225例大肠腺瘤癌变的临床病理、免疫组化及其超微结构  

A study on features of the clinicopathology,immunohistochemistry and ultrastructure in 225 cases colonic adenomas and adenocarcinoma arising from adenomas

作　　者：张共和[1] 金行藻[2] 张太和[2] 钱源澄[2] 

机构地区：[1]南京军区总医院疗养区,南京211131 [2]南京军区总医院病理科,210002

出　　处：《临床肿瘤学杂志》2008年第2期156-158,共3页Chinese Clinical Oncology

摘　　要：目的:探讨大肠腺瘤及其癌变的临床病理、免疫组织化学及其超微结构。方法:随机选择我院近5年间纤维肠镜1804人次,检出大肠腺瘤225枚,其中91例行CEA组织化学染色,15例行电镜观察。结果:腺瘤肠镜检出率为12.47%(225/1804),癌变33例,癌变率为14.67%(33/225),其中管状腺瘤癌变4例,绒毛管状腺瘤癌变8例,绒毛状腺瘤癌变21例。有蒂的管状腺瘤异型程度轻、癌变率低、预后好;宽蒂、无蒂的扁平型、凹陷型、绒毛状腺瘤,异形程度重,癌变率高,浸润深,预后差。CEA染色阳性率:腺瘤癌变者93.33%(14/15),绒毛状腺瘤78.95%(15/19),绒管状腺瘤70.50%(12/17),管状腺瘤67.5%(27/40)。电镜观察显示绒毛状腺瘤部分腺上皮细胞突破基底膜向间质伸长,可出现异形细胞,核大核沟深,常染色质丰富核仁明显,癌变者可见淋巴细胞溶解癌细胞膜现象。结论:大肠腺瘤为癌前病变,不同类型的大肠腺瘤其治疗及预后不同。Objective：To investigate features of the clinicopathology, immunohistochemistry and uhrastructure in colonic adenomas and adenocarcinomas arising from adenomas. Methods ： We selected 225 cases adenomas from 1 804 cases by intestinal endoscopy at random during 5 years recently and investigated by light microscopy. We studied 91 cases with CEA by immunohistochemistry staining and 15 cases by electron microscopy. Results： We found 33 cases adenocarcinomas arising from adenomas, including 4 cases from tubular adenomas,21 cases from villous adenomas,8 cases from tubular-villous adenomas. The positive rate of CEA was 93.33% （14/15） in carcinomas arising from adenomas,78.95% （15/19） in villous adenomas,70. 50% （ 12/17 ） in tubular - villous adenomas and 67.5% （27/40） in tubular adenomas. The tubular adenomas with long cords had mild bysplasia, low risk to carcinoma and good prognosis, but the villous adenomas with wide cords or no cords in flat type or depressed type had severe dysolasia, high risk to carcinoma and poor prognosis. Uhrastructurely, some adenoepithelial cells broke out cytomembrane and spread into stromal tissue. The tumour cell had enormous nucleus with grooves and was abundant in chromatin. The nucleoli were appearant. We observed the phenomena that lymphocyte lysing cytomembrane in adenocarcinomas arising from adenomas. Condusion：Colonic adenoma is a precareinoma lesions, different types have different therapeutic methods and prognosis.

关 键 词：大肠腺癌 临床病理 免搜组织化学 超微结构 

分 类 号：R735.34[医药卫生—肿瘤] R735.2[医药卫生—临床医学]