Odze R, Gallinger S, So K, Antonioli D
Department of Pathology, Mount Sinai Hospital, University of Toronto Medical School, Ontario, Canada.
Mod Pathol. 1994 Apr;7(3):376-84.
We performed a clinicopathologic analysis of 74 periampullary and duodenal adenomas from 30 patients with familial adenomatous polyposis to evaluate the growth pattern, mucin histochemical profile, and degree and significance of Paneth cell and endocrine cell differentiation in these lesions. A trend toward more numerous adenomas was seen in patients with the longest intervals since their previous colectomies. Adenomas were most often clustered in the periampullary region and were numerous (> 20) in 40% of patients. Periampullary and duodenal adenomas were morphologically similar; both exhibited the same size-villous shape-dysplasia relationship as sporadic and familial adenomatous polyposis-associated colonic adenomas. Adenomas showed a heterogenous pattern of mucin production (mixed small intestinal-large intestinal types), with a shift toward the colonic type (sulfomucin) in lesions that were larger, villous, or severely dysplastic. Ninety-two percent of adenomas showed Paneth cell differentiation (average n Paneth cells/high power field = 24.5), and 99% showed endocrine cell differentiation (average n endocrine cells/high power field = 64.4). In general, the proportion of these specialized cell types was inversely related to size, villous shape, and degree of epithelial dysplasia. These results suggest that periampullary and duodenal adenomas in familial adenomatous polyposis arise from the neoplastic transformation of an undifferentiated stem cell that retains its ability for multidirectional differentiation.
我们对30例家族性腺瘤性息肉病患者的74个壶腹周围和十二指肠腺瘤进行了临床病理分析，以评估这些病变的生长模式、黏液组织化学特征以及潘氏细胞和内分泌细胞分化的程度及意义。自上次结肠切除术后间隔时间最长的患者中腺瘤数量有增多趋势。腺瘤最常聚集在壶腹周围区域，40%的患者腺瘤数量众多（>20个）。壶腹周围和十二指肠腺瘤在形态学上相似；二者与散发性和家族性腺瘤性息肉病相关的结肠腺瘤一样，呈现相同的大小-绒毛形态-发育异常关系。腺瘤表现出黏液产生的异质性模式（小肠型和大肠型混合），在较大、呈绒毛状或严重发育异常的病变中向结肠型（硫酸黏液）转变。92%的腺瘤显示潘氏细胞分化（平均每高倍视野潘氏细胞数=24.5），99%显示内分泌细胞分化（平均每高倍视野内分泌细胞数=64.4）。一般来说，这些特殊细胞类型的比例与大小、绒毛形态和上皮发育异常程度呈负相关。这些结果表明，家族性腺瘤性息肉病中的壶腹周围和十二指肠腺瘤源于未分化干细胞的肿瘤性转化，该干细胞保留了多向分化能力。
