile duct dysplasia/CC supports the concept of a neoplastic "field effect" along the intrahepatic and extrahepatic biliary tract in PSC.     

Histogenesis of gallbladder cancer with special reference to metaplastic changes and distribution of various mucins and CEA

In order to study the histogenesis of gallbladder cancer, metaplastic changes and dysplasia in the mucosal epithelium were investigated in 30 cases of gallbladder cancer and 300 cases of chronic cholecystitis. Intestinal metaplasia was observed more frequently in the cases of cancer, both in cancerous and non-cancerous tissues, than those of chronic cholecystitis. In addition, CPS III type of mucin, which is preferably demonstrated in the pyloric glands, was observed in the tumor cells of 50% of cancers. Thus, gastric metaplasia as well as intestinal metaplasia seems to be important as a predisposing lesion to gallbladder cancer. By means of reconstruction method carried out on the specimens of cancer, multifocal gradual transition among metaplasia, dysplasia and cancer was observed and dysplasia is an important step in cancer development. As for mucin secretion, the rate of sialomucin-containing cells was notably high in the lesions of dysplasia and cancer, increasing in intensity in this order, accompanied with positive CEA. The results of the present study support the hypothesis that cancer arises from such pre-existing mucosal lesions as metaplasia and dysplasia.     

胆囊隆起性病变的临床分析

目的探讨胆囊隆起性病变中息肉、良性肿瘤和恶性肿瘤之间临床特点的差异性.方法回顾性总结325例胆囊隆起性病变的临床特点,对相关数据进行统计学处理.结果良性病变共308例,其中胆固醇息肉278例,其他类型息肉5例,腺瘤25例;恶性病变17例,其中腺瘤恶变2例,腺癌15例.息肉、腺瘤和腺癌组中年龄超过50岁的分别占36.0%、32.0%和82.4%,B超显示平均直径分别为8.5 mm、11.7 mm和31.1 mm,低回声分别占1.5%、0和52.9%,单发病灶分别占42.9%、68.0%和100%.结论息肉、腺瘤和腺癌三者之间在年龄、B超形态学改变上均有显著性差异.年龄,病变直径、数目、部位和B超回声表现可作为鉴别胆囊隆起性病变良恶性的根据.     

术中胆道造影在单纯胆囊结石手术治疗中的应用

目的 探讨术中胆道造影的价值。方法 对延安大学医学院附属医院的694例术中胆道造影的资料进行回顾性分析。结果 694例术中胆道造影有阳性发现的65例：伴胆道结石44例，其中22－50岁胆管结石的阳性率4．2％，50岁以后胆管结石的阳性率10．3％，50岁以后胆管结石的发病率随年龄增长而增高；胆囊管残留过长9例；肿囊管残余结石7例；胆道损伤2例；Mirizzi综合症3例。准确率98．0％。结论 术中胆道造影只要技术方法正确，不仅有利于残余结石的发现,还可判断胆道变异，及时发现胆道损伤。     

Routine versus selective histologic analysis of gallbladder specimens for the detection of incidental gallbladder cancers. A retrospective review over 9 years of activity with a special focus on patients' age

Background

Incidental gallbladder cancer (IGC) is an infrequent possibility in patients undergoing cholecystectomies. Routine histologic examination of all gallbladder specimens is the current approach to detect this disease. Our study presents the influence of age to perform a selective histologic analysis.

Methods

A retrospective review was conducted of all gallbladder specimens during the last 9 years in our hospital. The medical notes were retrieved for cases of IGC or dysplasia and perioperative data were collected.

Results

A total of 3,330 cholecystectomies were conducted over the study period, 3,041 for gallstone disease. Twelve patients were found with dysplasia and 13 patients with IGC, all of them occurred in gallbladders removed for gallstone diseases. There were 18 men with a median age of 65 years (range 18 to 85). Median age for cancer patients was 70 years (range 51 to 85) and 54 years for dysplasia (range 18 to 75). No patient below the age of 51 years (n = 1,464) experienced IGCs.

Conclusion

Age should be considered as an additional factor for a selective approach to the histologic analysis of all gallbladder specimens following cholecystectomies.     

Factors Associated with Premalignant Epithelial Changes in Chronic Calculous Cholecystitis: A Case–Control Study

Introduction

Gallstones are known to be associated with premalignant changes in the gallbladder epithelium that range from atypical hyperplasia, metaplasia, dysplasia to carcinoma. Recognition of factors associated with these changes in patients with gallstones can potentially be helpful in identifying patients to whom prophylactic cholecystectomy can be offered to reduce the chances of developing carcinoma.

Objective

To identify factors associated with premalignant epithelial changes including atypical hyperplasia, metaplasia, and dysplasia in gallbladder mucosa in patients with chronic calculus cholecystitis.

Materials and methods

This was retrospective case–control study conducted over a period of 10 years from 2004 to 2014. Cases were patients with reported histopathological premalignant epithelial changes along with chronic calculus cholecystitis, and controls were patients without premalignant epithelial changes but chronic calculus cholecystitis. Controls were twice the number of the cases.

Results

Over study period, 92 patients were reported to have premalignant epithelial changes on gall bladder histopathology for whom 184 controls were selected. Of cases, 61 (66%) patients had atypical hyperplasia, while metaplasia and dysplasia were present in 26 (28%) and 5 (5%) cases, respectively. Mean age was 47.5 ± 14.5 years, and 74% of the study population were female. Wall thickness of more than 3 mm (OR = 4.14, p value < 0.001) turned out to be statistically significant independent variables associated with premalignant lesions in gallbladder mucosa.

Conclusion

Odds of premalignant epithelial change in gall bladder mucosa in patients with gall bladder wall thickness of more than 3 mm is four times the odds of patients with wall thickness less than 3 mm, and the effect is statistically significant. Prophylactic cholecystectomy should be considered for this group of patients.