食管鳞状上皮内瘤变的临床病理学特征分析

Clinicopathological features of esophageal squamous intraepithelial neoplasia

目的探讨食管鳞状上皮内瘤变的临床病理学特征,准确把握“细胞异型性”和“组织结构异型性”,为临床病理医师正确诊断食管鳞状上皮内瘤变提供理论依据。方法选取食管鳞状上皮内瘤变典型病例162例,收集患者临床资料并进行比较,光镜下观察食管鳞状上皮内瘤变的典型表现,总结可能提示瘤变的临床病理学特征,并分析其形成的病理原因。结果162例食管鳞状上皮内瘤变患者中男女比例为126∶36,年龄(61.48±9.16)岁。在年龄分组中,经Mann-Whitney检验可知,不同年龄食管鳞状上皮内瘤变级别比较差异有统计学意义(Z=-2.911,P=0.0036)。与<61岁组相比,食管鳞状上皮内瘤变在≥61岁人群更易发生。在镜下观察中发现可能提示食管鳞状上皮内瘤变的临床病理学特征,如核质比增大,核分裂像增多;表层角化颗粒及有核细胞增多;瘤变细胞胞质嗜酸性增强;基底层出现皮脂腺样细胞;瘤变细胞平行或斜行生长;细胞排列紊乱、极向消失;成熟梯度消失;异常角化;上皮内血管增生;上皮脚延伸或推挤式生长。结论食管鳞状上皮内瘤变在≥61岁男性中更易发生;光镜下可能提示瘤变的临床病理学特征,可以帮助临床病理医师较为容易的把握食管上皮内瘤变的正确诊断。

Objective To investigate the clinicopathological characteristics of esophageal squamous intraepithelial neoplasia(ESIN),and to accurately differentiate between the“cell atypia”and“tissue atypia”,aiming to provide a theoretical basis for accurate diagnosis of ESCI for clinical pathologists.Methods Clinical data of 162 patients with typical ESIN were collected.Typical manifestations of ESIN were observed under light microscope.Clinicopathological features indicative of the neoplasia were summarized,and the pathological causes of the neoplasia were analyzed.Literature review was also conducted.Results The male-to-female ratio was 126∶36 and the average age was(61.48±9.16)years.In the age grouping,Mann-Whitney test showed that the differences in the median ESIN grade among different age groups were statistically significant(Z=-2.911,P=0.0036).Compared with the<61-yearold group,ESIN was more likely to occur in the≥61-year-old group.Light microscopy revealed clinicopathological features indicative of neoplasia,such as increased nuclear-cytoplasmic ratio,increased mitotic figures,more keratinized granules and nucleated cells in the surface layer,eosinophilic cytoplasm of tumor cells,sebaceous gland-like cells in the basal layer,neoplastic cells growing in parallel or obliquely,disordered cell arrangement and absence of polarization,absence of maturation gradient,abnormal keratosis,intraepithelial angiogenesis and epithelial foot extension or push-type growth.Conclusions ESIN is more likely to occur in men aged 61 years or older.Light microscopy reveals potential clinicopathological features indicative of neoplasia,which can assist clinical pathologists to make accurate diagnosis of ESIN.