各型大肠息肉灶性异型增生的形态学与组化特征

STUDY ON THE MORP HOLOGICAL FEATURES OF FOCALDYSPLASIA AND ITS SIGNIFICANCE OF VARIOUS COLO-RECTAL POLYPS

作者对７６例大肠各型息肉和腺瘤进行了组织形态学观察，对所见灶性异型增生的特征及其意义进行了分析。结果显示，大肠各型息肉灶性异型增生的检出率分别为：炎性息肉１０％，幼年性息肉为零，增生性息肉８．３％，息肉状腺瘤４２．９％，绒毛状腺瘤６６．７％，家族性腺瘤５０％和腺瘤癌变１００％。灶性异型增生细胞位于某一腺管或分支的乳头上，少者仅有２至５个细胞，多者达１０余个细胞。可向管腔内或基底膜外突起，拥挤排列，极向紊乱。细胞体积增大，尤其核增大明显，核染色质粗，可见核仁，有的核形不规则。灶性异型增生同两侧的腺上皮有明显的形态差异，亦可有过渡现象。灶性异型增生ｒａｓ癌基因产物Ｐ２１蛋白表达５９．３％，癌胚抗原７７．８％，ＭＣ３５９．３％，ＰＮＡ受体６３．０％，ＡｇＮＯＲ计数２．８４～８．６１个之间，每个细胞银颗粒超过４个的细胞４７．０５％，一些银颗粒增大，不规则。提示大肠粘膜腺体灶性异型增生是重要的癌前期病变。

The morphological features fo focal dysplasia and its significanceof various colo-rectal polyps and adenocarcinomas of 76 cases were studied. The resultsshowed that the detection rates of focal dysplasia in colo-rectal polyps of various typeswere:zero in the juvenile polyps,8.3% in the hyperplastic polyps,10% in the inflamma-tory polyps,42.9% in the polypoid adenomas,50% in the familial adenoma,66.7% in thevillous adenoma and l00% in the maligant and adenome,The focal dysplasia(2 to 5 cellsat least and l0 at most)might be located in a glandular cavity or in a papillary branch,They were arranged irregularly,some protruded to the lumen of the tubules,some outsidethe basal membrane.The focal dysplasia showed enlargement of the size of the cell nu-clei,so that the nuclear cytoplasmic ratio was altered.The chromatin was increased orcondensed,and nucleoli became more prominant.Nuclei were frequently lobes in shape,or otherwise irregular,Immunohistochemical examination showed that the expression of P21 in 59.3%,CEA in 77.8%,MC3 in 59.3%and PNA in 63%. The AgNOR counts were2.84-8.6l per cell, 47.05%of the cells contained more than 4 argentaffin granules percell, granules were enlarged and irregular. The findings indicated that focal dysplasiamight be an important malignant change of precancerous iesions.