结直肠纤维绒毛锯齿状腺瘤临床病理学及免疫组织化学的观察

Clinicopathologic and immunohistochemical study of colorectal filiform serrated adenomas

目的:探讨纤维绒毛锯齿状腺瘤(FSA)的临床病理学特征以及免疫组织化学特征的意义。方法:收集病理诊断为结直肠各类息肉和腺瘤切片5347例,从中筛选出FSA共18例,同时收集临床相关资料并观察病理学特征。对FSA11例、非纤维绒毛锯齿状腺瘤(NFSA)20例〔其中传统锯齿状腺瘤(TSA)15例、广基锯齿状腺瘤/息肉(SSA/P)5例〕、增生性息肉(HP)20例及绒毛管状腺瘤(VTA)20例分别进行免疫组化Ki-67、p53、-βCatenin、CK7、CK20及CDX-2染色。结果:FSA多发于左半结肠,组织学显示肿物表面可见许多细长丝状或绒毛状的突起,隐窝被覆异型增生的上皮细胞,伴有典型锯齿状改变,该类突起形似绒毛管状腺瘤,但其长度比绒毛管状腺瘤长。多数病例突起末端间质水肿明显(12/18),严重者可膨大呈"球茎"状改变(7/18)。FSA异型增生程度较NFSA和VTA要高,差异有统计学意义,P<0.05。在FSA中p53和Ki-67的表达与其他各组比较差异有统计学意义,P<0.05。结论:FSA是一种较少见的特殊类型锯齿状腺瘤,以其"长绒毛"的典型特征区别于其他锯齿状病变,异型增生程度重,可能具有更高的恶变潜能。

OBJECTIVE： To explore the significance of clinicopathological feature and immunohistochemical feature of colorectal Filiform serrated adenomas （FSA）. METHODS： A total of 5 347 cases of colorectal polyps/adenomas from five regional hospitals in five years were retrospectively reviewed, and 18 cases of FSA were selected. Twenty cases of Nonfiiiform Serrated Adenomas （NFSA） ,including 15 cases of Traditional serrated adenoma （TSA） and 5 cases of Sessile serrated adenoma/ polyp （SSA/P）, 20 cases of Hyperplastic polyp（HP）and 20 cases of Villous tubular adenoma （VTA） were selected as control group. The expression of Ki-67, p53, CK7,CK20, CDX2 and beta-catenin in FSA, NFSA, HP and VTA were compared by immunohistochemical stain. RESULTS： FSA showed a strong predilection located in the left colon. Elonga- ted filiform projections lined by cytological neoplastic epithelium with a serrated contour were observed. The filiform projections of FSA were longer than the villi present in typical VTA. Marked stromal edema was present （12/18） and the ＂bulb-like＂ change was showed in swelling of severe cases（7/18）. There was significant difference between FSA and NFSA in the degree of dysphasia（P〈 0.05）. The expression of Ki-67, p53 showed significant difference among FSA,NFSA, HP and VTA （P〈0.05）. CONCLUSIONS： In summary, FSA is an unusual type of adenoma with long filiform projections lined by neoplastic epithelium with a serrated contour, which shows higher malignant potential. Additional, long-term outcome studies are needed to fully understand the biologic features and neoplastic potential of these lesions.