Kilgore S P, Sigel J E, Goldblum J R
Department of Anatomic Pathology, Cleveland Clinic Foundation, Ohio 44195, USA.
Mod Pathol. 2000 Jul;13(7):797-801. doi: 10.1038/modpathol.3880138.
Patients with Crohn's disease are at increased risk of developing intestinal adenocarcinoma. Dysplasia is both a marker and a precursor of adenocarcinoma in this setting. In a review of our cases of Crohn's-related adenocarcinoma, we noted a peculiar hyperplastic-like mucosal change (HPC) in mucosa both adjacent to and distant from the adenocarcinoma in some cases. However, the significance of this change is unknown. We evaluated 30 cases of Crohn's-related adenocarcinoma and 30 age- and site-matched resection specimens with Crohn's disease without adenocarcinoma to determine the prevalence of this mucosal alteration in these groups. HPC was recognized by a diffuse expanse of flat mucosa with an architecture resembling that seen in colorectal hyperplastic polyps and composed of cells with cytologically bland basal nuclei and apical cytoplasmic mucin distention. The relationship of the HPC to the adenocarcinoma was noted in the Crohn's-related adenocarcinoma cases. An immunohistochemical stain for p53 (antibody DO7) was performed on all cases with HPC in both groups. HPC was identified in 10 of 30 (33%) cases of Crohn's-related adenocarcinoma compared with 3 of 30 (10%) cases in the control group (P = .03). In the 10 cases of Crohn's-related adenocarcinoma with HPC, this alteration was found adjacent to the adenocarcinoma in 3 cases, distant to the adenocarcinoma in 5 cases, and both adjacent to and distal from the adenocarcinoma in 2 cases. In two specimens, HPC was seen immediately adjacent to adenocarcinoma in the absence of adjacent dysplasia. p53 immunoreactivity was noted in HPC in 5 of 10 (50%) Crohn's-related adenocarcinomas. In contrast, p53 immunoreactivity was not seen in HPC in the three control cases with this mucosal alteration. In conclusion, HPC is found significantly more commonly in mucosa both adjacent to and distant from Crohn's-related adenocarcinoma when compared with age- and site-matched controls. In addition, p53 immunoreactivity is more commonly seen in HPC in cases of Crohn's-related adenocarcinoma compared with controls. These data suggest that this mucosal alteration may, in some cases, represent an unusual form of dysplasia in this setting.
克罗恩病患者发生肠腺癌的风险增加。在这种情况下，发育异常既是腺癌的标志物，也是腺癌的前体。在回顾我们的克罗恩病相关腺癌病例时，我们注意到在某些病例中，腺癌附近和远处的黏膜出现了一种特殊的增生样黏膜改变（HPC）。然而，这种改变的意义尚不清楚。我们评估了30例克罗恩病相关腺癌病例以及30例年龄和部位匹配的无腺癌克罗恩病切除标本，以确定这些组中这种黏膜改变的发生率。HPC表现为大片平坦黏膜，其结构类似于结直肠增生性息肉，由具有细胞学上平淡的基底核和顶端胞质黏液扩张的细胞组成。在克罗恩病相关腺癌病例中记录了HPC与腺癌的关系。对两组中所有有HPC的病例进行了p53（抗体DO7）免疫组化染色。30例克罗恩病相关腺癌病例中有10例（33%）发现了HPC，而对照组30例中有3例（10%）发现了HPC（P = 0.03）。在10例有HPC的克罗恩病相关腺癌病例中，3例在腺癌附近发现这种改变，5例在腺癌远处发现，2例在腺癌附近和远处均发现。在两个标本中，在没有相邻发育异常的情况下，紧邻腺癌处可见HPC。10例有HPC的克罗恩病相关腺癌中有5例（50%）在HPC中观察到p53免疫反应性。相比之下，在有这种黏膜改变的3例对照病例的HPC中未观察到p53免疫反应性。总之，与年龄和部位匹配的对照组相比，在克罗恩病相关腺癌附近和远处的黏膜中，HPC的发现更为常见。此外，与对照组相比，在克罗恩病相关腺癌病例的HPC中，p53免疫反应性更为常见。这些数据表明，在这种情况下，这种黏膜改变在某些病例中可能代表一种不寻常的发育异常形式。
