内镜特征有助于识别克罗恩特-加拿大综合征中结直肠息肉的组织病理学模式。

Department of Gastroenterology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.

Department of Pathology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.

J Dig Dis. 2023 Apr;24(4):271-277. doi: 10.1111/1751-2980.13197. Epub 2023 Jun 29.

OBJECTIVES

Cronkhite-Canada syndrome (CCS) is a rare nonhereditary gastrointestinal hamartomatous polyposis syndrome with a high risk of colorectal cancerogenesis. It is challenging to discriminate adenomas from nonneoplastic colorectal polyps macroscopically. This study aimed to explore the endoscopic features of different histopathological patterns of colorectal polyps in CCS.

METHODS

Sixty-seven lesions from 23 CCS patients were prospectively biopsied or resected during the colonoscopic examination for histopathological analysis. The Fisher's exact test and multivariate logistical analysis were conducted to reveal the predictive endoscopic features of CCS polyps with low-grade dysplasia (LGD) and adenomas.

RESULTS

There were seven (10.4%) adenomas, 20 (29.9%) CCS-LGD, and 40 (59.7%) nonneoplastic CCS polyps. Polyps were large (>20 mm) in none of the adenomas, 30.0% of CCS-LGD polyps, and 2.5% of nonneoplastic CCS polyps (P < 0.001). The color of the polyps was whitish for 71.4% of adenomas, 10.0% of CCS-LGD polyps, and 15.0% of nonneoplastic CCS polyps (P = 0.004). Pedunculated polyps were detected in 42.9% of adenomas, 45.0% of CCS-LGD polyps, and 5.0% of nonneoplastic CCS polyps (P < 0.001). The proportions of types IV and V in the Kudo classification were 42.9%, 95.0%, and 35.0% in adenomatous, CCS-LGD, and nonneoplastic CCS polyps, respectively (P = 0.002). The endoscopic activity was in remission for 71.4% of adenomas, 5.0% of CCS-LGD polyps, and 10.0% of nonneoplastic CCS polyps (P < 0.001).

CONCLUSION

Endoscopic features, including the size, color, sessility, Kudo's pit pattern classification of polyps, and endoscopic activity, help identify the histopathological patterns of colorectal polyps in CCS.

目的

Cronkhite-Canada 综合征（CCS）是一种罕见的非遗传性胃肠道错构瘤性息肉病综合征，结直肠癌发生风险较高。从宏观上区分腺瘤与非肿瘤性结直肠息肉具有挑战性。本研究旨在探讨 CCS 中不同组织病理学类型结直肠息肉的内镜特征。

方法

23 例 CCS 患者在结肠镜检查中前瞻性活检或切除了 67 处病变，进行组织病理学分析。采用 Fisher 确切检验和多变量逻辑回归分析，揭示 CCS 伴有低级别异型增生（LGD）和腺瘤的息肉的预测性内镜特征。

结果

7 例（10.4%）为腺瘤，20 例（29.9%）为 CCS-LGD，40 例（59.7%）为非肿瘤性 CCS 息肉。无腺瘤的息肉大于 20mm，30.0%的 CCS-LGD 息肉和 2.5%的非肿瘤性 CCS 息肉大于 20mm（P<0.001）。息肉颜色为白色的，71.4%的腺瘤为白色，10.0%的 CCS-LGD 息肉为白色，15.0%的非肿瘤性 CCS 息肉为白色（P=0.004）。带蒂息肉在 42.9%的腺瘤中、45.0%的 CCS-LGD 息肉中、5.0%的非肿瘤性 CCS 息肉中被发现（P<0.001）。在 Kudo 分类中，IV 型和 V 型的比例分别为 42.9%、95.0%和 35.0%，在腺瘤性、CCS-LGD 和非肿瘤性 CCS 息肉中（P=0.002）。71.4%的腺瘤、5.0%的 CCS-LGD 息肉和 10.0%的非肿瘤性 CCS 息肉的内镜活动处于缓解期（P<0.001）。