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目的探讨广基锯齿状腺瘤/息肉(SSA/P)和传统锯齿状腺瘤(TSA)的临床病理学、免疫组化特征及癌变通路的意义。方法收集病理诊断为结直肠锯齿状病变的病例共计291例,从中筛选出结直肠锯齿状腺瘤64例(SSA/P 41例,TSA 23例),收集临床相关资料和观察镜下病理学特征,同时进行MGMT、MLH1、β-catenin、p16、CDX2、RUNX3和Ki-67免疫组化染色。选取34例增生性息肉(HP)、24例正常肠组织和28例结直肠癌(CRC)作为对照,其中HP全部为微小泡型。结果 SSA/P和TSA均好发于左侧结肠。组织学显示,SSA/P锯齿状改变腺体紧靠黏膜肌层,基底隐窝呈倒“T”或“L”型分支;TSA腺体可见明显的锯齿状结构、异位隐窝和细胞异型增生,其中纤维绒毛状TSA(FSA)异型增生程度较高。免疫组化:Ki-67、β-catenin、p16和RUNX3表达阳性率,在SSA/P和TSA组与对照组之间比较差异显著(P<0.05);MLH1表达阳性率,在SSA/P与对照组HP和正常之间差异显著(P<0.05),且阳性表达率呈递增趋势,支持广基锯齿状通路学说,提示HP是SSA/P的一种前期病变。结论 SSA/P和TSA是CRC的癌前病变,通过锯齿状通路发生恶变,具有较高恶性潜能,需要与HP加以区别。
Objective To investigate the clinicopathological and immunohistochemical features of the wide-base serrated adenoma / polyp (SSA / P) and traditional serrated adenomas (TSA) and its significance. Methods A total of 291 cases of pathological diagnosis of colorectal serrated lesions were collected, of which 64 cases (41 cases of SSA / P and 23 cases of TSA) were screened for colorectal serrated adenomas. Clinical data and pathological features were collected Meanwhile, immunohistochemical staining of MGMT, MLH1, β-catenin, p16, CDX2, RUNX3 and Ki-67 were performed simultaneously. 34 cases of hyperplastic polyps (HP), 24 cases of normal intestinal tissue and 28 cases of colorectal cancer (CRC) were selected as control. All of them were micro vesicles. Results Both SSA / P and TSA developed in the left colon. Histology showed that SSA / P sawtoothly changed the gland close to the muscularis mucosa, and the basal recess showed “T ” or “L ” branches. The TSA gland showed obvious jagged structure, Litter and cell dysplasia, fibrovascular TSA (FSA) dysplasia to a higher degree. The positive rates of Ki-67, β-catenin, p16 and RUNX3 in SSA / P and TSA groups were significantly different from those in control group (P <0.05). The positive rates of MLH1 expression in SSA / The difference between the control group and normal HP (P <0.05), and the positive expression rate showed an increasing trend, support for wide-base serrated pathways, suggesting that HP is a pre-SSA / P lesions. Conclusions SSA / P and TSA are precancerous lesions of CRC. They undergo malignant transformation through serrated pathways and have high malignant potential. They need to be distinguished from HP.