Falco Enrico Costantino, Ribaldone Davide Giuseppe, Canavese Gabriella
Department of Pathology, Città della Salute e della Scienza di Torino, 10126 Turin, Italy.
Department of Gastroenterology, Città della Salute e della Scienza di Torino, 10126 Turin, Italy.
Diagnostics (Basel). 2024 Feb 26;14(5):499. doi: 10.3390/diagnostics14050499.
Mucin disfunction is a critical event in the pathogenesis of inflammatory bowel disease (IBD). Although hyper mucinous conditions have a still debated implication in the clinical evolution of this disorder, hyper mucinous villous proliferations were found to have a preneoplastic biologic potential. We studied morphologic and immunophenotypic characteristics of these lesions in ileocolonic resections for IBD to add evidence about the evolutive potential of these lesions in samples with well oriented wall structures.
Morphologic characteristics of bowel samples from 20 patients resected for IBD and with raised lesions at gross examination were studied and sections from cases with hyper mucinous lesions were stained with the following antibodies: Ki 67, p21, and p27, which were employed to evaluate the characteristics of the proliferative and differentiative activity of the epithelial structures; mismatch repair proteins and p53 have been studied as proteins implicated in carcinogenesis in IBD-affected mucosa; mucins subtypes in hyper mucinous structures were evaluated with MUC-2 and MUC-6. The results in 11 cases of saplings were that they harbored hyper mucinous proliferations. The occurrence of hyper mucinous structures was not related to dysplastic lesions, pseudo pyloric metaplasia, subtype of disease, or activity. In only one of our cases, mild cytologic atypia in the proliferative compartment was detected. Proliferation markers (Ki 67, p53) were expressed in the proliferative compartments of mucosal crypts and antiproliferative proteins p21 and p27 were expressed in differentiated epithelium. MMR proteins expression was limited to the proliferative compartment of the hyper mucinous projections. Mucin subtypes distribution was regular in the epithelium of hyper mucinous proliferations.
The present monocentric retrospective study was conducted on surgical samplings with well oriented crypts. Collected data show that hyper mucinous features are frequent occurrences in raised lesions in IBD patients. In hyper mucinous proliferations of the selected cases, the status of the proliferative cycle, the expression of the proteins most frequently involved in carcinogenetic pathways of mucosa affected by IBD, and the mucins subtypes expression have no evident anomalies. Findings are not consistent with the increased risk of neoplastic evolution observed in other studies; rather, they suggest a hyperplastic nature. However, the capacity of hyper mucinous raised lesions for neoplastic evolution should be ruled out with more extensive prospective studies to identify functional defects that could explain the hypothesized neoplastic potential.
粘蛋白功能障碍是炎症性肠病（IBD）发病机制中的关键事件。尽管高粘蛋白状态在这种疾病的临床演变中的意义仍存在争议，但高粘蛋白性绒毛增生被发现具有癌前生物学潜能。我们研究了IBD患者回结肠切除标本中这些病变的形态学和免疫表型特征，以补充关于这些病变在具有良好定向壁结构的样本中演变潜能的证据。
研究了20例因IBD接受手术切除且大体检查有隆起病变的肠道标本的形态学特征，对有高粘蛋白病变的病例切片用以下抗体进行染色：Ki 67、p21和p27，用于评估上皮结构的增殖和分化活性特征；错配修复蛋白和p53作为IBD受累黏膜中与致癌作用相关的蛋白进行了研究；用MUC - 2和MUC - 6评估高粘蛋白结构中的粘蛋白亚型。11例标本的结果显示存在高粘蛋白增生。高粘蛋白结构的出现与发育异常病变、假幽门化生、疾病亚型或活动度无关。在我们的病例中仅1例在增殖区检测到轻度细胞学异型性。增殖标志物（Ki 67、p53）在黏膜隐窝的增殖区表达，抗增殖蛋白p21和p27在分化上皮中表达。错配修复蛋白表达局限于高粘蛋白突起的增殖区。高粘蛋白增生上皮中的粘蛋白亚型分布规律。
本单中心回顾性研究是在具有良好定向隐窝的手术标本上进行的。收集的数据表明，高粘蛋白特征在IBD患者的隆起病变中很常见。在所选病例的高粘蛋白增生中，增殖周期状态、IBD受累黏膜致癌途径中最常涉及的蛋白表达以及粘蛋白亚型表达均无明显异常。这些发现与其他研究中观察到的肿瘤演变风险增加不一致；相反，它们提示具有增生性质。然而，需要更广泛的前瞻性研究来排除高粘蛋白性隆起病变的肿瘤演变能力，以确定可能解释假设的肿瘤潜能的功能缺陷。
