Ishizu Hideki, Kumagai Jiro, Eishi Yoshinobu, Takizawa Touichiro, Koike Morio
Department of Pathology, Faculty of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan.
J Gastroenterol. 2004;39(2):125-32. doi: 10.1007/s00535-003-1263-z.
In the categorization of colorectal mucinous carcinomas, much attention has been paid to the amount of extracellular mucin, but little to that of intracellular mucin. Perhaps this factor would be useful in further categorization.
We estimated the amount of intracellular mucin morphologically, and classified colorectal tumors (tubular adenomas, mucinous carcinomas, and nonmucinous carcinomas) into two categories each, those with and without intracellular mucus hyperplasia. From preliminary results, we chose a range of 50% or more for the ratio of intracellular mucus to the total area of tumor cells for our definition of such hyperplasia. Then, mucin expression in the different categories was examined immunochemically with antibodies to the mucin core proteins MUC1, MUC2, MUC5AC, and MUC6.
MUC1 expression was found in none of the 40 adenomas, 8 (17%) of the 48 mucinous carcinomas (with little difference in those with and without mucus hyperplasia), and 4 (16%) of the 25 nonmucinous carcinomas. MUC2 was found in all mucinous carcinomas. MUC5AC was found in 18 (86%) of the 21 mucinous carcinomas with mucus hyperplasia and 18 (90%) of the 20 adenomas with mucus hyperplasia, but in only 9 (33%) of the 27 mucinous carcinomas without mucus hyperplasia, 5 (20%) of the 25 nonmucinous carcinomas, and 2 (10%) of the 20 adenomas without mucus hyperplasia.
Mucinous carcinomas with and without mucus hyperplasia may arise from adenomas with and without mucus hyperplasia, respectively. The amount of intracellular mucin may be a morphologic reflection of the origin of colorectal mucinous carcinomas.
在结直肠黏液腺癌的分类中,人们对细胞外黏液的量给予了很多关注,但对细胞内黏液的量关注较少。或许这个因素在进一步分类中会有用。
我们从形态学上估计细胞内黏液的量,并将结直肠肿瘤(管状腺瘤、黏液腺癌和非黏液腺癌)各分为两类,即有和没有细胞内黏液增生的肿瘤。根据初步结果,我们选择细胞内黏液与肿瘤细胞总面积之比为50%或更高的范围来定义这种增生。然后,用针对黏液核心蛋白MUC1、MUC2、MUC5AC和MUC6的抗体进行免疫化学检测不同类别中的黏液表达。
在40例腺瘤中均未发现MUC1表达,48例黏液腺癌中有8例(17%)(有和没有黏液增生的病例差异不大),25例非黏液腺癌中有4例(16%)。所有黏液腺癌中均发现有MUC2表达。在21例有黏液增生的黏液腺癌中有18例(86%)、20例有黏液增生的腺瘤中有18例(90%)发现有MUC5AC表达,但在27例没有黏液增生的黏液腺癌中只有9例(33%)、25例非黏液腺癌中有5例(20%)、20例没有黏液增生的腺瘤中有2例(10%)发现有MUC5AC表达。
有和没有黏液增生的黏液腺癌可能分别起源于有和没有黏液增生的腺瘤。细胞内黏液的量可能是结直肠黏液腺癌起源的形态学反映。