临床医学论文-原发性胆囊混合性类癌的临床病理诊断与鉴别诊断.docVIP

临床医学论文-原发性胆囊混合性类癌的临床病理诊断与鉴别诊断 ????????????? 作者：任刚，于国，刘丽威，晋薇 【摘要】? 　　目的 探讨原发性胆囊混合性类癌的临床病理诊断及鉴别诊断。方法 对1例胆囊混合性类癌的临床资料进行临床病理学分析及免疫组化观察，并复习相关文献。结果 肿瘤病理大体上呈灰白色巨块状，发生在胆囊颈部，大小10 cm×9 cm×9 cm。光镜下肿瘤由两部分组成，大部分由大小一致的圆形、多角形小细胞组成，细胞排列成岛状、巢状等器官样结构；另一部分呈中分化腺癌形态特点。小细胞界限不清楚，核圆，细胞质颗粒状嗜酸性，可见中等大小核仁。免疫组化染色显示肿瘤细胞：CgA、Syn及NSE均强阳性。诊断为胆囊混合性类癌。结论 原发性胆囊类癌是一种少见的原发于胆囊的恶性肿瘤，胆囊混合性类癌更加罕见。病理形态及免疫组化检查是胆囊类癌确诊的关键,明确诊断对肿瘤的治疗及预后有重要意义。 【关键词】? 胆囊肿瘤 类癌瘤 混合性类癌 临床病理学 　　Abstract： Objective? To explore the clinicopathological and differential diagnosis of primary combined carcinoid in gallbladder. Methods? One case of primary combined carcinoid in gallbladder was studied with clinicopathology and immunohistochemistry, and the pertinent literature was meanwhile reviewed. Results? The tumor was located at the neck of gallbladder and looked like a gray huge mass by macroscopy. The largest diameter of the tumor was 10 centimeters. By light microscopy the tumor was composed of two parts. Main part consisted of small round or polygon tumor cells with an island or nestlike arrangement of organic structure. The other showed moderately differentiated characteristics. Small tumor cells’ boundaries were dim and the cells’nuclei were round. Granular cytoplasm appeared acidophilic with moderate nucleolus in it. Immunohistochemical staining showed that the small neoplastic cells were strongly positive for NSE, Syn and CgA. The final diagnosis was combined carcinoid of the gallbladder. Conclusion? As a malignant tumor, primary carcinoid of gallbladder is rare and the type of combined carcinoid is much rarer. Clinicopathology and immunohistochemistry act as the key to the confirmed diagnosis, which is significant to the therapy and the prognosis of the tumor. 　　Key? words： galbladder neoplasm; carcinoid tumor; combined carcinoid; clinicopathology 　　原发性胆囊混合性类癌是一种罕见的原发于胆囊的恶性肿瘤，国内外文献报道较少，其临床病理容易和其他肿瘤相混淆。现结合1例胆囊混合性类癌的临床及病理学资料，同时复习相关文献，进行临床病理学研究，探讨其诊断要点来指导治疗及判断预后。 　　1? 材料和方法 　　1.1? 一般资料? 患者，女性，43岁，于3个月前无明显诱因出现右上腹痛，无寒战发热，无恶心、偶有呕吐