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目的:观察结直肠锯齿状病变伴浸润癌及高级别上皮内肿瘤(HIN)的临床病理学特点及免疫组织化学表达,并分析其意义。方法:收集北京军区总医院、解放军252医院、海军总医院、河北省巨鹿县医院和北京中医药大学东直门医院5所医院2002-10-2009-09诊断为各类息肉和腺瘤的患者共计5 347例,从中筛选出结直肠锯齿状病变合并浸润性癌和HIN患者16例,采用MLH1、MSH2、K-ras和MGMT进行免疫组化染色。结果:TSA合并浸润性癌/HIN好发于直肠,TSA腺体可见明显锯齿状结构和异位隐窝,纤维绒毛状TSA异形增生程度较高。SSA合并浸润性癌/HIN好发于回盲部,SSA锯齿状改变腺体紧靠黏膜肌层,基底隐窝扩张,呈倒“T”或“L”型分支。4例合并浸润性腺癌。3例浸润癌癌旁可见HP,2例可见HP-SSA/TSA-癌变移行过程。免疫组织化学显示,MGMT在锯齿状病变组织与所伴癌组织和对照组癌组织表达差异有统计学意义,P值分别为0.022和0.002。结论:TSA、SSA可癌变或直接发展为浸润性腺癌,HP可为浸润癌的癌旁组织,紧靠癌组织,是否直接可癌变尚需进一步观察。
OBJECTIVE: To observe the clinicopathological features and immunohistochemical expression of invasive cervical carcinoma and high grade intraepithelial neoplasia (HIN) in the serrated lesions of the colorectum and to analyze its significance. METHODS: Five hospitals, including Beijing Military Region General Hospital, PLA 252 Hospital, Navy General Hospital, Hebei Province Julu County Hospital and Beijing Dongmin Hospital of Beijing University of Traditional Chinese Medicine 2002-10-2009-09 Total patients diagnosed with various types of polyp and adenoma 5 347 cases were selected from which 16 cases of colorectal serrated lesions with invasive carcinoma and HIN were screened for immunohistochemical staining with MLH1, MSH2, K-ras and MGMT. Results: TSA complicated with invasive carcinoma / HIN occurred in the rectum. TSA glands showed obvious jagged structures and ectopic crypts, and the degree of dysplasia of fibroids villous TSA was higher. SSA complicated with invasive carcinoma / HIN occurs in the ileocecal part. The SSA jagged gland changes close to the muscularis mucosa, and the basilar crypt expands, presenting a “T” or “L” type branch. 4 cases with invasive adenocarcinoma. 3 cases of invasive cancer adjacent to the HP can be seen in 2 cases of HP-SSA / TSA-carcinogenesis process. Immunohistochemistry showed that there was significant difference in the expression of MGMT between the jagged lesions and the cancer tissues and the control tissues, P values were 0.022 and 0.002 respectively. Conclusion: TSA and SSA can be carcinogenic or directly develop into invasive adenocarcinoma. HP can be a paracancer tissue of infiltrating carcinoma, close to the cancerous tissue.