肝囊腺癌的细针吸取细胞学诊断及文献复习  

Fine needle aspiration cytology of hepatobiliary cystadenocarcinoma

作　　者：王利霞[1] 施红旗[1] 朱寿田[1] 

机构地区：[1]金华市中心医院,浙江金华321000

出　　处：《肝胆胰外科杂志》2009年第4期279-281,284,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨肝内胆管囊腺癌的穿刺方法,结合文献复习并总结其术前细胞学诊断特点。方法2例肝脏囊实性占位患者在B超引导下行细针吸取细胞学(fine needle aspiration cytology,FNAC)检查,抽取囊液离心涂片,实质区吸取组织颗粒涂片,常规HE染色,部分吸取组织制作细胞蜡块,切片行HE染色及黏液AB染色,光镜观察,并与术后组织切片对照。结果2例患者均未出现出血、感染等并发症,两者均抽出多量淡咖啡色及淡黄色黏稠液体,囊液未找到肿瘤细胞;实质区穿刺涂片细胞丰富,上皮细胞形成团状或乳头状,核大深染、重叠拥挤,可见细胞异型。细胞蜡块切片可见腺管状、乳头状、团状的腺上皮,细胞排列杂乱无极性,AB染色显示背景及胞质内淡蓝色黏液的存在。结合影像学及临床资料,2例FNAC诊断考虑为胆管黏液性囊腺癌(例1结合细胞蜡块切片考虑黏液性乳头状囊腺癌)。穿刺诊断与术后组织切片基本一致。结论结合影像学及临床资料,B超引导下的肝脏FNAC是术前诊断肝囊腺癌的一种安全有效的检查方法,制作细胞蜡块有利于诊断的进一步完善。有关肝囊腺癌与囊腺瘤的FNAC的鉴别有待进一步积累资料。Objective To investigate the fine needle aspiration cytology （FNAC） features of hepatobiliary cystadenocarcinoma. Methods Two cases of hepatobiliary cystadenocarcinoma diagnosed by FNAC were stud,＂ied. FNA was performed under ultrasound guidance. The smears and cell blocks （CB） of solid portion were made. The smears were stained with routine H＆E methods and the slices of CB were stained with H＆E and AB methods. The cytologic findings were described and compared with corresponding histological features. Re,＂sults Neither hemorrhage nor infection were found after the examination. Much glutinous liquid was aspirated in two cases. Abundant cells were observed in the FNAC smears. The cytologic features revealed hypercellular smear, sheets and clusters of cells with some papillary configurations and dysplastic nuclear features. The slices of CB revealed glandular epithelium were irregularly arranged in clusters or papillary clusters. The AB stain showed mucinous background and clusrers of carcinoma cells contained mucoitin sulfate. Two cases FNAC were diagnosed hepatobiliary cystadenocarcinoma which was conformed histologically on the excised specimens. Conclusion FNAC is a safe and effective approach for the diagnosis of hepatobiliary cystadeno,＂carcinoma by a combination of radiologic and clinical findings. CB making is useful in differential diagnosis.

关 键 词：肝胆管 囊腺瘤 细针 细胞学 细胞蜡块 

分 类 号：R735.7[医药卫生—肿瘤]