Iannoni C, Marcheggiano A, Pallone F, Frieri G, Gallucci M, Di Silverio F, Caprilli R
Hum Pathol. 1986 Aug;17(8):834-40. doi: 10.1016/s0046-8177(86)80204-0.
Clinical and experimental evidence indicates that ureterosigmoidostomy is associated with a high risk for the development of colonic cancer, while there is no reported evidence of increased risk in patients who undergo urinary diversion of other types. In the present study the histochemical and lectin binding characteristics of goblet cell mucin were investigated in biopsy specimens from patients who had undergone ureterosigmoidostomy and from patients who had undergone rectal bladder surgery. Specimens from transitional mucosa surrounding colonic cancers and from normal rectal mucosa were also studied. For histochemical studies the high iron diamine-Alcian blue method was used. FITC-conjugated Dolichus biflorus agglutinin (FITC-DBA) and Arachis hypogaea agglutinin (FITC-PNA) were used for the study of lectin binding characteristics. In contrast to the striking increase in numbers of sialomucin-containing goblet cells found in the patients who had undergone ureterosigmoidostomy, the mucin proved to be histochemically normal in the rectal bladder surgery group. Abnormal lectin binding patterns were observed in colorectal mucosa after urinary diversion of both types, with the abnormalities consisting of dramatic decreases in FITC-DBA labeling (compared with controls) and the appearance of substantial numbers of FITC-PNA-labeled goblet cells. These findings indicate that the pattern of mucin secretion is definitely abnormal in patients who have undergone urinary diversion. Whether this abnormality is an indicator of premalignant changes remains to be established. These data, however, confirm that endoscopic and histologic follow-up studies may be of value in assessing the risk for the development of cancer in these patients.
临床和实验证据表明，输尿管乙状结肠吻合术与结肠癌发生的高风险相关，而对于接受其他类型尿流改道的患者，尚无证据表明其风险增加。在本研究中，对接受输尿管乙状结肠吻合术患者和接受直肠膀胱手术患者的活检标本进行了杯状细胞黏蛋白的组织化学和凝集素结合特征研究。还研究了结肠癌周围移行黏膜和正常直肠黏膜的标本。组织化学研究采用高铁二胺-阿尔辛蓝法。异硫氰酸荧光素偶联的双花扁豆凝集素（FITC-DBA）和花生凝集素（FITC-PNA）用于凝集素结合特征研究。与接受输尿管乙状结肠吻合术患者中含唾液黏蛋白的杯状细胞数量显著增加相反，直肠膀胱手术组的黏蛋白在组织化学上被证明是正常的。在两种类型的尿流改道后的结直肠黏膜中均观察到异常的凝集素结合模式，异常表现为FITC-DBA标记显著减少（与对照组相比）以及大量FITC-PNA标记的杯状细胞出现。这些发现表明，接受尿流改道的患者黏蛋白分泌模式肯定异常。这种异常是否是癌前病变的指标尚待确定。然而，这些数据证实，内镜和组织学随访研究可能有助于评估这些患者发生癌症的风险。
