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目的研究家族遗传性结直肠息肉病(FPC)恶性演变过程。方法采用真彩色医学图象分析系统对29例FPC、60例结直肠癌和56例腺瘤性息肉标本的DNA含量和倍体分布进行对比研究。结果恶变FPC组织DNA含量(DI)明显高于DucksA、B期和高、中分化腺癌,差异有显著性意义(P<0.05),而与DucksC、D期和低分化腺癌比较则差异无显著性意义(P>0.05)。从没有恶变的FPC息肉到恶变的FPC组中未恶变息肉再至恶变的FPC组织,DNA异倍体(≥5倍体)和DI值逐渐增加,各组间比较差异有显著性意义;在各息肉组中,恶变的FPC组息肉和重度异型性腺瘤性息肉,异倍体和DI值都高于轻中度异型性腺瘤性息肉和未恶变的FPC息肉(P<0.01),而且同DucksA期和高分化腺癌异倍体和DNA含量相近(P>0.05)。结论FPC恶变过程是逐渐发生的,一旦恶变,恶性程度较高,易发生转移,预后较差;而另一些未恶变的息肉已属于高危癌前病变,手术中应一并切除。
Objective To study the malignant evolution of familial colorectal polyposis (FPC). Methods The DNA content and ploidy distribution of 29 specimens of FPC, 60 specimens of colorectal cancer and 56 specimens of adenomatous polyp were compared using the true color medical image analysis system. Results The DNA content of malignantly changed FPC tissue was significantly higher than that of Ducks A and B stages and high-grade and moderately-differentiated adenocarcinomas. The difference was significant (P<0.05). However, there was no difference between Dukes C, D stage and poorly differentiated adenocarcinoma. Significant significance (P>0.05). From the non-malignant FPC polyps to the malignant fibroblasts in the FPC group, DNA heteroploids (≥5-ploidy) and DI values gradually increased, with significant differences between the groups; In the polyp group, the malignant FPC group polyp and the severe alloadenomatous polyp, aneuploid and DI values were higher than the mild to moderate alloadenomatous polyps and non-malignant FPC polyps (P <0.01), and the same with the DucksA period. The content of aneuploid and DNA was similar to that of well-differentiated adenocarcinoma (P>0.05). Conclusions The malignant process of FPC gradually occurs. Once malignancy occurs, the degree of malignancy is high, metastasis is prone to occur, and the prognosis is poor. However, other non-malignant polyps are already high-risk precancerous lesions and should be removed during surgery.