Abstract: Diagnosis and treatment of mucinous adenocarcinoma of the gallbladder (report of 16 cases)        LIU Xiao-feng*, DENG Zheng-dong, WANG Jian-ming. *Department of Hepatobiliary and Pancreatic Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan 430064, China
Corresponding authors: DENG Zheng-dong, E-mail: dzd0915@tjh.tjmu.edu.cn; WANG Jian-ming, E-mail: wjm18jgm@
aliyun.com
Abstract    Objective    To analyze clinicopathological characteristics of patients with mucinous adenocarcinoma of the gallbladder（MAC），and to provide evidence for the clinical diagnosis and treatment of MAC. Methods    From January 2017 to January 2022，16 patients with MAC who underwent treatment in Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology were , retrospectively, analyzed to summarize clinicopathological features, diagnosis and treatment, and prognosis characteristics of MAC. The number of patients undergoing a radical operation and non-radical operation was 6 and 10 ,respectively, and that of chemotherapy and non-chemotherapy was 7 and 9 respectively. The differences in prognosis between groups were compared by a Log-rank test. Results    Among the 16 patients, there were 6 males and 10 females with ages of(56.9±11.6) years. The main clinical manifestations were abdominal pain, jaundice and so on. CA19-9 increased in 6 cases(4 of them were more than 1000.0 kU/L) and CEA increased in 8 cases. Ultrasound showed high echo in the gallbladder in 4 cases. The pathological examination after the operation of all patients was MAC with stromal mucin deposition constituting more than 50% of the tumor cells. All 16 patients were discharged properly with no death during the perioperative period. The median survival time was 17.0 months, with overall survival time ranging from 2.0 to 41.0 months. There was no statistically significant difference in the prognosis between the radical surgery group and the non-radical surgery group(P=0.078). The difference between the chemotherapy group and the non-chemotherapy group was statistically significant（P=0.002）.Conclusion    The clinical features of MAC are not typical, so it is difficult to make a diagnosis before the operation. Ultrasound suggests that high echo may indicate that the tumor contains a large amount of mucin. Ultrasound-guided fine-needle aspiration cytology is helpful for the preoperative diagnosis of MAC, but the final diagnosis depends on postoperative histopathology. To some extent, radical surgery may help to improve the survival time of patients with resectable MAC. Reasonable chemotherapy is helpful in improving the prognosis of patients.

Key words: mucinous adenocarcinoma of gallbladder, diagnosis, treatment

摘要： 目的    探讨胆囊黏液腺癌（MAC）病人的临床病理特点，为临床诊治提供参考。方法    回顾性分析2017年1月至2022年1月间华中科技大学同济医学院附属同济医院诊治的16例MAC病人的临床资料，总结其临床特征、诊治方式和预后特征。其中行根治性手术和非根治性手术病人分别为6、10例；行化疗和非化疗病人分别为7、9例。通过对数秩检验（Log-rank检验）比较组间预后差异。结果    16例病人中男性6例，女性10例，年龄为（56.9±11.6）岁。临床表现主要为腹痛、黄疸等。CA19-9水平升高6例（其中4例均＞1000 kU/L），癌胚抗原（CEA）升高8例。超声检查提示胆囊内高回声4例。所有病人术后病理学检查证实为MAC，镜下观提示肿瘤细胞间质黏蛋白含量＞50%。16例病人均顺利出院，无围手术期死亡。总体生存时间2.0~41.0个月，中位生存时间17.0个月。根治性手术组和非根治性手术组预后差异无统计学意义（P=0.078）。化疗组和未化疗组差异有统计学意义（P=0.002）。结论    MAC临床特征不典型，术前诊断较为困难。超声提示高回声可能预示肿瘤内含大量黏液蛋白。超声引导下细针吸取细胞学检查有助于术前确诊，但最终确诊依赖术后病理组织学检查。根治性手术在一定程度上可能有助于提高MAC可切除病人的生存时间。合理的化疗方案有助于改善病人预后。

关键词: 胆囊黏液腺癌, 诊断, 治疗