Ehsanullah M, Naunton Morgan M, Filipe M I, Gazzard B
Histopathology. 1985 Feb;9(2):223-35. doi: 10.1111/j.1365-2559.1985.tb02437.x.
The clinical notes and histology of 374 patients treated by colectomy and ileo-rectal anastomosis for ulcerative colitis were reviewed. Only those with definite diagnosis of ulcerative colitis and follow-up rectal biopsies were included (171 cases). Morphology and patterns of mucin secretion were investigated to assess whether abnormal mucin with predominance of sialomucins is a useful indicator of malignancy-risk. Carcinoma has developed in six patients and 'precancer' in seven. The results show coexistence of dysplasia and sialomucin even in the absence of inflammation in all but three biopsies; in contrast the presence of both dysplasia and normal mucin profile was found in less than 1%. A significant correlation was noted between an inflamed mucosa and the development of cancer or precancer, the presence of sialomucins and the appearance of dysplasia. Sialomucins showed a greater sensitivity in detecting cancer than dysplasia (75% versus 30%). However, dysplasia was notably more specific (94% compared with 50%), hence its greater predictive value as indicator of malignancy (50% as against 15% for a positive sialomucin result). Mucin stains on routine fixed paraffin-embedded tissue provide a simple screening method to sharpen the assessment of dysplasia and cancer-risk in patients with ulcerative colitis despite the limitations referred to above. The lack of definite evidence of dysplasia in four patients who developed malignancy without premalignant changes in the rectal biopsies emphasises the need for frequent multiple biopsies in patients with an ileo-rectal anastomosis for ulcerative colitis.
回顾了374例因溃疡性结肠炎接受结肠切除术和回肠直肠吻合术治疗患者的临床记录和组织学情况。仅纳入那些确诊为溃疡性结肠炎且有随访直肠活检的患者（171例）。研究了黏蛋白分泌的形态和模式，以评估以涎黏蛋白为主的异常黏蛋白是否是恶性肿瘤风险的有用指标。6例患者发生了癌变，7例出现了“癌前病变”。结果显示，除3例活检外，在所有活检中，即使没有炎症，发育异常和涎黏蛋白也共存；相比之下，发育异常和正常黏蛋白谱同时存在的情况不到1%。观察到炎症黏膜与癌症或癌前病变的发生、涎黏蛋白的存在与发育异常的出现之间存在显著相关性。涎黏蛋白在检测癌症方面比发育异常更敏感（75%对30%）。然而，发育异常的特异性明显更高（94%对50%），因此其作为恶性肿瘤指标的预测价值更大（阳性涎黏蛋白结果为50%，而发育异常为15%）。尽管存在上述局限性，但常规固定石蜡包埋组织上的黏蛋白染色提供了一种简单的筛查方法，可用于强化对溃疡性结肠炎患者发育异常和癌症风险的评估。4例在直肠活检中没有癌前病变而发生恶性肿瘤的患者缺乏明确的发育异常证据，这强调了对接受溃疡性结肠炎回肠直肠吻合术的患者进行频繁多次活检的必要性。
