结直肠黏膜下浸润性腺癌活检病理特征分析

Pathological characters analysis on biopsy specimens of invasive adenocar-cinoma in colorectal submucosa

目的分析结直肠黏膜下浸润性腺癌的病理特征,为其临床病理诊断提供依据。方法选取2006年1月~2014年12月本院有手术标本对照的190例结直肠黏膜活检标本作为研究对象,其中手术标本诊断为浸润性腺癌(IAC)117例,诊断为高级别上皮内瘤变(HGIN)73例。观察两组活检标本的HE染色病理形态学特点,并进行统计学分析。结果 IAC组中明显出现腺体的筛状结构(60.7%)、锐角形腺体(33.3%)以及腺性结构消失(7.7%),HGIN组较少出现筛状结构(6.8%)、无锐角形腺体、无腺性结构消失,两组比较差异有统计学意义(P<0.05)。IAC组和HGIN组出现腺体分支出芽的比例分别为82.9%、78.1%,差异无统计学意义(P>0.05)。IAC组存在严重间质纤维化(84.6%),HGIN组无纤维组织增生,两组比较差异有统计学意义(P<0.05)。结论结直肠活检标本中瘤性病变出现筛状结构、锐角形腺体、腺性结构消失呈弥漫性生长、间质纤维化等特征,提示发生黏膜下IAC。

Objective To analysis on pathological characters of biopsy specimens of invasive adenocarcinoma in col- orectal submucosa to provide evidence for the clinical and pathological diagnosis. Methods 190 cases of colorectal mu- cosa biopsy specimen from January 2006 to December 2014 were selected as the research object.Among them,117 cases were diagnosed as invasive adenoearcinoma （IAC）,and 73 cases were diagnosed as high grade intraepithelial neoplasia （HGIN）.The pathological characters of HE staining in two groups of biopsy specimens was observed and analyzed ＂sta- tistically. Results There were significant glands eribriform structures （60.7%）,acute angle-shaped glands （33.3%） and glandular structure disappeared （7.7%） in the IAC group,there was cribriform gland structures appeared（6.8%）,while no acute an^le-shaped an^le-shaped or diffuse carcinoma cell proliferation were detected in the HGIN group,the differ- ence between two groups was statistically significant （P〈0.05）.The proportion of branch sprouting glands in the IAC group was 82.9%,the proportion of branch sprouting glands in the HGIN group was 78.1%,the difference was not signif- icant（P〉0：05）.There was severe interstitial fibrosis （84.6%） in the IAC group,and there was no fibrous tissue hyperplasia in the HGIN group,the difference between two groups was statistically significant（P〈0.05）. Conclusion The pathological characters such as the formation of cribriform structures,acute angle-shaped glands,diffuse carcinoma cell proliferation, interstitial fibrosis,and neoplastic glands in close contact with the thick-walled vessels suggest IAC happened.