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Invasive Papillary Carcinomas of the Extrahepatic Bile Ducts: a Clinicopathologic and Immunohistochemical Study of 13 Cases

机译:肝外胆管浸润性乳头状癌:13例临床病理和免疫组织化学研究

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Carcinomas of the extrahepatic bile ducts are uncommon neoplasms that are morphologically heterogeneous and associated with a poor prognosis. We have previously shown that the noninvasive and minimally invasive papillary carcinomas of the extrahepatic bile ducts behave as in situ carcinomas and are associated with a better prognosis. We reviewed the clinical records of 13 patients with invasive papillary carcinomas of the extrahepatic bile ducts and analyzed the microscopic features and selected immunohistochemical reactivity (p53, Mib-1, and Dpc4) that might correlate with patient survival. In addition, we present the updated SEER (Surveillance, Epidemiology, and End Results) data of the National Cancer Institute for the invasive extrahepatic bile duct carcinomas compiled from 1975 to 1998. The 13 patients with papillary carcinoma had a male to female ratio of 1:1, and their ages ranged from 33 to 89 years. Painless jaundice and abdominal pain were the most common complaints. Five tumors were located in the distal portion, one in the mid portion, and six in the proximal portion of the common bile duct. One papillary carcinoma arose in the right hepatic duct. The Whipple procedure was performed in six patients, common bile duct resection in six, and right hepatic lobectomy in one. The cell phenotype of the papillary carcinomas was biliary in nine and intestinal in three. One tumor had both biliary and intestinal phenotypes. Four tumors dedifferentiated (two to undifferentiated small cell carcinomas, one to small [oat] cell carcinoma, and one to giant cell carcinoma). Two papillary carcinomas extended into the pancreas and three into the liver. Only one patient had lymph node metastases at presentation. Follow-up was available in 10 patients. Six patients died of disease from 2 weeks to 2 years and 1 month after surgery. Four patients are alive with no evidence of disease from 4 months to 8 years and 8 months after surgery. Of 174 invasive papillary carcinomas compiled by the SEER program, 71 were confined to the ductal wall, and 61 had regional lymph node metastases. Papillary carcinomas confined to the ductal wall have better 10-year relative survival rates than adenocarcinomas limited to the wall (21% versus 12%). Likewise papillary carcinomas with lymph node metastasis have better prognosis than adenocarcinoma with nodal metastases (10-y survival rate of 12% versus 5%). Currently, the histologic type and the stage of the disease are the most important prognostic factors in these papillary carcinomas. Separation of invasive and noninvasive or minimally invasive papillary carcinoma is critical in estimating the patient outcome. Our findings suggest that there is no correlation between p53, Ki-67, and Dpc4 expression in these tumors and survival of the patients.
机译:肝外胆管癌是罕见的肿瘤,其形态学上异质且预后不良。先前我们已经表明,肝外胆管的非侵入性和微创性乳头状癌表现为原位癌,并与更好的预后相关。我们回顾了13例肝外胆管浸润性浸润性乳头状癌患者的临床记录,并分析了可能与患者生存率相关的微观特征和选定的免疫组化反应性(p53,Mib-1和Dpc4)。此外,我们还提供了1975年至1998年美国国家癌症研究所针对侵袭性肝外胆管癌编写的更新的SEER(监测,流行病学和最终结果)数据。13例乳头状癌患者的男女比例为1 :1,他们的年龄介于33至89岁之间。无痛性黄疸和腹痛是最常见的主诉。在胆总管的远端部分中有五个肿瘤,在中间部分中有一个,在近端部分中有六个。右肝管出现1例乳头状癌。 Whipple手术治疗6例,胆总管切除术6例,右肝叶切除术1例。乳头状癌的细胞表型为胆管癌的有9个,肠癌的有3个。一种肿瘤同时具有胆道和肠道表型。四个肿瘤已分化(两个到未分化的小细胞癌,一个到小燕麦细胞癌,一个到大细胞癌)。两种乳头状癌扩展到胰腺,另外三种扩展到肝。就诊时只有一名患者发生淋巴结转移。随访10例。术后2周至2年零1个月,有6名患者死于疾病。术后4个月至8年和8个月,有4名患者活着,没有疾病迹象。由SEER程序编辑的174例浸润性乳头状癌中,有71例局限于导管壁,61例具有区域淋巴结转移。局限于导管壁的乳头状癌比限于导管壁的腺癌具有更好的10年相对生存率(21%和12%)。同样,具有淋巴结转移的乳头状癌比具有淋巴结转移的腺癌具有更好的预后(10年生存率分别为12%和5%)。目前,在这些乳头状癌中,组织学类型和疾病分期是最重要的预后因素。浸润性和非浸润性或微浸润性乳头状癌的分离对于评估患者预后至关重要。我们的发现表明,这些肿瘤中的p53,Ki-67和Dpc4表达与患者生存率之间无相关性。

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