胆囊梭形细胞型未分化癌一例及文献复习

Undifferentiated Spindle Cell Carcinoma of the Gallbladder: A Case Report and Literature Review

摘要: 本文报道一例胆囊梭形细胞型未分化癌；患者，男，63岁，20天前因间断性上腹部疼痛就诊于当地医院，行B超提示：胆囊占位；为求进一步治疗于我院就诊；影像检查提示胆囊癌可能，术前考虑胆囊癌(T3期)可能，术中冰冻提示恶性梭形细胞肿瘤，故行胆囊癌根治术及肝部分切除术。大体示肿瘤位于胆囊腔内，呈息肉样生长，切面灰白灰红色，实性，质中；部分肝脏切面灰红色，质软，未见明显异常。镜下，肿瘤主要由梭形细胞组成，局部见少量高分化腺癌成分，核分裂象易见；免疫组化染色：梭形细胞同时表达波形蛋白(Vimentin)和细胞角蛋白(cytokeratin, CK)。胆囊梭形细胞型未分化癌是一种相对罕见的胆囊原发恶性肿瘤，临床症状不典型，发病率较低，术前诊断困难，明确诊断依赖于病理，恶性程度高，需予以重视。

Abstract: This article reports a case of undifferentiated spindle cell carcinoma of the gallbladder. The patient, a 63-year-old male, consulted a local hospital 20 days ago due to intermittent epigastric pain, and ultrasound showed that the gallbladder was occupied. In order to seek for further treatment, he consulted our hospital, and the image suggested that gallbladder cancer might be possible; pre-operative consideration was given to possible gallbladder cancer (stage T3) and intraoperative freezing suggestive of malignant spindle cell tumor, so radical cholecystectomy and partial hepa-tectomy for gallbladder cancer were performed. Grossly, the tumor was located in the lumen of the gallbladder, with polypoid growth, grayish-white and grayish-red in color, solid and medium in texture; part of the liver was grayish-red in color, soft in texture, and no obvious abnormality was seen. Under the microscope, the tumor was mainly composed of spindle cells, with a small amount of highly differentiated adenocarcinoma locally, and nuclear schizophrenia was easy to be seen. Immunohistochemical staining: the spindle cells expressed both vimentin and cytokeratin. Undif-ferentiated spindle cell carcinoma of the gallbladder is a relatively rare primary malignant tumor of the gallbladder with atypical clinical symptoms, low incidence, difficult preoperative diagnosis, de-finitive diagnosis relying on pathology, and high degree of malignancy, which needs to be taken se-riously.