Yamamoto Tomoko, Hiroi Atsuko, Itagaki Hiroko, Kato Yoichiro, Iizuka Bunei, Itabashi Michio, Shibata Noriyuki, Nagashima Yoji
Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan; Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan.
SAGE Open Med Case Rep. 2017 Feb 8;5:2050313X17692902. doi: 10.1177/2050313X17692902. eCollection 2017.
Adenocarcinoma is known to be associated with ulcerative colitis, but the diagnosis is sometimes challenging, both clinically and pathologically.
We present a case of extremely well-differentiated adenocarcinoma associated with ulcerative colitis, in which preoperative diagnosis was not possible. Glands in biopsy specimens showed a serrated appearance that looked like low-grade dysplasia or regenerative mucosa. After an operation due to severe symptoms of stenosis, carcinoma was diagnosed. Tumor cells, especially in invasive glands, tended to show stronger immunoreactivity against anti-CK7, TNF-α and Aurora B antibodies compared to cells of mucosal lesion. Interestingly, CD44v6, one of the adhesion molecules, was less expressed in invasive glands, while those glands exhibited stronger expression of a disintegrin and metalloproteinase 17 (ADAM 17), one of the sheddases that cleaves an extracellular domain of CD44.
These observations appear interesting to consider the pathogenesis and to diagnose extremely well-differentiated adenocarcinoma in ulcerative colitis, although further investigation is needed.
已知腺癌与溃疡性结肠炎相关，但在临床和病理上，其诊断有时具有挑战性。
我们报告一例与溃疡性结肠炎相关的高分化腺癌病例，术前无法做出诊断。活检标本中的腺体呈锯齿状外观，看似低级别异型增生或再生黏膜。因严重狭窄症状进行手术后，诊断为癌。与黏膜病变细胞相比，肿瘤细胞，尤其是浸润性腺体中的肿瘤细胞，对抗细胞角蛋白7（CK7）、肿瘤坏死因子-α（TNF-α）和极光激酶B（Aurora B）抗体的免疫反应性更强。有趣的是，黏附分子之一的CD44v6在浸润性腺体中表达较少，而这些腺体中裂解素和金属蛋白酶17（ADAM 17，一种裂解CD44胞外结构域的裂解酶）的表达较强。
尽管需要进一步研究，但这些观察结果对于考虑溃疡性结肠炎中高分化腺癌的发病机制和诊断似乎很有意义。
