胆囊肝样腺癌的镜下特征：相互交织移行的肝样分化区和腺癌区_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

方会娟 ,  徐小艳

河南中医药大学第五临床医学院（郑州人民医院）病理科（郑州 450053）;

Corresponding author：

徐小艳, Email: xxy123com@sina.com

Keywords：

胆囊肝样腺癌; 病理诊断; 治疗; 预后

DOI：

10.7507/1007-9424.202312053

Video：

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目的总结胆囊肝样腺癌（hepatoid adenocarcinoma，HAC）的临床及病理学特点、鉴别诊断、治疗、预后等情况。方法收集郑州人民医院收治的1例胆囊HAC患者的临床表现、病理特征及治疗和预后情况并复习国内外文献。结果患者为一57岁男性。CT见胆囊占位；血清甲胎蛋白（alpha-fetoprotein，AFP）207.23 μg/L；术后组织病理学检查结果显示肿瘤由95%的实性片状区域和5%的腺样结构组成，实性片状区域胞浆透亮或嗜碱性，胞核大、核仁明显，核分裂象易见，部分区域血管丰富，可见肿瘤性坏死。免疫表型显示实性片状区域AFP、细胞角质蛋白19、热休克蛋白70、谷氨酰胺合成酶、Glypican-3均弥漫阳性，Hepatocyte少量阳性；腺样结构细胞角质蛋白19阳性。诊断胆囊HAC伴少量腺癌。术后随访21个月，患者死亡。复习文献报道36例胆囊HAC（包括本例），男14例，女22例，男∶女约为1∶1.57；年龄38～80岁。肿瘤长径1.1～12.0 cm。位于胆囊底6例、胆囊体8例、胆囊颈6例、底-颈或底-体2例。血清AFP正常9例，升高18例。免疫表型AFP、Glypican-3、Hepatocyte至少1项阳性。随访1～60个月，死亡11例，2例发生肝转移。结论胆囊HAC是一种高度恶性肿瘤，治疗以手术切除为主，预后差，该肿瘤形态学少见，鉴于其临床表现、治疗及预后有别于普通腺癌，其最终依赖于病理诊断，因此认识其形态学及免疫表型至关重要。

Citation： 方会娟, 徐小艳. 胆囊肝样腺癌的镜下特征：相互交织移行的肝样分化区和腺癌区. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(4): 474-478. doi: 10.7507/1007-9424.202312053 Copy

1.	Watanabe M, Hori Y, Nojima T, et al. Alpha-fetoprotein-producing carcinoma of the gallbladder. Dig Dis Sci, 1993, 38(3): 561-564.
2.	Vardaman C, Albores-Saavedra J. Clear cell carcinomas of the gallbladder and extrahepatic bile ducts. Am J Surg Pathol, 1995, 19(1): 91-99.
3.	李树庆, 钟延丰, 廖松林. 胆囊肝样腺癌一例. 中华病理学杂志, 1999, 28(5): 399.
4.	Nakashima H, Nagafuchi K, Satoh H, et al. Hepatoid adenocarcinoma of the gallbladder. J Hepatobiliary Pancreat Surg, 2000, 7(2): 226-230.
5.	Sakamoto K, Kimura N, Tokumura H, et al. Hepatoid adenocarcinoma of the gallbladder. Histopathology, 2005, 47(6): 649-651.
6.	van den Bos IC, Hussain SM, Dwarkasing RS, et al. Hepatoid adenocarcinoma of the gallbladder: a mimicker of hepatocellular carcinoma. Br J Radiol, 2007, 80(960): e317-e320. doi: 10.1259/bjr/97773297.
7.	Gakiopoulou H, Givalos N, Liapis G, et al. Hepatoid adenocarcinoma of the gallbladder. Dig Dis Sci, 2007, 52(12): 3358-3362.
8.	Koswara T, Marwoto W, Siregar NC, et al. Hepatoid carcinoma of the gallbladder. Acta Med Indones, 2007, 39(4): 179-182.
9.	林敏, 叶钦, 陈健, 等. 胆囊肝样腺癌一例. 中华医学杂志, 2008, 88(1): 69-70.
10.	Sakamoto K, Monobe Y, Kouno M, et al. Hepatoid adenocarcinoma of the gallbladder: Case report and review of the literature. Pathol Int, 2004, 54(1): 52-56.
11.	Ellouze S, Slim C, Ahmad G, et al. Hepatoid adenocarcinoma of the gallbladder. World J Surg Oncol, 2011, 9: 103. doi: 10.1186/1477-7819-9-103.
12.	Karayiannakis AJ, Kakolyris S, Giatromanolaki A, et al. Hepatoid adenocarcinoma of the gallbladder : case report and literature review. J Gastrointest Cancer, 2012, 43 Suppl 1: S139-S144. doi: 10.1007/s12029-011-9326-5.
13.	Lee JH, Lee KG, Paik SS, et al. Hepatoid adenocarcinoma of the gallbladder with production of alpha-fetoprotein. J Korean Surg Soc, 2011, 80(6): 440-444.
14.	杨岳, 孙冬林, 邹岩, 等. 胆囊肝样腺癌合并甲胎蛋白升高一例. 中华肝胆外科杂志, 2014, 20(9): 643, 669.
15.	李扬, 刘志艳, 刘新农, 等. 胆囊肝样腺癌伴肝脏、网膜多发转移一例. 中华肝胆外科杂志, 2015, 21(4): 247, 252.
16.	Devi NR, Sathyalakshmi R, Devi J, et al. Hepatoid adenocarcinoma of the gall bladder—A rare variant. J Clin Diagn Res, 2015, 9(8): ED09-ED10. doi: 10.7860/JCDR/2015/10799.6324.
17.	狄纯婵, 周平. 胆囊肝样腺癌并淋巴结转移一例. 中华病理学杂志, 2016, 45(2): 125-126.
18.	张鹏, 王禹, 廖佳桦, 等. 胆囊肝样腺癌行胆囊癌根治术1例. 癌症进展, 2017, 15(12): 1493-1494.
19.	司友娇, 赵凯凯, 黄九宁, 等. 胆囊肝样腺癌1例. 中国医学影像技术, 2017, 33(9): 1440.
20.	Yoshioka S, Ishida M, Okano K, et al. Cytological features of hepatoid adenocarcinoma of the gallbladder: A case report with immunocytochemical analyzes. Diagn Cytopathol, 2018, 46(8): 711-715.
21.	Qian X, Zhou D, Gao B, et al. An alpha-fetoprotein-negative hepatoid adenocarcinoma of the gallbladder with squamous differentiation. Hepatobiliary Surg Nutr, 2020, 9(1): 116-118.
22.	陈佳菁, 林慧, 陈婷婷, 等. 胆囊肝样腺癌1例. 诊断病理学杂志, 2020, 27(5): 359-360.
23.	吴嫣, 周先荣, 袁静萍, 等. 肺、胆囊、膀胱原发肝样腺癌三例临床病理学观察. 中华病理学杂志, 2021, 50(2): 137-139.
24.	张娟, 冯亚园, 霍雷, 等. 胆囊肝样腺癌的临床影像病理分析. 中华消化病与影像杂志(电子版), 2022, 12(4): 210-214.
25.	Li Z, Jiang Q, Chen X, et al. Primary hepatoid adenocarcinoma of gallbladder with MB21D2/GALNT12/ARID2 mutations: a case report. Front Endocrinol (Lausanne), 2022, 12: 791153. doi: 10.3389/fendo.2021.791153.
26.	Iwasaki S, Hidaka H, Uojima H, et al. A case of successful treatment with lenvatinib in primary hepatoid adenocarcinoma of the gallbladder that was difficult to distinguish from hepatocellular carcinoma. Clin J Gastroenterol, 2022, 15(6): 1108-1114.
27.	李巧转, 周志华, 王倩, 等. 胆囊肝样腺癌4例临床病理分析. 武警医学, 2023, 34(1): 54-57.
28.	王鹤霖, 戴朝六. 胆囊肝样腺癌的诊断与治疗现状. 中华消化外科杂志, 2017, 16(11): 1163-1166.
29.	Metzgeroth G, Ströbel P, Baumbusch T, et al. Hepatoid adenocarcinoma—review of the literature illustrated by a rare case originating in the peritoneal cavity. Onkologie, 2010, 33(5): 263-269.

1. Watanabe M, Hori Y, Nojima T, et al. Alpha-fetoprotein-producing carcinoma of the gallbladder. Dig Dis Sci, 1993, 38(3): 561-564.
2. Vardaman C, Albores-Saavedra J. Clear cell carcinomas of the gallbladder and extrahepatic bile ducts. Am J Surg Pathol, 1995, 19(1): 91-99.
3. 李树庆, 钟延丰, 廖松林. 胆囊肝样腺癌一例. 中华病理学杂志, 1999, 28(5): 399.
4. Nakashima H, Nagafuchi K, Satoh H, et al. Hepatoid adenocarcinoma of the gallbladder. J Hepatobiliary Pancreat Surg, 2000, 7(2): 226-230.
5. Sakamoto K, Kimura N, Tokumura H, et al. Hepatoid adenocarcinoma of the gallbladder. Histopathology, 2005, 47(6): 649-651.
6. van den Bos IC, Hussain SM, Dwarkasing RS, et al. Hepatoid adenocarcinoma of the gallbladder: a mimicker of hepatocellular carcinoma. Br J Radiol, 2007, 80(960): e317-e320. doi: 10.1259/bjr/97773297.
7. Gakiopoulou H, Givalos N, Liapis G, et al. Hepatoid adenocarcinoma of the gallbladder. Dig Dis Sci, 2007, 52(12): 3358-3362.
8. Koswara T, Marwoto W, Siregar NC, et al. Hepatoid carcinoma of the gallbladder. Acta Med Indones, 2007, 39(4): 179-182.
9. 林敏, 叶钦, 陈健, 等. 胆囊肝样腺癌一例. 中华医学杂志, 2008, 88(1): 69-70.
10. Sakamoto K, Monobe Y, Kouno M, et al. Hepatoid adenocarcinoma of the gallbladder: Case report and review of the literature. Pathol Int, 2004, 54(1): 52-56.
11. Ellouze S, Slim C, Ahmad G, et al. Hepatoid adenocarcinoma of the gallbladder. World J Surg Oncol, 2011, 9: 103. doi: 10.1186/1477-7819-9-103.
12. Karayiannakis AJ, Kakolyris S, Giatromanolaki A, et al. Hepatoid adenocarcinoma of the gallbladder : case report and literature review. J Gastrointest Cancer, 2012, 43 Suppl 1: S139-S144. doi: 10.1007/s12029-011-9326-5.
13. Lee JH, Lee KG, Paik SS, et al. Hepatoid adenocarcinoma of the gallbladder with production of alpha-fetoprotein. J Korean Surg Soc, 2011, 80(6): 440-444.
14. 杨岳, 孙冬林, 邹岩, 等. 胆囊肝样腺癌合并甲胎蛋白升高一例. 中华肝胆外科杂志, 2014, 20(9): 643, 669.
15. 李扬, 刘志艳, 刘新农, 等. 胆囊肝样腺癌伴肝脏、网膜多发转移一例. 中华肝胆外科杂志, 2015, 21(4): 247, 252.
16. Devi NR, Sathyalakshmi R, Devi J, et al. Hepatoid adenocarcinoma of the gall bladder—A rare variant. J Clin Diagn Res, 2015, 9(8): ED09-ED10. doi: 10.7860/JCDR/2015/10799.6324.
17. 狄纯婵, 周平. 胆囊肝样腺癌并淋巴结转移一例. 中华病理学杂志, 2016, 45(2): 125-126.
18. 张鹏, 王禹, 廖佳桦, 等. 胆囊肝样腺癌行胆囊癌根治术1例. 癌症进展, 2017, 15(12): 1493-1494.
19. 司友娇, 赵凯凯, 黄九宁, 等. 胆囊肝样腺癌1例. 中国医学影像技术, 2017, 33(9): 1440.
20. Yoshioka S, Ishida M, Okano K, et al. Cytological features of hepatoid adenocarcinoma of the gallbladder: A case report with immunocytochemical analyzes. Diagn Cytopathol, 2018, 46(8): 711-715.
21. Qian X, Zhou D, Gao B, et al. An alpha-fetoprotein-negative hepatoid adenocarcinoma of the gallbladder with squamous differentiation. Hepatobiliary Surg Nutr, 2020, 9(1): 116-118.
22. 陈佳菁, 林慧, 陈婷婷, 等. 胆囊肝样腺癌1例. 诊断病理学杂志, 2020, 27(5): 359-360.
23. 吴嫣, 周先荣, 袁静萍, 等. 肺、胆囊、膀胱原发肝样腺癌三例临床病理学观察. 中华病理学杂志, 2021, 50(2): 137-139.
24. 张娟, 冯亚园, 霍雷, 等. 胆囊肝样腺癌的临床影像病理分析. 中华消化病与影像杂志(电子版), 2022, 12(4): 210-214.
25. Li Z, Jiang Q, Chen X, et al. Primary hepatoid adenocarcinoma of gallbladder with MB21D2/GALNT12/ARID2 mutations: a case report. Front Endocrinol (Lausanne), 2022, 12: 791153. doi: 10.3389/fendo.2021.791153.
26. Iwasaki S, Hidaka H, Uojima H, et al. A case of successful treatment with lenvatinib in primary hepatoid adenocarcinoma of the gallbladder that was difficult to distinguish from hepatocellular carcinoma. Clin J Gastroenterol, 2022, 15(6): 1108-1114.
27. 李巧转, 周志华, 王倩, 等. 胆囊肝样腺癌4例临床病理分析. 武警医学, 2023, 34(1): 54-57.
28. 王鹤霖, 戴朝六. 胆囊肝样腺癌的诊断与治疗现状. 中华消化外科杂志, 2017, 16(11): 1163-1166.
29. Metzgeroth G, Ströbel P, Baumbusch T, et al. Hepatoid adenocarcinoma—review of the literature illustrated by a rare case originating in the peritoneal cavity. Onkologie, 2010, 33(5): 263-269.

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胆囊肝样腺癌的镜下特征：相互交织移行的肝样分化区和腺癌区

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