Kambham Neeraja, Troxell Megan, Longacre Teri A
Department of Pathology, Stanford University, Stanford, CA 94305, USA.
Am J Surg Pathol. 2005 Jul;29(7):912-9. doi: 10.1097/01.pas.0000164614.30576.da.
Multinucleated epithelial giant cells (MEG) simulating viral cytopathic effect and/or dysplasia have been reported in the esophagus in association with inflammation, but the occurrence of similar cells in the colon has not been documented. Twenty-three colon specimens (22 biopsies and 1 partial colectomy) featuring MEG from 21 patients were evaluated for a variety of histologic features and correlated with clinical, endoscopic, and follow-up data. Patients included 9 males and 12 females (mean age, 64.9 years; range, 45-86 years). Eleven cases were obtained from 10 asymptomatic patients undergoing surveillance biopsies. Presenting symptoms in the remaining patients were dyspepsia, anemia, abdominal pain, and hematochezia. Over half (13 of 23) of the specimens were from descending and rectosigmoid colon, and almost all were visualized as polyps on endoscopy. Microscopically, all but 1 of the cases featured multiple MEG (range, 6 to >50 cells per biopsy) in the base and mid crypt zones of inflamed polyps with serrated architecture. Immunohistochemical stains for CMV, HSV, adenovirus, EBV, and polyoma virus were negative and no viral particles were identified on ultrastructural examination. Nuclear staining for hMLH1 and hMSH2, markers of microsatellite instability, was similar in distribution to adjacent serrated crypts, but reduced staining intensity was noted in occasional multinucleated cells. Expression of Ki-67 and cleaved caspase 3 was consistent with a quiescent or low proliferative state. Clinical follow-up was available for 9 patients (mean duration, 22.7 months). One patient died of heart failure; all others were well at last follow-up. Bizarre MEG may occasionally be seen within the crypts of inflamed polyps with serrated architecture, raising concern for dysplasia or viral infection. Immunohistochemical and ultrastructural studies fail to establish a viral etiology, and follow-up does not indicate clinically aggressive disease. These changes appear to represent a nonspecific, possibly degenerative response to inflammation and injury, and should be distinguished from dysplasia.
多核上皮巨细胞（MEG）模拟病毒细胞病变效应和/或发育异常已在食管中被报道，与炎症相关，但在结肠中出现类似细胞的情况尚未见文献记载。对来自21例患者的23份具有MEG的结肠标本（22份活检标本和1份部分结肠切除术标本）进行了多种组织学特征评估，并与临床、内镜及随访数据相关联。患者包括9名男性和12名女性（平均年龄64.9岁；范围45 - 86岁）。11例标本来自10名接受监测活检的无症状患者。其余患者的主要症状为消化不良、贫血、腹痛和便血。超过半数（23例中的13例）标本来自降结肠和直肠乙状结肠，并且在内镜检查中几乎所有都表现为息肉。显微镜下，除1例病例外，所有病例在具有锯齿状结构的炎性息肉的底部和隐窝中区均有多个MEG（范围为每个活检标本6至>50个细胞）。针对巨细胞病毒（CMV）、单纯疱疹病毒（HSV）、腺病毒、EB病毒和多瘤病毒的免疫组化染色均为阴性，并且在超微结构检查中未发现病毒颗粒。微卫星不稳定性标志物hMLH1和hMSH2的核染色在分布上与相邻的锯齿状隐窝相似，但在偶尔的多核细胞中观察到染色强度降低。Ki-67和裂解的半胱天冬酶3的表达与静止或低增殖状态一致。9名患者有临床随访资料（平均随访时间22.7个月）。1例患者死于心力衰竭；所有其他患者在最后一次随访时情况良好。在具有锯齿状结构的炎性息肉隐窝内偶尔可见奇异的MEG，这引起了对发育异常或病毒感染的担忧。免疫组化和超微结构研究未能证实病毒病因，且随访未显示临床侵袭性疾病。这些改变似乎代表了对炎症和损伤的一种非特异性、可能是退行性的反应，应与发育异常相鉴别。
