Jass J R
Department of Pathology, University of Queensland Medical School, Herston, Australia.
World J Surg. 2000 Sep;24(9):1016-21. doi: 10.1007/s002680010152.
The histopathologic spectrum of early colorectal cancer (ECC) is compared from the Western and Japanese perspective. In the West, most ECC presents as a malignant adenoma, whereas superficial ECC with no adenomatous component is well described in the Japanese literature. Furthermore, superficial ECC is thought to progress rapidly and disseminate early. The discrepant viewpoints are considered in the light of different approaches to histopathologic interpretation. Lesions reported by Japanese pathologists as superficial carcinomas limited to the mucosa are diagnosed as flat adenomas in the West. In one Japanese series only 4 of 218 (1.8%) flat or small sessile neoplasms removed by endoscopic mucosal resection were associated with submucosal invasion by carcinoma. Therefore superficial ECC with submucosal spread is uncommon. Most ECC in hereditary nonpolyposis colorectal cancer evolves through the adenoma-carcinoma pathway (including flat adenoma). However, adenoma removal in the context of population-based screening programs has not lowered the incidence of colorectal cancer; flat colorectal neoplasia may be important in clinical practice.
从西方和日本的视角比较早期结直肠癌（ECC）的组织病理学谱。在西方，大多数ECC表现为恶性腺瘤，而日本文献中对无腺瘤成分的浅表ECC有详尽描述。此外，浅表ECC被认为进展迅速且早期播散。鉴于组织病理学解释方法的不同，对这些不同观点进行了考量。日本病理学家报告为局限于黏膜的浅表癌的病变在西方被诊断为扁平腺瘤。在一个日本系列研究中，经内镜黏膜切除术切除的218个扁平或小的无蒂肿瘤中，只有4个（1.8%）与癌浸润黏膜下层有关。因此，伴有黏膜下扩散的浅表ECC并不常见。大多数遗传性非息肉病性结直肠癌中的ECC通过腺瘤-癌途径（包括扁平腺瘤）演变。然而，在基于人群的筛查项目中切除腺瘤并未降低结直肠癌的发病率；扁平结直肠肿瘤在临床实践中可能很重要。
