Nowicki Michael J, Bishop Phyllis R, Subramony Charu, Wyatt-Ashmead Josephine, May Warren, Crawford Maxine
Division of Pediatric Gastroenterology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
J Pediatr Gastroenterol Nutr. 2005 Nov;41(5):600-6. doi: 10.1097/01.mpg.0000179658.09210.b6.
Colonic polyps are common both in adults and children; however, the malignant potential varies according to the type of polyp. Most childhood polyps are solitary juvenile polyps, which have negligible malignant potential. Chicken-skin mucosa (CSM) is an endoscopic finding initially described associated with adenomatous polyps and adenocarcinoma, suggesting a preneoplastic lesion. Subsequently, CSM was described in association with juvenile polyps, suggesting that this mucosal finding is not a precursor to dysplasia. To determine whether CSM represents a preneoplastic lesion, we studied endoscopic colonic mucosal biopsies for markers of cell replication (Ki-67) and malignant transformation (p53) in mucosal biopsies of CSM, normal colonic tissue, tubular adenomas, and adenocarcinomas. Samples were subjected to immunostaining for the presence of Ki-67 and p53. The degree of Ki-67-positive staining cells was similar for CSM and normal colonic tissue, whereas there was significantly increased staining for both tubular adenomas and adenocarcinomas. There was no evidence of p53 staining in CSM and normal colonic mucosa, whereas there was varying degrees of staining in tubular adenomas and adenocarcinomas. The association of CSM with benign juvenile polyps and the absence of histologic markers for increased replication and malignant transformation support the notion that this endoscopic finding is not preneoplastic. Rather, CSM arises in proximity to polyps of all histologic types because of local mucosal damage.
结肠息肉在成人和儿童中都很常见；然而，其恶变潜能因息肉类型而异。大多数儿童息肉是孤立性幼年息肉，恶变潜能可忽略不计。鸡皮样黏膜（CSM）是一种内镜下表现，最初被描述为与腺瘤性息肉和腺癌相关，提示为癌前病变。随后，CSM被描述与幼年息肉有关，这表明这种黏膜表现并非发育异常的先兆。为了确定CSM是否代表癌前病变，我们研究了CSM、正常结肠组织、管状腺瘤和腺癌的内镜结肠黏膜活检组织中细胞增殖标志物（Ki-67）和恶性转化标志物（p53）。对样本进行Ki-67和p53免疫染色。CSM和正常结肠组织中Ki-67阳性染色细胞的程度相似，而管状腺瘤和腺癌的染色均显著增加。CSM和正常结肠黏膜中没有p53染色的证据，而管状腺瘤和腺癌中有不同程度的染色。CSM与良性幼年息肉相关，且缺乏细胞增殖增加和恶性转化的组织学标志物，这支持了这种内镜表现并非癌前病变的观点。相反，CSM是由于局部黏膜损伤而出现在所有组织学类型息肉的附近。
