Colonic Perforation with Abscess Formation Secondary to Metastatic Adenosquamous Cell Carcinoma of the Gallbladder

　　　　　腺鱗狀細胞癌不管在大腸直腸或膽囊都是很少見的腫瘤。所謂腺鱗狀細胞癌是指癌細胞由柵狀腺表皮產生，可以在腺癌組織中找到鱗狀細胞癌島，其中鱗狀癌細胞及腺癌細胞均可能個別或同時發生轉移。腺鱗狀細胞癌在大腸直腸惡性腫瘤的機率佔0.05%到0.20%，而在惡性膽囊癌約佔2%，且線鱗狀細胞癌比腺癌之預後差。我們在此發生一個68歲女性，因右上腹痛並可摸到腫塊。電腦斷層發現肝臟屈曲部的大腸壁增厚且肝內有一約六公司之膿瘍。手術發現此處大腸穿孔併右葉肝膿瘍且膽囊亦有侵犯。病理發現此為膽囊腺鱗狀細胞癌造成大腸穿孔併膿瘍的個案報告。故在肝臟屈曲部的腫瘤，除了大腸原發性以外，應將膽囊之惡性腫瘤列入鑑別診斷。
　　　　　Adenosquamous cell carcinoma (ASCC) is a rare neoplasm involving the colorectrum or gallbladder. ASCC refers to a carcinoma arising in columnar glandular epithelium where islands of squamous carcinoma are found within the adenocarcinomatous tissue. Both squamous and adenocarcinomatous cells can metastasize, either separately or together. The incidence of ASCC in malignant tumors of the colon ??,??,?? ranged from 0.05 to 0.20 percentage and about 2% of all gallbladder carcinoma. We herein report a case of colonic perforation with abscess formation associated with ASCC of gallbladder.