【双语病例】Gallbladder carcinoma with invasion of the liver来自：双语学影像；病例选自《Mayo Clinic Body MRI Case Review》 History69-year-old woman with epigastric and retrosternal pain and jaundice 69岁女性，上腹部及胸骨后疼痛，伴有黄疸。
Fig 3.5.1：
Fig 3.5.2：
Fig 3.5.3： 
Imaging Findings
Axial fat-suppressed FSE T2-weighted images (Figure 3.5.1) demonstrate extensive adenopathy in the porta hepatis, as well as heterogeneous, mildly hyperintense masses in the gallbladder and adjacent right hepatic lobe. Note the large gallstone in Figure 3.5.1B. Axial arterial phase (Figure 3.5.2) and portal venous phase (Figure 3.5.3) postgadolinium 3D SPGR images show a heterogeneously enhancing mass centered in the gallbladder and extending through the gallbladder wall to directly invade the liver. 横断位T2WI FSE脂肪抑制序列(Figure 3.5.1)示肝门部多发肿大淋巴结，胆囊区及肝右叶临近肝实质可见不均匀稍高信号肿块。Figure 3.5.1B图可见胆囊内大结石。 3D SPGR增强扫描动脉期(Figure 3.5.2)、门脉期(Figure 3.5.3)示胆囊区肿块不均匀强化，并通过胆囊壁侵犯临近肝实质。
Diagnosis Gallbladder carcinoma with invasion of the liver 胆囊癌侵犯肝脏
Comment
Adenocarcinoma of the gallbladder is a rare lesion that nevertheless is the most common malignant neoplasm of the biliary tract and the seventh most common gastrointestinal cancer.Gallbladder carcinoma affects women more frequently than men, and although there are multiple risk factors, its incidence is highly correlated with cholelithiasis.The vast majority of patients with gallbladder carcinoma have gallstones, and the presence of gallstones is thought to increase the risk of gallbladder carcinoma 4 to 5 times over the risk in patients without cholelithiasis (although only about 1% of persons with gallstones develop gallbladder carcinoma). 胆囊腺癌是一种少见病变，但仍是胆道系统最常见的恶性肿瘤，占全部消化系统肿瘤的第7位。胆囊癌女性多于男性。尽管有很多致病的危险因素，但发病率与胆石症有着高度的相关性。绝大部分胆囊癌患者都有胆囊结石病史，而胆囊结石患者的胆囊癌发病率是非胆囊结石患者的4-5倍（尽管胆囊结石进展为胆囊癌的几率只有1%）。
Porcelain gallbladder was once thought to represent a significant risk for development of gallbladder carcinoma, but this view has changed in recent years. The most recent studies indicate no additional risk or a slight additional risk(see Case3.3 for further discussion of porcelain gallbladder). Gallbladder polyps rarely may transform into frank carcinomas; the risk increases with increasing lesion diameter,increasing patient age, and presence of a solitary polyp or gallstones. Other risk factors for gallbladder carcinoma include xanthogranulomatous cholecystitis, adenomyomatosis, and inflammatory bowel disease. 瓷胆囊既往曾被认为是诱发胆囊癌的高危因素，但最近的研究认为瓷胆囊并不增加胆囊癌的发病率，或仅有略微增加。（见Case3.3） 胆囊息肉有很小的可能性发展成为胆囊癌。癌变的几率随息肉直径、发病年龄的增加而增加，孤立性息肉或结石也可增加癌变几率。 其他胆囊癌的危险因素包括黄色肉芽肿性胆囊炎、胆囊腺肌瘤病、肠炎等。
Most gallbladder cancers are adenocarcinomas, and these have been subdivided into papillary, tubular, and nodular variants, with papillary tumors having the least aggressive behavior. The modified Nevin system is commonly used for staging gallbladder carcinoma. Stage I disease is limited to the mucosa; stage II has tumor invasion into the muscularis layer; stage III, direct extension into the liver; stage IV,lymph node metastases; and stage V, distant metastases. Five-year survival rates are poor: 39% for stage I, 15% for stage II, and 5% or less for stages III through V. 大部分胆囊癌为腺癌，可以分为乳头型、管型、结节变异型（*小编：此分型与我们查到的分型略有不同，具体问BAIDU）。其中乳头型恶性程度最低。 修订版的Nevin系统临床上广泛应用于胆囊癌的分期。I期为病变局限性与粘膜；II期肿瘤侵犯至肌层；III期为肝脏受侵；IV期出现淋巴结转移；V期出现远处转移。
胆囊癌的预后很长，I期胆囊癌5年生存率为39%，II期为15%，III期~IV期的5年生存率不足5%。
In general, symptoms of gallbladder carcinoma are nonspecific and include abdominal pain, nausea and vomiting, jaundice, anorexia, and weight loss.At least 20% of patients receive the diagnosis at cholecystectomy performed for biliary colic and cholelithiasis. 一般来说，胆囊癌临床症状没有明显的特异性，包括腹痛、恶性呕吐、黄疸、食欲减退、体重减轻。 约20%的患者是在胆绞痛、胆囊炎行胆囊切除术时才确诊为胆囊癌的。
The appearance of this case is unfortunately a fairly typical one: a heterogeneously enhancing polypoid mass in the gallbladder that is growing through the wall and directly invading the liver. These lesions are usually hypointense relative to the liver on arterial phase dynamic 3D SPGR images and show greater enhancement on portal venous and equilibrium phase images. They generally are mildly to moderately hyperintense on T2-weighted images.The hepatic invasion and lymph node metastases in this case constitute stage IV disease—inoperable and with a poor prognosis. 本例胆囊癌的表现非常典型：胆囊息肉样肿块突破胆囊壁侵犯肝脏，增强扫描不均匀强化。增强扫描动脉期病灶信号低于肝实质，门脉期及平衡期病灶信号增高，高于肝实质信号。T2WI病灶一般称等或略高信号。肝脏受侵及淋巴结转移，提示本例为IV期胆囊癌--无法手术，且预后很差。
The differential diagnosis for an appearance like this one is limited. Occasionally, the gallbladder is difficult to visualize among the large hepatic metastases, but the hepatic lesions are often clustered around the gallbladder fossa, which is suggestive of the diagnosis. 类似本病例的影像学表现，需要鉴别诊断的疾病并不多。 有时，肝脏的转移病灶较大，正常的胆囊结构不能清晰显示，但肝脏病灶多成簇聚集于胆囊窝，这是主要的鉴别点之一。
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