Griffioen G, Bosman F T, Verspaget H W, Sier K F, Biemond I, Lamers C B
Department of Gastroenterology and Hepatology, University Hospital, Leiden, The Netherlands.
Gastroenterology. 1991 Oct;101(4):919-26. doi: 10.1016/0016-5085(91)90716-x.
Of 124 patients who underwent endoscopic polypectomy, 70 were colonoscopically reevaluated during a mean period of 10 years. On the basis of the clinical outcome, the patients were divided into three groups: group 1, 31 patients who had a colon still with no adenomas or cancer; group 2, 35 patients in whom one or more metachronous adenomatous polyps developed; and group 3, 4 patients in whom a carcinoma of the colon subsequently developed. In addition to the clinical and pathological features, the pattern of the immunohistologic staining for carcinoembryonic antigen and secretory component was studied. Moreover, the mucin histochemical staining intensity of neutral mucins, sulfomucins, and sialomucins was evaluated. The features of the 40 index adenomas obtained from patients in group 1 were compared with the features of the 51 index adenomas from patients in group 2. Furthermore, these characteristics of the index adenomas were compared with those in the 69 metachronous adenomas of the group 2 patients. It was found that male sex (P less than 0.005) and a history of colorectal neoplasia (P less than 0.02) are main factors for the development of new adenomas. The neutral mucins were less abundant in the group 2 index adenomas (r = -0.21; P less than 0.05). The expression of the other evaluated markers was not significantly different between both groups, although the group 2 index adenomas were significantly smaller (r = -0.22; P less than 0.05) and showed a trend toward a more pronounced cytoplasmic expression of carcinoembryonic antigen than the index adenomas from group 1 (22% vs. 12.5%). Moreover, it was found that in comparison with the index adenomas, metachronous adenomas were significantly smaller (r = -0.24; P less than 0.01) and more sessile (r = 0.20; P less than 0.002). Significant negative correlations, i.e., decrease, were also found in the expression of carcinoembryonic antigen (surface P less than 0.001; cytoplasmic P less than 0.05) and neutral mucins (P less than 0.005) between the index adenomas and the metachronous adenomas, whereas positive correlations were found for secretory component (P = 0.0001) and sulfomucins (P less than 0.05). These findings suggest that a limited production of neutral mucins in the goblet cells of a small index adenoma from a male patient with a history of colorectal neoplasia is indicative of an increased risk for the development of new colorectal adenomas. Furthermore, the clinical, mucin histochemical, and immunohistochemical findings of the metachronous adenomas show less malignancy-associated features than those of the index adenomas.
在124例行内镜下息肉切除术的患者中，70例在平均10年的时间里接受了结肠镜复查。根据临床结果，患者被分为三组：第1组，31例患者结肠内仍无腺瘤或癌症；第2组，35例患者出现一个或多个异时性腺瘤性息肉；第3组，4例患者随后发生了结肠癌。除了临床和病理特征外，还研究了癌胚抗原和分泌成分的免疫组织化学染色模式。此外，还评估了中性黏液素、硫酸黏液素和唾液酸黏液素的黏液组织化学染色强度。将第1组患者的40个索引腺瘤的特征与第2组患者的51个索引腺瘤的特征进行比较。此外，还将这些索引腺瘤的特征与第2组患者的69个异时性腺瘤的特征进行比较。结果发现，男性（P<0.005）和结直肠肿瘤病史（P<0.02）是新腺瘤发生的主要因素。第2组索引腺瘤中的中性黏液素含量较少（r=-0.21；P<0.05）。两组之间其他评估标志物的表达没有显著差异，尽管第2组索引腺瘤明显较小（r=-0.22；P<0.05），并且与第1组的索引腺瘤相比，癌胚抗原的细胞质表达有更明显的趋势（分别为22%和12.5%）。此外，发现与索引腺瘤相比，异时性腺瘤明显较小（r=-0.24；P<0.01）且更无蒂（r=0.20；P<0.002）。在索引腺瘤和异时性腺瘤之间，癌胚抗原（表面P<0.001；细胞质P<0.05）和中性黏液素（P<0.005）的表达也存在显著负相关，即降低，而分泌成分（P=0.0001）和硫酸黏液素（P<0.05）则呈正相关。这些发现表明，有结直肠肿瘤病史的男性患者的小索引腺瘤杯状细胞中中性黏液素的产生有限，表明发生新的结直肠腺瘤的风险增加。此外，异时性腺瘤的临床、黏液组织化学和免疫组织化学结果显示出比索引腺瘤更少的恶性相关特征。
