Jaramillo E, Watanabe M, Slezak P, Rubio C
Department of Diagnostic Radiology, Karolinska Hospital, Stockholm, Sweden.
Gastrointest Endosc. 1995 Aug;42(2):114-22. doi: 10.1016/s0016-5107(95)70066-8.
Because small flat colorectal neoplastic lesions (i.e., flat adenomas and flat adenocarcinomas) may be as translucent as the surrounding mucosa, they can remain undetected at conventional endoscopy. By combining high-resolution video endoscopy and chromoscopy, we detected 109 colorectal flat neoplastic lesions in 55 of 232 patients studied. Forty-three (78%) of the 55 patients with flat neoplastic lesions were over 60 years of age. No flat neoplastic lesions were seen in patients under 40 years of age. Flat neoplastic lesions were more frequent in men (35%) than in women (15%). Seventy-seven (71%) of the 109 flat neoplastic lesions measured 0.5 cm or less, 23 (21%) between 0.6 and 1.0 cm, and 9 (8%) more than 1.0 cm. Low-grade dysplasia and high-grade dysplasia were found in 94 (86%) and 13 (12%) of the flat neoplastic lesions, respectively. Adenocarcinoma was diagnosed in 3 (3%) flat lesions: 1 (1%) carcinoma originating in a flat adenoma and 2 (2%) adenocarcinomas without recognizable adenomatous elements. No adenocarcinomas were seen in lesions measuring 1.0 cm or less. Fourteen flat neoplastic lesions had a central depression at endoscopy. Flat neoplastic lesions with central depression more frequently showed high-grade dysplasia (43%) than did flat neoplastic lesions without central depression (7%). Central depression in flat neoplastic lesions should be considered a possible endoscopic marker for severe dysplasia. Our results suggest that flat neoplastic lesions occur more frequently than previously reported in Scandinavia. Flat adenomas may play an important role in the histogenesis of colorectal cancer.
由于小型扁平结直肠肿瘤性病变（即扁平腺瘤和扁平腺癌）可能与周围黏膜一样呈半透明状，因此在传统内镜检查中可能无法被发现。通过结合高分辨率视频内镜检查和染色内镜检查，我们在232例接受研究的患者中的55例中检测到109个结直肠扁平肿瘤性病变。55例有扁平肿瘤性病变的患者中，43例（78%）年龄超过60岁。40岁以下患者未发现扁平肿瘤性病变。男性的扁平肿瘤性病变（35%）比女性（15%）更常见。109个扁平肿瘤性病变中，77个（71%）直径为0.5 cm或更小，23个（21%）直径在0.6至1.0 cm之间，9个（8%）直径超过1.0 cm。扁平肿瘤性病变中，低级别异型增生和高级别异型增生分别见于94个（86%）和13个（12%）。3个（3%）扁平病变被诊断为腺癌：1个（1%）起源于扁平腺瘤的癌和2个（2%）无明显腺瘤成分的腺癌。直径1.0 cm或更小的病变中未发现腺癌。14个扁平肿瘤性病变在内镜检查时有中央凹陷。有中央凹陷的扁平肿瘤性病变比无中央凹陷的扁平肿瘤性病变更常出现高级别异型增生（43%比7%）。扁平肿瘤性病变中的中央凹陷应被视为严重异型增生的一个可能的内镜标志物。我们的结果表明，扁平肿瘤性病变的发生率比斯堪的纳维亚半岛先前报道的更高。扁平腺瘤可能在结直肠癌的组织发生中起重要作用。
