CAJ | 학술논문

目的：探讨结直肠转移肿瘤的临床病理学特征。方法回顾性分析53例结直肠转移肿瘤的临床病理学特征,对部分病例行免疫组化检测,并复习相关文献。结果明确累及结直肠肠壁者53例,其中43．4%(23/53)仅累及浆膜/浆膜下,侵至黏膜层者占37．7%(20/53)。受累肠段以乙状结肠、直肠为主(24/53,45．3%),原发肿瘤来源以女性生殖系统最为多见(33/53,62．3%),其次为消化系统(15/53,28．3%)。组织学类型以卵巢浆液性癌为主(22/53,41．5%)。96．2%(51/53)的转移肿瘤中心位于浆膜/浆膜下或肌层,26．4%(14/53)可见广泛脉管内癌栓。累及黏膜层时,35%(7/20)的转移肿瘤局灶缺乏间质结缔组织反应,20%(4/20)可见“原位生长”及“反向分化成熟”现象。17例术前活检标本中,2例被误诊为腺瘤或慢性炎症。结论肿瘤自浆膜面侵向黏膜面的“自外而内”的生长方式,以及广泛的脉管内癌栓,均高度提示转移肿瘤。“原位生长”及“反向分化成熟”现象在肠镜活检标本中易被误诊,日常工作中需引起注意。
목적：탐토결직장전이종류적림상병이학특정。방법회고성분석53례결직장전이종류적림상병이학특정,대부분병례행면역조화검측,병복습상관문헌。결과명학루급결직장장벽자53례,기중43．4%(23/53)부루급장막/장막하,침지점막층자점37．7%(20/53)。수루장단이을상결장、직장위주(24/53,45．3%),원발종류래원이녀성생식계통최위다견(33/53,62．3%),기차위소화계통(15/53,28．3%)。조직학류형이란소장액성암위주(22/53,41．5%)。96．2%(51/53)적전이종류중심위우장막/장막하혹기층,26．4%(14/53)가견엄범맥관내암전。루급점막층시,35%(7/20)적전이종류국조결핍간질결체조직반응,20%(4/20)가견“원위생장”급“반향분화성숙”현상。17례술전활검표본중,2례피오진위선류혹만성염증。결론종류자장막면침향점막면적“자외이내”적생장방식,이급엄범적맥관내암전,균고도제시전이종류。“원위생장”급“반향분화성숙”현상재장경활검표본중역피오진,일상공작중수인기주의。
Purpose To investigate the clinicopathologic characteristics of colorectal metastatic tumors. Methods Cases which were clinically diagnosed as metastatic tumors to the colorectum were retrieved from the data base of the Department of Pathology, Peking U-niversity Third Hospital. The clinicopathologic features were studied and immunohistochemical stains were performed on some of the ca-ses for differential diagnosis. Results Fifty three cases which showed intestinal wall involvement were studied. In 43. 4% (23/53) of them, only serosa/subserosa was involved and mucosal involvement was observed in 37. 7% (20/53) of the cases. Sigmoid colon and rectum were the most frequently involved intestinal segments (24/53, 45. 3%). Female reproductive system was the most common ori-gin of the metastatic tumors (33/53, 62. 3%), followed by the digestive system (15/53, 28. 3%). The most common histological type was ovarian serous carcinoma (22/53, 41. 5%). 96. 2% (51/53) of the metastatic tumors were centrally located at the serosa/subserosa or the muscular propria and prominent lymphovascular invasion was observed in 26. 4% (14/53) of the cases. In cases with mucosal involvement, 35% ( 7/20 ) had foci that were lack of desmoplastic reaction, 20% ( 4/20 ) exhibited in-situ growth and/or paradoxical maturation of tumor cells which led to misdiagnosis in 2 of the 17 pre-operative biopsies. Conclusions Metastatic carcino-ma in the colorectum can be highly informed by predominantly involving the serosa/subserosa or muscular propria and prominent lym-phovascular invasion. In-situ growth and paradoxical maturation of tumor cells in the mucosa are diagnostic pitfalls in pre-operative co-lonic biopsy and should be aware in practice.