应用于结直肠腺瘤的维也纳分类。

The Vienna classification applied to colorectal adenomas.

作者信息

Rubio Carlos A, Nesi Gabriella, Messerini Lucca, Zampi Gian Carlo, Mandai Koichi, Itabashi Masayuki, Takubo Kaiyo

机构信息

Department of Pathology and Oncology, University of Florence, Florence, Italy.

出版信息

J Gastroenterol Hepatol. 2006 Nov;21(11):1697-703. doi: 10.1111/j.1440-1746.2006.04258.x.

DOI:10.1111/j.1440-1746.2006.04258.x

PMID:16984592

Abstract

BACKGROUND AND AIM

In 1999, a group of Western and Asian pathologists gathered in Vienna reached consensus regarding the classification of gastrointestinal epithelial neoplasia. In this study, that classification is applied to colorectal adenomas.

METHODS

Colorectal adenomas from 1552 patients were histologically classified according to the categories listed in Vienna: category 3, low-grade dysplasia; 4.1, high-grade dysplasia; 4.2, carcinoma in situ; 4.3, suspicious of intramucosal carcinoma; 5.1, intramucosal carcinoma; and 5.2, submucosal carcinoma. The criteria used to diagnose these lesions are described in detail. Adenomas with dysplasia (categories 3 and 4.1) or with carcinoma (categories 4.2, 4.3, 5.1 and 5.2) were analyzed separately. On basis of their configuration, adenomas were classified into tubular, tubulovillous, villous, serrated, microtubular and combined phenotypes (i.e. other than tubulovillous).

RESULTS

The highest percentage of adenomas with carcinoma was found amongst villous adenomas (29.6%), followed by combined adenomas (27.8%). Villous adenoma with carcinoma was the most frequent neoplasia at all ages; combined adenomas with carcinoma were more frequent among younger patients. In elderly patients (> or = 60 years of age) the highest percentage of adenomas with carcinoma was recorded in villous adenomas (28.1%), followed by serrated adenomas (19.2%). Villous adenomas and combined adenomas with carcinoma were more frequent in males.

CONCLUSION

The Vienna classification of colorectal adenomas seems to be influenced by parameters inherent to the patient such as age and sex and by the histological phenotype of the adenoma. With the recent improvement in medical technology it is possible to laser-microdissect a defined group of neoplastic glands (such as with carcinoma in situ or with intramucosal carcinoma) for specific molecular analysis. This modern technology will permit in future the translation of histological structures into molecular terms.

摘要

背景与目的

1999年，一群西方和亚洲病理学家齐聚维也纳，就胃肠道上皮肿瘤的分类达成了共识。在本研究中，该分类应用于结直肠腺瘤。

方法

根据维也纳分类列出的类别，对1552例患者的结直肠腺瘤进行组织学分类：3类，低级别异型增生；4.1类，高级别异型增生；4.2类，原位癌；4.3类，可疑黏膜内癌；5.1类，黏膜内癌；5.2类，黏膜下癌。详细描述了用于诊断这些病变的标准。分别分析了伴有异型增生（3类和4.1类）或伴有癌（4.2类、4.3类、5.1类和5.2类）的腺瘤。根据其形态，腺瘤被分为管状、绒毛状、锯齿状、微管状和混合型（即除绒毛状管状腺瘤以外的其他类型）。

结果

绒毛状腺瘤中伴有癌的腺瘤比例最高（29.6%），其次是混合型腺瘤（27.8%）。伴有癌的绒毛状腺瘤在各年龄段都是最常见的肿瘤；伴有癌的混合型腺瘤在年轻患者中更为常见。在老年患者（≥60岁）中，伴有癌的腺瘤比例最高的是绒毛状腺瘤（28.1%），其次是锯齿状腺瘤（19.2%）。伴有癌的绒毛状腺瘤和混合型腺瘤在男性中更为常见。