Rubio Carlos A, Befrits Ragnar, Ericsson Jannis
Carlos A Rubio, Gastrointestinal and Liver Pathology Research Laboratory, Department of Pathology, Karolinska Institute and University Hospital, 7176 Stockholm, Sweden.
World J Gastrointest Endosc. 2013 Jun 16;5(6):293-6. doi: 10.4253/wjge.v5.i6.293.
THE COLORECTAL MUCOSA INCLUDES TWO QUANTITATIVELY, STRUCTURALLY AND FUNCTIONALLY DISSIMILAR AREAS: one, built with columnar and goblet cells, covers the vast majority of the mucosa, and the other consists of scattered minute gut-associated lymphoid tissue (GALT). The overwhelming majority of colorectal carcinomas evolve in GALT-free mucosal areas and very rarely in GALT aggregates. Remarkably, the colonic mucosa in patients with ulcerative colitis (UC) displays a high number of newly formed GALT-aggregates. The patient here described is a 68-year-old female with a history of UC since 1984. At surveillance colonoscopy in 2012, one of two detected polyps was a tubular adenoma with high-grade dysplasia. Beneath this adenoma, a well-circumscribed GALT sheltering a carcinoma was found. Serial sections revealed no connection between the villous adenoma and the GALT-carcinoma. The GALT-carcinoma here reported seems to have evolved in a newly formed, UC-dependent, GALT complex. This notion is substantiated by the fact that 27% or 4 out of the 15 cases of GALT-carcinomas in the colon reported in the literature (including the present case) evolved in patients with UC.
结直肠黏膜包含两个在数量、结构和功能上均不相同的区域：一个区域由柱状细胞和杯状细胞构成，覆盖了绝大部分黏膜；另一个区域则由散在的微小肠道相关淋巴组织（GALT）组成。绝大多数结直肠癌发生于无GALT的黏膜区域，极少发生于GALT聚集处。值得注意的是，溃疡性结肠炎（UC）患者的结肠黏膜会出现大量新形成的GALT聚集。本文描述的患者是一位68岁女性，自1984年起患有UC。在2012年的监测结肠镜检查中，检测到的两个息肉中有一个是高级别异型增生的管状腺瘤。在这个腺瘤下方，发现了一个边界清晰的GALT，其中隐匿着癌。连续切片显示绒毛状腺瘤与GALT癌之间没有联系。本文报道的GALT癌似乎是在新形成的、依赖UC的GALT复合体中发生的。文献报道的（包括本病例在内）15例结肠GALT癌中有27%（即4例）发生于UC患者，这一事实证实了这一观点。
