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中华结直肠疾病电子杂志 ›› 2016, Vol. 05 ›› Issue (05) : 413 -418. doi: 10.3877/cma.j.issn.2095-3224.2016.05.009

所属专题: 文献

论著

结肠锯齿状病变临床病理分析
王续1, 刘月平1, 杨会钗1, 王贵英2,()   
  1. 1. 050000 河北医科大学第四医院病理科
    2. 河北医科大学第四医院外二科
  • 收稿日期:2016-05-13 出版日期:2016-10-25
  • 通信作者: 王贵英

Clinical pathology analysis of colon serrated lesions

Xu Wang1, Yueping Liu1, Huichai Yang1, Guiying Wang2,()   

  1. 1. Department of Pathology, Fourth Hospital of Hebei Medical University, Hebei 050000, China
    2. Department of General Surgery, Fourth Hospital of Hebei Medical University, Hebei 050000, China
  • Received:2016-05-13 Published:2016-10-25
  • Corresponding author: Guiying Wang
  • About author:
    Corresponding author: Wang Guiying, Email:
引用本文:

王续, 刘月平, 杨会钗, 王贵英. 结肠锯齿状病变临床病理分析[J/OL]. 中华结直肠疾病电子杂志, 2016, 05(05): 413-418.

Xu Wang, Yueping Liu, Huichai Yang, Guiying Wang. Clinical pathology analysis of colon serrated lesions[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2016, 05(05): 413-418.

目的

锯齿状病变代表一种异源性病变,其中一些具有恶性潜能。进一步明确锯齿状病变的临床病理特征,以期为临床治疗提供广阔思路。

方法

对河北医科大学第四医院切除的788例结肠息肉病变进行形态学观察、免疫组化检测。按不同的检测方法确定每种锯齿状病变的临床病理特征,病变的比例通过χ2检验,P值<0.05为差异具有统计学意义。

结果

增生性息肉(hyperplastic polyp,HP)占息肉总数比例较高(508,64.6%),好发于远端结肠(381,75.1%),多数伴有急性、慢性炎反应(330,64.9%;178,35.1%);而在广基锯齿状腺瘤/息肉(sessile serrated adenoma,SSA)(伴或不伴不典型增生)、传统性锯齿状腺瘤(traditional serrated adenoma,TSA)具有较多以下特征如伴发急性炎反应,平滑肌束长入固有层。以及临床特征中传统锯齿状腺瘤、广基锯齿状腺瘤/息肉伴异型增生中BRAF检测阳性44(62.8%)、19(35.2%);而且有肠病恶变的患者中(TSA)比例较高42例及随访健康的患者中(HP)比例较高490例,两组比较差异具有统计学意义(χ2=21.438,P<0.05)

结论

锯齿状病变仍是一种在基因水平认识不足的综合征,而且与结肠腺癌的患病风险的相关性无从论证。因此,临床病理工作者对疾病的正确认识在需要每年检查结肠镜的患者中担任着非常重要的责任。

Objective

Serrated lesions represent a different kind of lesions, some of which have malignant potential. Understanding the clinical pathological characteristics of serrated lesions is essential for treatment.

Methods

Based on the morphological observation of pathological changes of 788 cases of colon polyps with immunohistochemical testing, better diagnosis according to the World Health Organization Criteria. According to different detection methods learned that each of the serrated lesions in clinical pathological features, by chi-square test, the difference is statistically significant (P<0.05).

Results

The ratio of polyp numbers is high (508, 64.6%) , located at the distal colon (381, 75.1%), most associated with acute and chronic inflammatory response (330, 64.9%; 178, 35.1%). But in wide base serrated adenomatous polyps (SSA/P) / (with or without atypical hyperplasia), traditional serrated adenoma (TSA) with more features such as associated with acute and chronic inflammatory response, smooth muscle bundle of lamina propria ingrowth . And clinical characteristics of traditional serrated adenoma, wide base serrated adenoma/polyp with hyperplasia of BRAF testing positive for 44 19 (35.2%). And there is higher percentage (TSA) in patients with bowel disease malignant progression of 42 patients and follow-up health (HP) in the higher percentage of 490 , differences between the two groups have statisticd significance (χ2=21.438, P<0.05).

Conclusions

The serrated lesions is still insufficient understanded, and the correlation between serrated lesions and colon cancer is not clear. Therefore, precise understanding the serrated lesions is very important for patients with enteroscopy.

图1 A、B:增生性息肉、广基锯齿状腺瘤/息肉HE染色(100×);C:传统锯齿状腺瘤HE染色(200×);D、E、F、G:增生性息肉、广基锯齿状腺瘤/息肉BRAF免疫组化染色(阴性)(D、E、F为100×)(G为200×);H、I、J:传统锯齿状腺瘤BRAF免疫组化染色(阳性)(200×)
表1 对照形态学的改变各种病变的比例表[例(%)]
组别 例数 HP SSA/P TSA SSA/P伴异型增生 χ2 P
部位 ? ? ? ? ? 20.615 <0.05
? 近端结肠 230 69(30) 109(47.4) 17(7.4) 35(15.2) ? ?
? 横结肠 109 58(53.2) 8(7.3) 32(29.4) 11(10.1) ? ?
? 远端结肠 449 381(84.9) 39(8.7) 21(4.7) 8(1.7) ? ?
固有层表现 ? ? ? ? ? 1.000 >0.05
? 膨胀性水肿 320 238(74.4) 46(14.4) 25(7.8) 11(3.4) ? ?
? 广泛纤维化 243 160(65.9) 65(26.7) 9(3.7) 9(3.7) ? ?
? 炎性反应 114 40(35.1) 39(34.2) 20(17.5) 15(13.2) ? ?
? 脂肪增殖 111 70(63.1) 6(5.4) 16(14.4) 19(17.1) ? ?
炎症表现 ? ? ? ? ? 21.032 <0.05
? 急性炎反应 520 330(63.5) 120(23.1) 40(7.7) 30(5.7) ? ?
? 慢性炎反应 268 178(66.4) 36(13.4) 30(11.2) 24(9) ? ?
腺体变化 ? ? ? ? ? 1.000 >0.05
? 腺体扭曲 567 385(68.0) 125(22.0) 20(3.5) 37(6.5) ? ?
? 腺体富含粘液 221 123(55.7) 31(14.0) 50(22.6) 17(7.7) ? ?
周围结缔组织变化 ? ? ? ? ? 19.864 <0.05
? 平滑肌束长入固有层 300 150(50.0) 79(26.3) 35(11.7) 36(12.00) ? ?
? 腺体周围环绕纤维束 163 115(70.6) 40(24.5) 6(3.7) 2(1.2) ? ?
? 呈簇的腺体 325 243(74.8) 37(11.4) 29(8.9) 16(4.9) ? ?
伴发病变 ? ? ? ? ? 0.322 >0.05
? 低级别不典型增生 266 50(18.8) 120(45.1) 46(17.3) 50(18.8) ? ?
? 腺瘤 522 458(87.7) 36(6.9) 24(4.6) 4(0.8) ? ?
表2 在锯齿状病变中BRAF表达及其临床特征表[例(%)]
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