中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2010年
7期
447-451
,共5页
王鲁平%陈健%宁浩勇%张新忠%程涓%李琳%王斌%代小娟%朱红艳%苗金红%王琳
王魯平%陳健%寧浩勇%張新忠%程涓%李琳%王斌%代小娟%硃紅豔%苗金紅%王琳
왕로평%진건%저호용%장신충%정연%리림%왕빈%대소연%주홍염%묘금홍%왕림
结直肠肿瘤%腺瘤性息肉%癌前状态%增生%腺癌
結直腸腫瘤%腺瘤性息肉%癌前狀態%增生%腺癌
결직장종류%선류성식육%암전상태%증생%선암
Colorectal neoplasms%Adenomatous polyps%Precancerous conditions%Hyperplasia%Adenocarcinoma
目的 分析结直肠锯齿状病变发生情况,并对锯齿状腺瘤与普通腺瘤的恶性潜能进行病理学比较观察.方法 收集北京军区总医院、海军总医院、解放军第二五二医院、河北省巨鹿县医院、北京中医药大学东直门医院约5年中病理诊断为结直肠各类息肉和腺瘤的病例5347例,进行回顾性分析,经3名病理医师4～5轮阅片从中筛选出腺体具有锯齿状特征的息肉及腺瘤共258例,按文献标准分类,观察传统锯齿状腺瘤(TSA)及普通腺瘤异型增生程度.随机收集普通腺瘤(管状腺瘤160例及绒毛管状腺瘤27例)187例,浸润性腺癌36例作为对照.对部分TSA、广基锯齿状腺瘤(SSA)、管状腺瘤、浸润性腺癌进行免疫组织化学(Max Vision法)Ki-67、p53、β-catenin染色.结果 五所医院的5347例结直肠息肉/腺瘤中共筛选出锯齿状病变258例,占4.8%.其中增生性息肉(HP)112例,占锯齿状病变43.4%(112/258);TSA 78例,占锯齿状病变30.2%(78/258);SSA26例,占锯齿状病变10.1%(26/258);锯齿状病变合并高级别黏膜内肿瘤及浸润性腺癌11例,占锯齿状病变4.3%(11/258).重点观察62例TSA的异型增生等级.62例TSA呈中度异型增生13例,高级别黏膜内肿瘤4例,浸润性腺癌癌旁有TSA成分2例.中度以上异型增生占30.6%(19/62),高级别黏膜内肿瘤和浸润性腺癌占9.6%(9/62).收集的普通腺瘤187例,其中中度异型增生27例,高级别黏膜内肿瘤12例,13例在不同部位伴有浸润性腺癌,中度以上异型增生占27.8%(52/187),高级别黏膜内肿瘤和浸润性癌占13.3%(25/187).TSA与普通腺瘤比较X2=19.373,P=0.000.北京军区总医院19个月期间结直肠同时、不同部位具有锯齿状腺瘤及普通腺瘤13例(管状或绒毛管状腺瘤),其中锯齿状腺瘤13例中12例旱轻度异型增生,1例呈轻-中度异型增生;13例管状腺瘤中7例呈轻度异型增生,2例呈轻-中度异型增生,4例呈中度异型增生(两者相比X2=5.432,P=0.052).对两组病例进行了Ki-67、p53、β-catenin检测,在锯齿状腺瘤(TSA、SSA)和普通腺瘤(管状)中的表达差异无统计学意义(P>0.05),但锯齿状腺瘤与腺癌表达差异有统计学意义(P=0.000).结论 结直肠锯齿状病变发病率似较低.锯齿状腺瘤有明显恶性潜能.与普通腺瘤相比,锯齿状腺瘤合并高级别黏膜内肿瘤及浸润性癌的病例有所减少.
目的 分析結直腸鋸齒狀病變髮生情況,併對鋸齒狀腺瘤與普通腺瘤的噁性潛能進行病理學比較觀察.方法 收集北京軍區總醫院、海軍總醫院、解放軍第二五二醫院、河北省巨鹿縣醫院、北京中醫藥大學東直門醫院約5年中病理診斷為結直腸各類息肉和腺瘤的病例5347例,進行迴顧性分析,經3名病理醫師4～5輪閱片從中篩選齣腺體具有鋸齒狀特徵的息肉及腺瘤共258例,按文獻標準分類,觀察傳統鋸齒狀腺瘤(TSA)及普通腺瘤異型增生程度.隨機收集普通腺瘤(管狀腺瘤160例及絨毛管狀腺瘤27例)187例,浸潤性腺癌36例作為對照.對部分TSA、廣基鋸齒狀腺瘤(SSA)、管狀腺瘤、浸潤性腺癌進行免疫組織化學(Max Vision法)Ki-67、p53、β-catenin染色.結果 五所醫院的5347例結直腸息肉/腺瘤中共篩選齣鋸齒狀病變258例,佔4.8%.其中增生性息肉(HP)112例,佔鋸齒狀病變43.4%(112/258);TSA 78例,佔鋸齒狀病變30.2%(78/258);SSA26例,佔鋸齒狀病變10.1%(26/258);鋸齒狀病變閤併高級彆黏膜內腫瘤及浸潤性腺癌11例,佔鋸齒狀病變4.3%(11/258).重點觀察62例TSA的異型增生等級.62例TSA呈中度異型增生13例,高級彆黏膜內腫瘤4例,浸潤性腺癌癌徬有TSA成分2例.中度以上異型增生佔30.6%(19/62),高級彆黏膜內腫瘤和浸潤性腺癌佔9.6%(9/62).收集的普通腺瘤187例,其中中度異型增生27例,高級彆黏膜內腫瘤12例,13例在不同部位伴有浸潤性腺癌,中度以上異型增生佔27.8%(52/187),高級彆黏膜內腫瘤和浸潤性癌佔13.3%(25/187).TSA與普通腺瘤比較X2=19.373,P=0.000.北京軍區總醫院19箇月期間結直腸同時、不同部位具有鋸齒狀腺瘤及普通腺瘤13例(管狀或絨毛管狀腺瘤),其中鋸齒狀腺瘤13例中12例旱輕度異型增生,1例呈輕-中度異型增生;13例管狀腺瘤中7例呈輕度異型增生,2例呈輕-中度異型增生,4例呈中度異型增生(兩者相比X2=5.432,P=0.052).對兩組病例進行瞭Ki-67、p53、β-catenin檢測,在鋸齒狀腺瘤(TSA、SSA)和普通腺瘤(管狀)中的錶達差異無統計學意義(P>0.05),但鋸齒狀腺瘤與腺癌錶達差異有統計學意義(P=0.000).結論 結直腸鋸齒狀病變髮病率似較低.鋸齒狀腺瘤有明顯噁性潛能.與普通腺瘤相比,鋸齒狀腺瘤閤併高級彆黏膜內腫瘤及浸潤性癌的病例有所減少.
목적 분석결직장거치상병변발생정황,병대거치상선류여보통선류적악성잠능진행병이학비교관찰.방법 수집북경군구총의원、해군총의원、해방군제이오이의원、하북성거록현의원、북경중의약대학동직문의원약5년중병리진단위결직장각류식육화선류적병례5347례,진행회고성분석,경3명병리의사4～5륜열편종중사선출선체구유거치상특정적식육급선류공258례,안문헌표준분류,관찰전통거치상선류(TSA)급보통선류이형증생정도.수궤수집보통선류(관상선류160례급융모관상선류27례)187례,침윤성선암36례작위대조.대부분TSA、엄기거치상선류(SSA)、관상선류、침윤성선암진행면역조직화학(Max Vision법)Ki-67、p53、β-catenin염색.결과 오소의원적5347례결직장식육/선류중공사선출거치상병변258례,점4.8%.기중증생성식육(HP)112례,점거치상병변43.4%(112/258);TSA 78례,점거치상병변30.2%(78/258);SSA26례,점거치상병변10.1%(26/258);거치상병변합병고급별점막내종류급침윤성선암11례,점거치상병변4.3%(11/258).중점관찰62례TSA적이형증생등급.62례TSA정중도이형증생13례,고급별점막내종류4례,침윤성선암암방유TSA성분2례.중도이상이형증생점30.6%(19/62),고급별점막내종류화침윤성선암점9.6%(9/62).수집적보통선류187례,기중중도이형증생27례,고급별점막내종류12례,13례재불동부위반유침윤성선암,중도이상이형증생점27.8%(52/187),고급별점막내종류화침윤성암점13.3%(25/187).TSA여보통선류비교X2=19.373,P=0.000.북경군구총의원19개월기간결직장동시、불동부위구유거치상선류급보통선류13례(관상혹융모관상선류),기중거치상선류13례중12례한경도이형증생,1례정경-중도이형증생;13례관상선류중7례정경도이형증생,2례정경-중도이형증생,4례정중도이형증생(량자상비X2=5.432,P=0.052).대량조병례진행료Ki-67、p53、β-catenin검측,재거치상선류(TSA、SSA)화보통선류(관상)중적표체차이무통계학의의(P>0.05),단거치상선류여선암표체차이유통계학의의(P=0.000).결론 결직장거치상병변발병솔사교저.거치상선류유명현악성잠능.여보통선류상비,거치상선류합병고급별점막내종류급침윤성암적병례유소감소.
Objective To study the serrated lesions of colon and to compare the malignant potential between traditional serrated adenomas (TSA )and conventional adenomas (CAD). Methods A total of 5347 cases of colorectal polyps encountered in five regional hospitals during a five-year period were retrospectively reviewed. The serrated lesions were classified on the basis of histologic examination. One hundred and eighty-seven cases of CAD (including 160 cases of tubular adenoma and 27 cases of villous adenoma)and 36 cases of invasive adenocarcinoma were randomly selected as the controls. The degree of dysplasia and expressions of Ki-67,p53 and beta-catenin in TSA and CAD were compared. Results Amongst the 5347 colorectal polyps studied,258 cases (4.8%)of serrated lesions were found,which included 112 cases (43. 4% ,112/258)of hyperplastic polyp,78 cases (30. 2% ,78/258)of TSA and 26 cases (10. 1% ,26/258)of sessile serrated adenoma. Sixty-two cases of TSA were identified from 3 hospitals,in which moderate dysplasia was found in 13 cases. High-grade intraepithelial neoplasia and ICA were found in 6 cases (9. 6% ). Compared with the 187 cases of CAD,moderate dysplasia were found in 27 cases and high-grade intraepithelial neoplasia and invasive adenocarcinoma were found in 25 cases (13. 3% ,X2 = 19. 373,P =0. 000). There was statistically significant difference between TSA and CAD in the degree of dysphasia. The expression of Ki-67,p53 and beta-catenin in TSA and CAD showed no significant difference (P > 0. 05 ). Conclusions The incidence of serrated lesions is lower in northern Chinese population than that in Caucasians. TSA has obvious malignant potential; but the rate associated with highgrade intraepithelial neoplasia and invasive adenocarcinoma is lower than that in CAD.
