Department of Pathology and Laboratory Medicine, University of California Irvine School of Medicine, 101 The City Drive South, Orange, CA 92868, USA.
Adv Anat Pathol. 2011 Jan;18(1):46-52. doi: 10.1097/PAP.0b013e3182028366.
Modern evaluation of specimens from biopsies of colorectal polyps has become increasingly complex because of tremendous progress in the understanding of colorectal neoplasia. Although pathologists are generally familiar with the basic handling of carcinoma in the setting of polypectomies or resections, the comprehensive evaluation of specimens from biopsies of colorectal polyps obtained with forceps is far from intuitive and has yet to be reviewed. Comprehensive evaluation requires always addressing several key issues, even when dealing with seemingly routine cases. These issues include taking further action when initial sections lack polyps, accurately quantitating polyps, accurately classifying polyps, determining whether thresholds are met for considering conditions at high risk for carcinoma, detecting incidental findings other than polyps, and determining which incidental findings are clinically significant. In particular, polyposis with attenuated phenotype or Lynch syndrome may be clinically occult, and the possibility of these entities should always be kept in mind, regardless of age or history. Ancillary studies performed immediately on carcinoma that is detected at biopsy guides surgery, guides medical therapy, prognosticates, provides evidence for hereditary neoplasia, and guides surveillant colonoscopy for the family.
由于对结直肠肿瘤学的理解取得了巨大进展，对结直肠息肉活检标本的现代评估变得日益复杂。虽然病理学家通常熟悉息肉切除术或肠段切除术中的癌的基本处理方法，但活检钳获得的结直肠息肉标本的全面评估远非直观，且尚未得到回顾。全面评估始终需要解决几个关键问题，即使是在处理看似常规病例时也是如此。这些问题包括：当初始切片中没有息肉时采取进一步的措施，准确地定量息肉，准确地分类息肉，确定是否满足将某些条件归类为癌高危的标准，检测除息肉以外的偶然发现，以及确定哪些偶然发现具有临床意义。特别是，表型减弱型息肉病或 Lynch 综合征可能是临床隐匿性的，无论年龄或病史如何，都应始终考虑到这些情况的可能性。在活检时检测到的癌立即进行的辅助研究可指导手术、指导药物治疗、预测预后、为遗传性肿瘤提供证据，并指导家族成员的结肠镜监测。
