溃疡性结肠炎合并结肠多发性锯齿状息肉的临床病理分析

Ulcerative colitis with multiple serrated lesions:a clinicopathologic analysis

目的探讨溃疡性结肠炎(UC)合并结肠多发性锯齿状息肉的临床病理特点及免疫组化表型。方法报告2例分别有10年和8年溃疡性结肠炎病史、合并多发性结肠锯齿状息肉病的临床、内窥镜及病理组织学改变。行AE1/AE3、CK7、CK20、CEA、CD34、SMA、p53和Ki-67免疫组化染色,并结合文献进行复习讨论。结果2名患者均为中年女性,间断腹泻10年和8年,分别多次行内窥镜检查发现结直肠黏膜多处糜烂、浅表溃疡。例1,降、乙状结肠可见密集分布、大小不等的息肉,最大直径3 cm;例2,全结肠可见10余枚息肉。镜检:结直肠溃疡糜烂处符合溃疡性结肠炎病变;息肉处腺体大部分呈锯齿状扩张增生,部分细胞核增生呈复层,可见异型增生。免疫组化:息肉部腺体CEA(+),Ki-67阳性细胞位于锯齿状隐窝基底及中1/3;例2局部p53(+)。结论UC相关锯齿状息肉/腺瘤病具有肿瘤性病变特征,UC合并锯齿状息肉或腺瘤可能更易癌变。

Objective To investigate the clinicopathological features and phenotype in ulcerative colitis （UC） with multiple mixed serrated lesions. Mcthods Two cases of UC with 10-year and 8-year history combined multiple mixed serrated polyposis were reported. The endoscopic findings, histopathological changes and expression AE1/AE3, CK7, CK20, CEA, CD34, SMA, p53, Ki67 were observed. Results Both of the patients were female and had interval diarrhea for 8- 10 years. There were multiple mucosal erosions, superficial ulceration and different sized polyps under endoscope. Histopathology showed classical ulcerative colitis lesions in area of multiple mucosal superficial ulceration, and serrated lesion with glands proliferation and expansion, and some nuclei stratified hyperplasia in the area of polyps. Immtmohistochemistry in serrated lesion showed that CEA was positive, Ki-67 positive index 25% - 50% and positive cells located in middle potion of the serrated crypt, p53 was local positive. Conclusion UC associated with serrated polyposis/adenomas shows tumor feature and may be easily transformed into cancer.