Graham D M, Appelman H D
Department of Pathology, University of Michigan, Ann Arbor.
Mod Pathol. 1990 May;3(3):332-5.
A distinctive Crohn's disease-like reaction (CLR) consisting of discrete lymphoid aggregates, some with germinal centers, and surrounding stellate fibrosis is commonly found around colorectal adenocarcinomas in the absence of clinical or pathologic evidence of prior Crohn's disease. Most lymphoid aggregates are located one or more millimeters beyond the advancing tumor fronts, mainly in muscularis propria and pericolic adipose tissue. The intensity of this reaction was graded as absent, mild, or intense for 100 consecutive colorectal carcinomas. These tumors also were evaluated for invasion beyond muscularis propria, lymphoid infiltrates at the tumor margin, and nodal metastases. The degree of CLR was correlated with survival. Results indicated that CLR is more likely to occur in transmurally invasive carcinomas than in those confined to the colonic wall, especially in the right side. An intense CLR is associated with an intense lymphoid infiltrate at the tumor edge, a lower incidence of nodal metastases, and a statistically significant increase in 10-yr survival. These results suggest that the Crohn's-like reaction around colorectal carcinomas may be a favorable host response, similar to lymphocytic infiltrates at the advancing tumor edge. Analysis of more cases should clarify whether this CLR is independent of other variables.
在无既往克罗恩病临床或病理证据的情况下，在结直肠癌周围通常可发现一种独特的克罗恩病样反应（CLR），其由离散的淋巴样聚集物组成，部分伴有生发中心，并伴有周围星状纤维化。大多数淋巴样聚集物位于肿瘤前沿以外一毫米或更远处，主要位于固有肌层和结肠周脂肪组织中。对100例连续的结直肠癌，将这种反应的强度分为无、轻度或重度。还对这些肿瘤进行了固有肌层外侵犯、肿瘤边缘淋巴浸润及淋巴结转移的评估。CLR的程度与生存率相关。结果表明，CLR在透壁浸润性癌中比局限于结肠壁的癌更易发生，尤其是在右侧。强烈的CLR与肿瘤边缘强烈的淋巴浸润、较低的淋巴结转移发生率以及10年生存率的统计学显著提高相关。这些结果表明，结直肠癌周围的克罗恩病样反应可能是一种有利的宿主反应，类似于肿瘤前沿的淋巴细胞浸润。对更多病例的分析应能阐明这种CLR是否独立于其他变量。
