Shatz B A, Weinstock L B, Thyssen E P, Mujeeb I, DeSchryver K
Department of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
Am J Gastroenterol. 1998 Apr;93(4):623-7. doi: 10.1111/j.1572-0241.1998.177_b.x.
We recently described an endoscopic finding of pale yellow-speckled mucosa adjacent to colonic neoplasms. This resembled the appearance of chicken skin and was named chicken skin mucosa (CSM). CSM differs from previously reported gastrointestinal xanthelasmas in that this entity always occurs in association with colonic neoplasms. The prevalence, endoscopic characteristics, clinical significance, and possible etiology were investigated.
Eight hundred fifty-two consecutive colonoscopies were prospectively evaluated for the presence of CSM associated with either cancer or adenomas > or = 1 cm. Electron microscopy and histopathology using hemotoxylin and eosin, mucicarmine, and oil red O stains were performed. Twelve consecutive colon cancer resection specimens were prospectively examined to determine the presence of histologic CSM.
CSM was adjacent to eight of 10 distal colorectal cancers, one of four proximal colon cancers, 16 of 42 distal adenomas, and three of 44 proximal adenomas. Four of seven resected distal cancers demonstrated histological evidence of CSM. Biopsies of the CSM revealed that lipid-filled macrophages in the lamina propria were responsible for this endoscopic appearance. Electron microscopy showed that the surface epithelial cells had small intestine-like microvilli. CSM was not seen with other colonic conditions and was not associated with the laxative preparation. In four instances, identification of the CSM alerted the endoscopist to the presence of polyps in locations difficult to visualize.
CSM is an endoscopic entity that occurs as a result of fat accumulation in macrophages in the lamina propria of the mucosa adjacent to colonic neoplasms. Small intestine-like microvilli were present in CSM and the pathophysiological implications remain to be elucidated.
我们最近描述了一种在结肠肿瘤附近发现的内镜表现，即淡黄色斑点状黏膜。其外观类似鸡皮，被命名为鸡皮黏膜（CSM）。CSM与先前报道的胃肠道黄色瘤不同，该病变总是与结肠肿瘤相关。我们对其患病率、内镜特征、临床意义及可能的病因进行了研究。
对连续852例结肠镜检查进行前瞻性评估，以确定是否存在与癌症或直径≥1 cm的腺瘤相关的CSM。进行了电子显微镜检查以及使用苏木精和伊红、黏液卡红和油红O染色的组织病理学检查。对连续12例结肠癌切除标本进行前瞻性检查，以确定组织学CSM的存在情况。
CSM见于10例远端结直肠癌中的8例、4例近端结肠癌中的1例、42例远端腺瘤中的16例以及44例近端腺瘤中的3例。7例切除的远端癌中有4例显示出CSM的组织学证据。CSM活检显示，固有层中充满脂质的巨噬细胞是这种内镜表现的原因。电子显微镜检查显示，表面上皮细胞具有类似小肠的微绒毛。在其他结肠疾病中未见到CSM，且其与泻药制剂无关。有4例中，CSM的发现提醒内镜医师注意到难以观察到的部位存在息肉。
CSM是一种内镜下的病变，是由于结肠肿瘤附近黏膜固有层中巨噬细胞脂肪堆积所致。CSM中存在类似小肠的微绒毛，其病理生理意义仍有待阐明。
