传统型锯齿状腺瘤200例临床病理学分析  

Clinicopathological analysis of 200 cases of traditional serrated adenoma

作　　者：李莉 李惠 陈劼 韩梅 李秀清 可飞 章宜芬 Li Li;Li Hui;Chen Jie;Han Mei;Li Xiuqing;Ke Fei;Zhang Yifen(Department of Pathology,Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of TCM,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院(江苏省中医院)病理科,南京210029

出　　处：《临床与实验病理学杂志》2025年第3期345-351,共7页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨传统型锯齿状腺瘤(traditional serrated adenoma,TSA)临床病理特征。方法回顾性分析200例TSA患者的临床资料、内镜和病理学特征,行HE、免疫组化染色,采用χ^(2)检验对临床病理学特征进行统计学分析,并复习相关文献。结果男性114例(57.0%),女性86例(43.0%),发病年龄27~92岁(平均56.2岁)。患者年龄≥50岁者147例(73.5%),<50岁者53例(26.5%)。207枚TSA中有143枚(69.1%)位于远端结直肠,57枚(27.5%)位于近端结直肠。内镜下可见带蒂病变72枚(34.8%),扁平状48枚(23.2%),部分有松果样外观。最大径≤10 mm有136枚(65.7%),最大径>10 mm有71枚(34.3%)。TSA典型组织学特征:锯齿状轮廓、嗜酸性细胞质、铅笔状细胞核和异位隐窝灶。最常见病理类型为经典型TSA(152枚,73.4%),其次为富于黏液型TSA(39枚,18.8%)。12枚TSA(5.8%)伴高级别上皮内瘤变,3例(1.5%)TSA继发癌变,符合起源于TSA结直肠癌诊断。免疫表型:34例TSA中Ki67基底部细胞弥漫表达,表面散在表达,35例p53核弱表达(1%~60%),PTEN及MLH1均保留表达。12例TSA伴高级别上皮内瘤变及3例起源于TSA结直肠癌中Ki67弥漫表达、CK20弥漫强表达、MLH1保留表达;9例TSA伴高级别上皮内瘤变p53弥漫核强表达,12例PTEN缺失表达。3例起源于TSA结直肠癌p53均弥漫核强表达。分子检测:8例检测出BRAF V600E基因突变;另7例检测出KRAS基因突变(6例KRAS G12V突变,1例KRAS G13D突变)。手术方式以内镜下黏膜切除术为主(111例,53.6%)。结论TSA有其典型的组织学及内镜特征,病变最大径>10 mm者易进展为高级别上皮内瘤变或腺癌;提高病理与临床医师对该病变尤其是TSA伴异型增生或浸润性癌的认识,避免误、漏诊。Purpose To investigate the clinicopathological features of traditional serrated adenoma(TSA).Methods A retrospective analysis was conducted on the clinical data,endoscopic,and pathological features of 200 TSA patients.HE staining and immunohistochemical staining were performed.The clinical pathological features were statistically analyzed usingχ^(2)test,and relevant literature was reviewed.Results There were 114 males(57.0%)and 86 females(43.0%),with ages ranging from 27 to 92 years(mean age 56.2 years).Among the patients,147(73.5%)were aged≥50 years,and 53(26.5%)were aged<50 years.Of the 207 TSA lesions,143(69.1%)were located in the distal colon and rectum,while 57(27.5%)were in the proximal colon and rectum.Endoscopic features included 72 lesions(34.8%)with a perpendiculated appearance,48 lesions(23.2%)with a flat appearance,and some exhibiting a pinecone-like appearance.The maximum diameter of the lesions was≤10 mm in 136 cases(65.7%),and>10 mm in 71 cases(34.3%).The typical histopathological features of TSA included serrated contours,eosinophilic cytoplasm,pencil-like nuclei,and ectopic crypt foci.The most common pathological type was the classic TSA(152 lesions,73.4%),followed by the mucin-rich TSA(39 lesions,18.8%).12 cases(5.8%)of TSA exhibited high-grade intraepithelial neoplasia(HGIN)and 3 case(1.5%)of TSA progressed to carcinoma,consistent with TSA-originated colorectal cancer(TSA-CRC).Immunophenotype:in 34 cases TSA,Ki67 showed diffuse positivity in basal cells and scattered positivity on the surface.In all 35 cases TSA,p53 showed weak positive nuclear positivity(1%to 60%),and PTEN and MLH1 were retained.In the 12 cases of TSA with HGIN and 3 cases of TSA-CRC,Ki67 showed diffusely positive,CK20 was strongly positive diffusely,and MLH1 was retained.In 9 cases of TSA with HGIN,p53 was diffusely strongly positive,and in 12 cases,PTEN was lost.All 3 cases of TSA-CRC showed diffuse strong nuclear p53 positivity.The molecular detection showed there were BRAF V600E gene mutation in 8 cases.There were 6 c

关 键 词：结直肠肿瘤 传统型锯齿状腺瘤 内镜特征 病理特征 

分 类 号：R735.3[医药卫生—肿瘤]