Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Arch Pathol Lab Med. 2010 Jun;134(6):896-906. doi: 10.5858/134.6.896.
Classic pathology teaching emphasizes that neoplastic lesions of the gastrointestinal tract are characterized by architectural and cytologic abnormalities that distinguish it from normal tissue. Recent studies suggest that many important-and in some cases clonal-molecular abnormalities that lead to dysregulation of cell proliferation and differentiation (neoplasia) occur before morphologic expression of dysplasia.
To summarize the biologic and pathologic features of preneoplastic conditions of the tubal gut that reveal evidence of neoplastic alteration, but without the traditional morphologic features of dysplasia, in order to provide guidance on how to identify these lesions. Particular attention is given to Barrett esophagus, a chronic inflammatory condition in which early molecular and morphologic events that drive carcinogenesis are best understood.
Selected references and abstracts were obtained by a PubMed (US National Library of Medicine) search by using the search headings neoplasia, preneoplasia, dysplasia, adenoma, serrated polyps, and Barrett's esophagus between the years 1980 and 2009.
Many types of lesions throughout the tubal gut fulfill the most basic and classic principles of a neoplastic precursor lesion but lack conventional morphologic evidence of dysplasia and/or maintain the capacity for cell differentiation and maturation. All of these lesions, such as squamous dysplasia of the esophagus, dysplasia in Barrett esophagus, and hyperplastic/serrated polyps of the colon, represent early neoplastic precursor lesions but without conventional histologic features of dysplasia. It is important for pathologists to be aware of these lesions, both for diagnostic and prognostic purposes, but also so that future studies can be performed with regard to risk stratification of patients.
经典病理学教学强调，胃肠道的肿瘤病变的特征在于其结构和细胞学异常，这使其与正常组织区分开来。最近的研究表明，许多导致细胞增殖和分化失调（肿瘤形成）的重要——在某些情况下是克隆——分子异常，在发育不良的形态表现之前就已经发生。
总结肠型小管的癌前状态的生物学和病理学特征，这些特征揭示了肿瘤改变的证据，但没有发育不良的传统形态特征，以便提供如何识别这些病变的指导。特别关注 Barrett 食管，这是一种慢性炎症性疾病，其中驱动癌变的早期分子和形态事件最容易理解。
通过使用“neoplasia”、“preneoplasia”、“dysplasia”、“adenoma”、“serrated polyps”和“Barrett's esophagus”等搜索标题，在美国国家医学图书馆的 PubMed 上进行了搜索，时间范围为 1980 年至 2009 年，获得了选定的参考文献和摘要。
小管肠的许多类型的病变都符合肿瘤前体病变的最基本和经典原则，但缺乏发育不良的常规形态学证据和/或保持细胞分化和成熟的能力。所有这些病变，如食管的鳞状发育不良、Barrett 食管的发育不良和结肠的增生/锯齿状息肉，都代表了早期的肿瘤前体病变，但没有发育不良的常规组织学特征。病理学家了解这些病变很重要，无论是出于诊断还是预后目的，而且还可以对患者进行风险分层的未来研究。
