Zhang Ying-Jie, Yuan Meng-Xia, Wen Wu, Li Fan, Jian Yi, Zhang Chuan-Ming, Yang Ye, Chen Feng-Lin
Department of Digestive Diseases, Chengdu Second People's Hospital, Chengdu 610000, Sichuan Province, China.
Graduate School, Chengdu Medical College, Chengdu 610000, Sichuan Province, China.
World J Gastrointest Oncol. 2024 Mar 15;16(3):750-760. doi: 10.4251/wjgo.v16.i3.750.
Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions, including colorectal adenoma. Screening colonoscopy frequently reveals chicken skin mucosa (CSM; white or yellow-white speckled mucosa) surrounding colorectal polyps, caused by macrophages engulfing and accumulating the lipids decomposed by colon cells or adjacent tumors. CSM-positive colorectal polyps are associated with various diseases; however, their prognosis varies greatly. Cold snare polypectomy is commonly used to resect lesions up to 10 to 15 mm in diameter without signs of submucosal invasion but is controversial for CSM-positive colorectal polyps. Improved imaging is required to diagnose and treat CSM-positive colorectal polyps.
To highlight the clinical significance of CSM surrounding colorectal polyps and clarify the associated treatment for endoscopists.
This retrospective cohort study included 177 patients with CSM-positive colorectal polyps diagnosed using endoscopy. All patient-related information was extracted from the Goldisc soft-clinic DICOM system or electronic medical record system. Based on the pathological results, patients were classified as non-neoplastic polyps (five juvenile polyps), neoplastic polyps, non-invasive high-grade neoplasia (NHGN), or submucosal invasive carcinoma (SM stage cancer). We analyzed and compared the clinical features, suspected risk factors for malignant transformation of neoplastic polyps, and early infiltration of submucosal carcinoma.
The diameters of NHGN and SM polyps were much smaller than those of neoplastic polyps. Most NHGN polyps had a deeper red mucosal color. On logistic regression analyses, diameter and deeper red mucosal color were independent risk factors for malignant transformation of neoplastic polyps. Type 1 CSM was more common in high-grade intraepithelial neoplasia and SM; type 2 CSM was more common in neoplastic polyps. Logistic regression analyses revealed no significant differences in the malignant transformation of neoplastic polyps or early submucosal invasion of CSM-positive colorectal cancer. Changes in the CSM mucosa surrounding neoplastic polyps and submucosal invasion of colorectal cancer disappeared within 12 months. No tumor recurrence was found during either partial or complete endoscopic resection of the CSM.
CSM-positive colorectal polyps > 1 cm in diameter or with deeper red mucosa may be related to NHGN. Resection of CSM surrounding colorectal adenomas did not affect tumor recurrence.
脂质代谢重编程被怀疑存在于癌前病变中，包括结直肠腺瘤。筛查结肠镜检查经常发现结直肠息肉周围有鸡皮样黏膜（CSM；白色或黄白色斑点状黏膜），这是由巨噬细胞吞噬并积累结肠细胞或邻近肿瘤分解的脂质所致。CSM阳性的结直肠息肉与多种疾病相关；然而，它们的预后差异很大。冷圈套息肉切除术通常用于切除直径达10至15毫米且无黏膜下浸润迹象的病变，但对于CSM阳性的结直肠息肉存在争议。需要改进成像技术来诊断和治疗CSM阳性的结直肠息肉。
强调结直肠息肉周围CSM的临床意义，并为内镜医师阐明相关治疗方法。
这项回顾性队列研究纳入了177例经内镜诊断为CSM阳性结直肠息肉的患者。所有患者相关信息均从Goldisc软临床DICOM系统或电子病历系统中提取。根据病理结果，患者被分类为非肿瘤性息肉（5例幼年性息肉）、肿瘤性息肉、非侵袭性高级别瘤变（NHGN）或黏膜下浸润癌（SM期癌）。我们分析并比较了临床特征、肿瘤性息肉恶变的可疑危险因素以及黏膜下癌的早期浸润情况。
NHGN和SM息肉的直径远小于肿瘤性息肉。大多数NHGN息肉的黏膜颜色更深红。在逻辑回归分析中，直径和更深红的黏膜颜色是肿瘤性息肉恶变的独立危险因素。1型CSM在高级别上皮内瘤变和SM中更常见；2型CSM在肿瘤性息肉中更常见。逻辑回归分析显示，肿瘤性息肉的恶变或CSM阳性结直肠癌的早期黏膜下浸润无显著差异。肿瘤性息肉周围CSM黏膜的变化以及结直肠癌的黏膜下浸润在12个月内消失。在对CSM进行部分或完全内镜切除期间均未发现肿瘤复发。
直径大于1厘米或黏膜颜色更深红的CSM阳性结直肠息肉可能与NHGN有关。切除结直肠腺瘤周围的CSM不影响肿瘤复发。
