Rubio Carlos A, Nesi Gabriella, Messerini Lucca, Zampi Gian Carlo, Mandai Koichi, Itabashi Masayuki, Takubo Kaiyo
Department of Pathology and Oncology, University of Florence, Florence, Italy.
J Gastroenterol Hepatol. 2006 Nov;21(11):1697-703. doi: 10.1111/j.1440-1746.2006.04258.x.
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.
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).
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.
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.
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。
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）。
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。
结直肠腺瘤的维也纳分类似乎受患者固有参数（如年龄和性别）以及腺瘤组织学表型的影响。随着医学技术的不断进步，现在有可能对特定的一组肿瘤腺体（如原位癌或黏膜内癌）进行激光显微切割，以进行特定的分子分析。这种现代技术未来将使组织学结构能够转化为分子术语。
