结直肠无蒂锯齿状腺瘤的临床病理及免疫组化特征

[Clinicopathological and immunohistochemical features of colorectal sessile serrated adenoma].

作者信息

Wang Lu-ping, Yang Guang-zhi, Li Lin, Zhou Zhi-yong, Gao Bao-lin, Wang Bin, Han Ying

机构信息

Department of Pathology, General Hospital of Beijing Military Command, Beijing 100700, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2009 Apr;31(4):269-73.

PMID:19615281

Abstract

OBJECTIVE

To investigate the clinicopathological characteristics and expression status of Ki67, p53, CEA, CDX, CK7 in colorectal sessile serrated adenoma (SSA).

METHODS

The clinicopathological data of 11 cases of SSA, 51 cases of hyperplastic polyp (HP) and one case with mixed HP/SSA were reviewed and analyzed retrospectively. The expression of Ki67, p53, CEA, CDX and CK7 were detected by immunohistochemistry.

RESULTS

The major histological features in SSA were architectural abnormality in crypts, dilatation of serrated crypt bases like an inverted "T" or "L" shape adjacent to muscularis mucosa. Atypical cells containing round to oval nuclei and nucleoli were also observed. The immunohistochemical staining showed that the expression of p53 increased gradually from HP to TA: 11.8% in HP, 20.0% in SSA, 41.2% in VTA and 75.0% in TA, with a significant difference among the groups (chi(2) = 17.996, P = 0.000). However, no significant difference in the expression of CDX and CK7 was observed between HP and SSA. Of the 10 SSA cases, positive expression of Ki67 was found in cells located in the base or middle part of crypt in 6 cases, positive cells index was 26% - 50% in 5 cases, and > 50% in 3. Compared with the expression of Ki67 in the HP, VTA and VA, SSA showed a significant difference in both the positive cell number and in the positive regions. (positive number: chi(2) = 34.601, P = 0.000; positive regions: chi(2) = 63.077, P = 0.000).

CONCLUSION

Morphological diagnosis of SSA was mainly based on crypt architectural and cellular abnormalities, and the crypt architectural abnormality may be more important than cellular features. Detection of p53 and Ki67 expression may be helpful in differential diagnosis and understanding the nature of SSA.

摘要

目的

探讨结直肠无蒂锯齿状腺瘤（SSA）的临床病理特征及Ki67、p53、CEA、CDX、CK7的表达情况。

方法

回顾性分析11例SSA、51例增生性息肉（HP）及1例HP/SSA混合型病例的临床病理资料。采用免疫组织化学法检测Ki67、p53、CEA、CDX及CK7的表达。

结果

SSA主要组织学特征为隐窝结构异常，锯齿状隐窝底部扩张，呈倒“T”形或“L”形，紧邻黏膜肌层。还可见含圆形至椭圆形核及核仁的非典型细胞。免疫组织化学染色显示，p53表达从HP至管状腺瘤（TA）逐渐升高：HP中为11.8%，SSA中为20.0%，绒毛状管状腺瘤（VTA）中为41.2%，TA中为75.0%，组间差异有统计学意义（χ² = 17.996，P = 0.000）。然而，HP与SSA之间CDX和CK7表达无显著差异。10例SSA病例中，6例在隐窝底部或中部细胞中发现Ki67阳性表达，5例阳性细胞指数为26% - 50%，3例> 50%。与HP、VTA和TA中Ki67表达相比，SSA在阳性细胞数量及阳性区域均有显著差异。（阳性细胞数：χ² = 34.601，P = 0.000；阳性区域：χ² = 63.077，P = 0.000）。