胆囊鳞癌、腺鳞癌7例临床病理分析

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-67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胆囊上皮及腺鳞癌阳性而鳞癌弱表达，EP腺鳞癌，鳞癌均表达，CA19－9胆囊上皮及腺鳞癌旨阳性布鳞癌阴性，Ki-67在中一低分化癌中阳性，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-67,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。

Squamous cell carcinoma and adenosquamous carcinoma of the gallbladder: a clinicopathologic analysis of 7 cases

Objective To investigate the clinicopathologic characteristics and histogenesis of squamous cell carcinoma and adenosquamous carcinoma of the gallbladder. Methods Seven cases of carcinomas were analyzed with histopathologic and immunohistochemical techniqucs. Results There were 5 female and 2 male with range of agc from 47 to 79 years.Histologically,2 cases were classified as squamous cell carcinoma and 5,adenosquamous carcinoma.The tumors showed an invasive growth pattern, significant necrosis,inflammation and gall stones,with involvement in the liver and other adjacent tissues.All the cases existed proliferation,metaplasia, dysplasia, and carcinoma in situ in the neoplastic tissues.There also was a transition from benign to malignant components.Immunohistochemically,both glandular and squamous elements were stained strong positivities for EMA,AE 1,AE 3 and ER,but only glandular clement was positive for CA19-9.Adenocarcinoma element was much stronger stained for CEA and AFP than that of squamous cell carcinoma.Ki-67 staining sbowed positive in the moderate or low-differentiated carcinomas and negative in the well-differentiated ones. Conclusions The incidence of the carcinomas is higher in women than in men.Chronic choleocytitis and gallstones may play an important role in carcinogenesis of the gallbladder.The transition between atypical hyperplasia or dysplasia or carcinoma in situ and invasive carcinoma in adjacent mucosa of the tumors suggests that the lesions mentioned above are closely relative to the carcinogenosis.Ki-67,ER and AFP can be used to evaluate the degrees of the differentiation,malignancy and prognosis.