Role of apoptosis in modulation of the growth of human colorectal tubular and villous adenomas.

To estimate the effect of cell proliferation and deletion on the growth of the human colorectal adenoma, 27 tubular adenomas and eight villous adenomas were examined. Tubular adenomas were categorized into three grades of cellular atypia: mild, moderate, and severe. Villous adenomas were given a single grade. Morphological characteristics of apoptosis (nuclear condensation and budding) were used to quantify an apoptotic index, AI (percentage of apoptotic cells in viable adenomatous cells). The apoptotic cells were found mainly among the basal site of the adenomatous tubules. The AIs of tubular adenomas with mild, moderate, and severe grades of atypia were 3.5, 5.7 and 8.8 per cent, respectively. The AI of villous adenomas was 1.8 per cent, which was significantly lower than that of tubular adenomas. The mitotic indices, MIs (percentage of mitotic cells in viable adenomatous cells) of tubular adenomas were 0.41 per cent (mild), 0.58 per cent (moderate), and 0.83 per cent (severe), and for villous adenomas the MI was 0.38 per cent. There was a close positive relationship between the AI and MI of tubular adenomas, which paralleled the grade of atypia. These results indicate that both cell proliferation and death were more frequent in adenomas with severe atypia than in adenomas with mild atypia. Moreover, the significantly lower AI of villous adenomas, known to develop into large tumours when compared with tubular adenomas, suggests that reduced apoptoses may lead to a shift in tissue kinetics towards expansive growth.