Rubio C A, Jaramillo E
Department of Pathology, Karolinska Hospital, Stockholm, Sweden.
Jpn J Cancer Res. 1996 Mar;87(3):305-9. doi: 10.1111/j.1349-7006.1996.tb00221.x.
A total of 47 flat serrated neoplasias of the colorectal mucosa are presented: 44 were flat serrated adenomas and the remaining 3 flat serrated adenocarcinomas arising in flat serrated adenomas. These lesions were found among 600 flat mucosal lesions removed at colonoscopy during a 3-year period (1992 and 1994) at the Karolinska Hospital. Thirty-five of the 47 patients (74%) were males and the remaining 12 (26%), females. Depending upon the degree of cellular dysplasia within the epithelium, serrated adenomas were divided into those with low-grade dysplasia (LGD), when the dysplastic nuclei were present in the deeper half of the epithelium, and those with high-grade dysplasia (HGD), when the dysplastic nuclei were found even in the upper half of the epithelium. LGD was present in 37 (84.1%) of the 44 serrated adenomas and HGD in the remaining 7 (15.9%). Depending upon the topographic distribution of the dysplastic epithelium within the crypts, flat serrated adenomas were divided into type I, when the dysplastic epithelium was limited to the lower half of the serrated crypts, and type II, when the dysplastic epithelium was even present in the superficial half of the serrated crypts. Of the 44 serrated adenomas, 38 (86.1%) were type I and the remaining 6 (13.9%) type II. The dysplastic epithelium seemed to originate at the base of the crypts and to progress upwards, replacing the scalloped, serrated epithelium of the sides of the crypts. Invasive adenocarcinomas (i.e., with submucosal extension) were seen to arise from flat serrated adenomas with LGD type I (n = 2) or with HGD type II (n = 1). This preliminary survey suggests that flat serrated adenomas of the colorectal mucosa may be lesions with a propensity to evolve into invasive adenocarcinoma, irrespective of the degree of the epithelial dysplasia or of their extension along the crypts.
本文呈现了47例大肠黏膜扁平锯齿状肿瘤：44例为扁平锯齿状腺瘤，其余3例为起源于扁平锯齿状腺瘤的扁平锯齿状腺癌。这些病变是在卡罗林斯卡医院1992年至1994年的3年期间，在结肠镜检查时切除的600例扁平黏膜病变中发现的。47例患者中35例（74%）为男性，其余12例（26%）为女性。根据上皮细胞发育异常的程度，锯齿状腺瘤分为低级别发育异常（LGD）型，即发育异常的细胞核出现在上皮深层的一半；以及高级别发育异常（HGD）型，即发育异常的细胞核甚至出现在上皮的上半部分。44例锯齿状腺瘤中37例（84.1%）为LGD型，其余7例（15.9%）为HGD型。根据发育异常上皮在隐窝内的地形分布，扁平锯齿状腺瘤分为I型，即发育异常上皮局限于锯齿状隐窝的下半部分；以及II型，即发育异常上皮甚至出现在锯齿状隐窝的上半部分。44例锯齿状腺瘤中，38例（86.1%）为I型，其余6例（13.9%）为II型。发育异常上皮似乎起源于隐窝底部并向上发展，取代隐窝侧面的扇形、锯齿状上皮。浸润性腺癌（即伴有黏膜下浸润）可见于LGD I型（n = 2）或HGD II型（n = 1）的扁平锯齿状腺瘤。这项初步调查表明，大肠黏膜扁平锯齿状腺瘤可能是一种有发展为浸润性腺癌倾向的病变，无论上皮发育异常的程度或其沿隐窝的扩展情况如何。
