直肠癌黏膜下浸润癌与直肠高级别上皮内瘤变的病理特征比较

Comparison of pathological features of submucosal invasive carcinoma and high-grade intraepithelial neoplasia in pathological biopsy of rectum

目的比较直肠癌黏膜下浸润癌与直肠高级别上皮内瘤变的病理特征。方法回顾性分析2015年1月至2017年1月本院收集的直肠肿瘤性病变黏膜活检标本240例资料,经病理确诊为浸润性腺癌标本161例(观察组)及高级别上皮内瘤变标本79例(对照组),对比两组HE染色处理后病理形态学特征。结果观察组及对照组中可见黏膜肌结构的标本占比分别为39.1%(63/161)、31.6%(25/79),差异无统计学意义(P>0.05)。观察组中可见黏膜肌且未穿过黏膜肌层占比显著低于对照组,差异有统计学意义(P<0.05)。观察组异常腺体结构,包括筛状结构腺体、锐角形腺体及腺性结构消失检出率均明显高于对照组,差异均有统计学意义(均P<0.05)。两组腺体分支出芽占比差异无统计学意义(P>0.05)。对照组未见黏膜间质病理化改变特征,观察组均表现出不同程度的黏膜间质病理化改变特征,其中观察组标本间质纤维化、厚壁血管检出率明显高于对照组,差异均有统计学意义(均P<0.05)。结论在直肠肿瘤性病变标本中出现的腺体呈筛状结构变化、黏膜间质纤维化等特征,对于鉴别直肠癌黏膜下浸润癌与直肠高级别上皮内瘤变具有一定的参考价值。

Objective To compare the pathological features of submucosal invasive adenocarcinoma of the rectum and high-grade intraepithelial neoplasia in pathological biopsy of rectal cancer. Methods We performed a retrospective analysis of 161 patients of invasive adenocarcinoma and 79 patients with high-grade intraepithelial neoplasia in 79 cases collected from January 2015 to January 2017 in our hospital. Pathological findings were compared with surgical specimens. The pathological features of HE staining were compared between the two groups by pathological diagnosis of surgical specimens. Results In the observation group and the control group, the proportion of specimens with mucosal muscle structure was 39.1%（63/161） and 31.6%（25/79）, respectively, and the difference was not statistically significant（P〈0.05）. In the observation group, the proportion of not through the muscularis mucosa layer was significantly lower than that of the control group（P〈0.05）. The detection rate of abnormal gland structure in the observation group, including the sieve-like structure gland, acute angle gland and glandular structure disappearance, was significantly higher than that of the control group（all P〈0.05）. The proportion of budding branch glands showed no significant difference between the two groups（P〉0.05）. The control group had no pathological changes of mucosa mesenchymal characteristics and the observation group showed different pathological changes. In the observation group, the detection rate was significantly higher than that the control group in terns of interstitial fibrosis and thick walled blood vessels（P〈0.05）. Conclusion For differential diagnosis of submucosal invasive carcinoma and High-grade intraepithelial neoplasia in rectum specimen, the sieve-like structure gland and interstitial fibrosis of mucosa would do some help.