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目的:探讨河南省食管癌高发区食管固有腺的组织分布和组织化学特征。方法:采用组织病理学和组织化学奥新蓝-雪夫染色(AB-PAS染色)法,对来自河南林州食管癌高发区的4263例食管癌、贲门癌手术切除标本中食管固有腺的分布进行分析。结果:4263例患者中,检出食管固有腺2591例(61%),不同性别各年龄段均可检出食管固有腺,40岁以上年龄段检出率较高。从2591例中挑选出切片完整、染色均匀、无折叠的787例共1428张切片进行腺体分类:黏液腺占42.4%,混合腺占25.2%,贲门腺占24.5%,浆液腺仅占7.9%。抽取2653张切片进行腺体分布部位分析:黏膜下层腺体占49.0%,固有层腺体占26.7%,固有层/黏膜下层腺体占24.3%(P<0.05)。AB-PAS染色结果显示,食管黏膜固有层腺体以中性黏液腺为主,与贲门腺相似;食管黏膜下层以酸性黏液腺为主。食管固有层腺体良性增生、不典型增生、肠化和癌发生率均高于黏膜下层腺体(P<0.05)。腺体良性增生主要表现为腺体呈肿瘤侵袭性生长,侵犯食管上皮或破坏食管上皮,直至全部取代食管上皮。结论:食管固有腺增生,尤其是固有层内腺体增生是河南食管癌高发区较为常见的病理改变;固有层腺体从良性增生、不典型增生和肠化、取代食管上皮到癌变可能是该地区特殊的食管贲门交界部腺癌组织学发生模式。
Objective: To investigate the tissue distribution and histochemical characteristics of esophageal parenchyma in high risk area of esophageal cancer in Henan province. Methods: The distribution of esophageal intrinsic glands in 4263 cases of esophageal and cardiac cancer resected specimens from the high risk area of esophageal cancer in Linzhou, Henan Province was analyzed by histopathology and histochemistry Aoxan blue-Schiff staining (AB-PAS staining) analysis. Results: Of the 4263 patients, 2591 cases (61%) of the esophageal glandular gland were detected. The esophageal glandular gland was detected in all age groups and the detection rate was higher in those over 40 years old. A total of 1428 sections of 787 cases with complete, evenly stained and unfolded sections were selected from 2591 cases for gland classification: mucinous gland 42.4%, mixed gland 25.2%, cardial gland 24.5%, serous gland only 7.9% . A total of 2653 sections were taken for gland distribution analysis. The submucosal glands accounted for 49.0%, the lamina propria glands accounted for 26.7%, and the lamina propria / submucosal glands accounted for 24.3% (P <0.05). The results of AB-PAS staining showed that the lamina propria of esophageal mucosa was predominantly mucocutaneous glands, which was similar to cardiac glandular gland. The submucosa of esophageal mucosa was mainly acidic mucous gland. Esophageal lamina propria glandular benign hyperplasia, dysplasia, intestinal metaplasia and cancer incidence were higher than the submucosal glands (P <0.05). Gland benign hyperplasia mainly manifested as tumor aggressive growth of the gland, invasion of esophageal epithelium or destruction of esophageal epithelium, until all replace the esophageal epithelium. Conclusion: Esophageal intrinsic glandular hyperplasia, especially lamina propria glandular hyperplasia, is a more common pathological change in high risk area of esophageal cancer in Henan Province. The lamina propria glands may be the main pathological factors of benign hyperplasia, dysplasia and intestinal metaplasia. Regional special esophageal junction cardiac adenocarcinoma histological patterns.