本例肯定是有问题的，只是目前还没有充分的证据说是浸润性癌，但疑癌。多取材。

说其有问题，是因为：

多量乳头状结构，部分区域乳头结构稍复杂；

腺腔的不规则性；

不规则腺体与平滑肌垂直生长，并呈横截状，是最怀疑为癌的区域，图6所示。

腺体周围促纤维反应（但非肿瘤性胆囊也可出现）；

腺上皮极性紊乱，细胞核不是一致的位于基底部，而是上上下下不一致；

细胞假复层；

细胞还是具有一定异型性。

如果重取还是这样，至少要发到高度上皮内瘤变。

 同意细胞有异型，诊断癌不敢，建议多取材

Well differentiated adenocarcinoma of gallbladder is always a very difficult diagnosis to make. Equally difficult is a well differentiated pancreatic adenocarcinoma or cholangiocarcinoma with direct extension to gallbladder wall. I have seen rare cases of both diagnoses that showed very subtle changes. Stromal desmoplasia is always a worrisome sign, but many cases of chronic cholecystitis have Aschoff-Rokitansky sinuses extending from mucosa to muscle wall. Some normal gallbladder contain ducts of Luschka on the adventitia and subserosal soft tissue that are surrounded by desmoplastic stroma. All of these makes detection of primary gallbladder adenocarcinoma very difficult. I have always looked for epithelial dysplasia in the overlying mucosa to support the possibility of a rare incidental case of gallbladder adenocarcinoma. In the photos uploaded from this case, I do not see definite epithelial dysplasia. Certainly an isolated cell budding off the nearby gland and embedded in the stroma is very suspicious, but I would like to see deeper levels of this focus to better appreciate its three-dimensional extent before making a final judgement. I believe more extensive histologic sampling of the remaining specimen would definitely help. An interesting and challenging case this is!

 至少高级别上皮内瘤变吧