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Cholangiocarcinoma with intraductal tubular growth pattern versus intraductal papillary growth pattern.

伴管内管状生长或管内乳头状生长的胆管癌

Tsukahara T,Shimoyama Y,Ebata T,Yokoyama Y,Igami T,Sugawara G,Mizuno T,Yamaguchi J,Nakamura S,Nagino M
阅读:885 Modern PathologyMar 2016; 29 (3): 210 - 314:293-301 

Abstract

Intraductal neoplasms of the bile duct are macroscopically characterized by exophytic or polypoid growth patterns and have a favorable prognosis. Although some tumors with a predominantly tubular microscopic pattern have been reported, they have not been well characterized clinicopathologically. The purpose of the present study was to compare the newly recognized cholangiocarcinoma with an intraductal tubular growth pattern and cholangiocarcinoma with an intraductal papillary growth pattern and to investigate the pathological and prognostic significance of the former. This study analyzed 161 patients with tumors with exophytic or polypoid growth patterns from a large series of 733 cholangiocarcinoma cases surgically resected from January 1998 to May 2013. The study patients were divided into two groups: those whose tumors showed a predominantly tubular growth pattern (n=52) and those whose tumors exhibited a predominantly papillary growth pattern (n=109). Tubular growth pattern was associated with combined vascular resection and the absence of macroscopic mucin. Several histological indexes were significantly higher for the tubular growth pattern than the papillary one, including tubular adenocarcinoma, depth of invasion, microscopic lymphatic invasion, venous invasion, perineural invasion, and necrosis. Although the survival curves overlapped (P=0.693), the rate of liver metastasis was significantly higher for the tubular growth pattern than for the papillary one (P=0.012). Genomic DNA analysis focusing on somatic mutations in codons 12 and 13 of KRAS and codon 600 of BRAF revealed only one (4%) KRAS and no BRAF mutation among the 25 tubular cases examined. In conclusion, the tubular growth pattern exhibited differences in some histologic indexes, in addition to a higher hepatic metastasis rate and a lower KRAS mutation frequency, compared with the papillary growth pattern, but no difference in prognosis was observed. The distinctiveness of this tubular neoplasm should be further examined in the future.

摘要

胆管管内肿瘤大体呈外生性或息肉样生长方式,预后良好。虽然已报道一些肿瘤镜下主要呈管状生长,但其临床病理学特征仍不明确。本研究的目的是比较新近认识的伴管内管状生长的胆管癌和伴管内乳头状生长的胆管癌,并研究前者的临床病理学和预后意义。本研究分析161名伴外生性或息肉样生长的肿瘤,这些肿瘤来自1998年1月到2013年5月经外科手术切除的733例胆管癌病例。患者分成两组:主要以管状生长为主的肿瘤患者(n=52)和主要为乳头状生长的肿瘤患者(n=109)。管状生长方式与联合血管切除和大体缺乏粘液有关。管状生长肿瘤中几个组织学指征显著高于乳头状生长肿瘤,包括管状腺癌,浸润深度,镜下淋巴管浸润,脉管浸润,神经周浸润和坏死。虽然生存曲线有重叠(p=0.693),但管状生长肿瘤肝转移率显著高于乳头状生长肿瘤(p=0.012)。聚焦于KRAS密码子12和13及BRAF密码子600体系突变的基因组DNA分析显示仅1例(4%)出现KRAS突变,25例检测的管状病例无BRAF突变。总之,与乳头状生长相比,管状生长方式显示某些组织学指征差异,及高肝转移率和低KRAS突变率,但预后无差异。未来管状肿瘤的特殊性仍需进一步研究。

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