结直肠锯齿状息肉40例临床、内镜和病理学特征分析
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摘要
背景:结直肠锯齿状息肉是一组具有恶性潜能的组织学异质性病变,包括增生性息肉(HP)、广基锯齿状腺瘤/息肉(SSA/P)和传统锯齿状腺瘤(TSA)。SSA/P是散发性结直肠癌的主要癌前病变之一。目的:分析结直肠锯齿状息肉的临床、内镜和病理学特点,提高临床和内镜医师对该病的认识水平。方法:复习江苏省南通和苏州地区三家医院2012年1月—2017年10月的结肠镜检查资料,筛选出内镜或外科手术切除且病理确诊的锯齿状息肉病例40例,进行回顾性分析。结果:结直肠锯齿状息肉占近5年结肠镜检查的0. 1%(40/39 607),男性患者多于女性,平均年龄(56. 5±13. 4)岁。对46枚有代表性的息肉进行分析(SSA/P 9枚,TSA 13枚,HP 24枚),不同类型锯齿状息肉的临床特征以及内镜下部位、形态和大小差异均无统计学意义(P> 0. 05),SSA/P与TSA的异型增生检出率及其严重程度、癌变检出率差异亦无统计学意义(P> 0. 05)。结论:结直肠锯齿状息肉临床上相对少见,不同类型病变的内镜和病理学表现有其自身特点。SSA/P和TSA有重度异型增生和癌变风险。
Background: Colorectal serrated polyps are a group of histologically heterogeneous lesions with malignant potential,and can be typically classified into the following three types: hyperplastic polyps (HPs),sessile serrated adenomas/polyps (SSA/Ps),and traditional serrated adenomas (TSAs). SSA/Ps are known to be one of the major precursors of sporadic colorectal cancer. Aims: To investigate the clinical,endoscopic and pathological features of colorectal serrated polyps for improving the understanding of this kind of diseases in clinicians and endoscopists. Methods: Colonoscopic records from Jan. 2012 to Oct. 2017 at three hospitals in Nantong and Suzhou,Jiangsu Province were collected and reviewed. Forty cases of endoscopically or surgically resected and pathologically proved serrated polyps were identified and a retrospective analysis was conducted. Results: The prevalence of colorectal serrated polyps was 0. 1% (40/39 607) in recent 5 years.It appeared more frequent in males and in middle-aged and elderly subjects with a mean age of (56. 5 ± 13. 4) years.Forty-six polyps were available for analysis,including 9 SSA/Ps,13 TSAs and 24 HPs. There were no statistically significant differences in clinical features and the endoscopic location,morphology and size among SSA/Ps,TSAs and HPs (P > 0. 05). Furthermore,no significant differences were found in prevalence and severity of dysplasia and prevalence of cancer between SSA/Ps and TSAs (P > 0. 05). Conclusions: Colorectal serrated polyps are relatively rare in clinical practice. Different types of colorectal serrated polyps are characterized by distinctive morphology endoscopically and pathologically. SSA/Ps and TSAs are high risk lesions for colorectal cancer and adenoma with high-grade dysplasia.
Background: Colorectal serrated polyps are a group of histologically heterogeneous lesions with malignant potential,and can be typically classified into the following three types: hyperplastic polyps (HPs),sessile serrated adenomas/polyps (SSA/Ps),and traditional serrated adenomas (TSAs). SSA/Ps are known to be one of the major precursors of sporadic colorectal cancer. Aims: To investigate the clinical,endoscopic and pathological features of colorectal serrated polyps for improving the understanding of this kind of diseases in clinicians and endoscopists. Methods: Colonoscopic records from Jan. 2012 to Oct. 2017 at three hospitals in Nantong and Suzhou,Jiangsu Province were collected and reviewed. Forty cases of endoscopically or surgically resected and pathologically proved serrated polyps were identified and a retrospective analysis was conducted. Results: The prevalence of colorectal serrated polyps was 0. 1% (40/39 607) in recent 5 years.It appeared more frequent in males and in middle-aged and elderly subjects with a mean age of (56. 5 ± 13. 4) years.Forty-six polyps were available for analysis,including 9 SSA/Ps,13 TSAs and 24 HPs. There were no statistically significant differences in clinical features and the endoscopic location,morphology and size among SSA/Ps,TSAs and HPs (P > 0. 05). Furthermore,no significant differences were found in prevalence and severity of dysplasia and prevalence of cancer between SSA/Ps and TSAs (P > 0. 05). Conclusions: Colorectal serrated polyps are relatively rare in clinical practice. Different types of colorectal serrated polyps are characterized by distinctive morphology endoscopically and pathologically. SSA/Ps and TSAs are high risk lesions for colorectal cancer and adenoma with high-grade dysplasia.
引文
1 Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
2中华医学会消化病学分会;中华医学会消化病学分会肿瘤协作组.中国结直肠癌预防共识意见(2016年,上海)[J].胃肠病学,2016,21(11):668-686.
3 Singh R,Zorrón Cheng Tao Pu L,Koay D,et al.Sessile serrated adenoma/polyps:Where are we at in 2016?[J].World J Gastroenterol,2016,22(34):7754-7759.
4杜沁仁,高峰.锯齿状息肉的研究进展[J].胃肠病学,2018,23(1):59-61.
5高珊,焦宇飞.结直肠锯齿状病变病理诊断及鉴别诊断[J].现代肿瘤医学,2016,24(5):825-827.
6魏振军,安贺娟,余东亮,等.225例结直肠锯齿状腺瘤的临床、内镜及病理学特征分析[J].胃肠病学和肝病学杂志,2014,23(9):1035-1038.
7 Saito S,Tajiri H,Ikegami M.Serrated polyps of the colon and rectum:Endoscopic features including image enhanced endoscopy[J].World J Gastrointest Endosc,2015,7(9):860-871.
8 Shida Y,Ichikawa K,Fujimori T,et al.Differentiation between sessile serrated adenoma/polyp and non-sessile serrated adenoma/polyp in large hyper plastic polyp:AJapanese collaborative study[J].Mol Clin Oncol,2013,1(1):53-58.
9徐勤伟,沈建伟,沈睿伟,等.结直肠锯齿状腺瘤45例临床病理分析[J].现代实用医学,2017,29(5):622-623.
10王续,刘月平,杨会钗,等.结肠锯齿状病变临床病理分析[J/CD].中华结直肠疾病电子杂志,2016,5(5):413-418.
11 Longacre TA,Fenoglio-Preiser CM.Mixed hyperplastic adenomatous polyps/serrated adenomas.A distinct form of colorectal neoplasia[J].Am J Surg Pathol,1990,14(6):524-537.
12 Fu X,Qiu Y,Zhang Y.Screening,management and surveillance for the sessile serrated adenomas/polyps[J].Int J Clin Exp Pathol,2014,7(4):1275-1285.
13 Suzuki D,Matsumoto S,Mashima H.A Case with Serrated Polyposis Syndrome Controlled by Multiple Applications of Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection[J].Am J Case Rep,2017,18:304-307.
14 Cao HL,Chen X,Du SC,et al.Detection Rate,Distribution,Clinical and Pathological Features of Colorectal Serrated Polyps[J].Chin Med J(Engl),2016,129(20):2427-2433.
15张浩,田怡,陈永其,等.结直肠锯齿状腺瘤52例临床、内镜及病理特点分析[J].蚌埠医学院学报,2012,37(11):1294-1295,1297.
16 Kimura T,Yamamoto E,Yamano HO,et al.A novel pit pattern identifies the precursor of colorectal cancer derived from sessile serrated adenoma[J].Am J Gastroenterol,2012,107(3):460-469.
17 East JE,Atkin WS,Bateman AC,et al.British Society of Gastroenterology position statement on serrated polyps in the colon and rectum[J].Gut,2017,66(7):1181-1196.
2中华医学会消化病学分会;中华医学会消化病学分会肿瘤协作组.中国结直肠癌预防共识意见(2016年,上海)[J].胃肠病学,2016,21(11):668-686.
3 Singh R,Zorrón Cheng Tao Pu L,Koay D,et al.Sessile serrated adenoma/polyps:Where are we at in 2016?[J].World J Gastroenterol,2016,22(34):7754-7759.
4杜沁仁,高峰.锯齿状息肉的研究进展[J].胃肠病学,2018,23(1):59-61.
5高珊,焦宇飞.结直肠锯齿状病变病理诊断及鉴别诊断[J].现代肿瘤医学,2016,24(5):825-827.
6魏振军,安贺娟,余东亮,等.225例结直肠锯齿状腺瘤的临床、内镜及病理学特征分析[J].胃肠病学和肝病学杂志,2014,23(9):1035-1038.
7 Saito S,Tajiri H,Ikegami M.Serrated polyps of the colon and rectum:Endoscopic features including image enhanced endoscopy[J].World J Gastrointest Endosc,2015,7(9):860-871.
8 Shida Y,Ichikawa K,Fujimori T,et al.Differentiation between sessile serrated adenoma/polyp and non-sessile serrated adenoma/polyp in large hyper plastic polyp:AJapanese collaborative study[J].Mol Clin Oncol,2013,1(1):53-58.
9徐勤伟,沈建伟,沈睿伟,等.结直肠锯齿状腺瘤45例临床病理分析[J].现代实用医学,2017,29(5):622-623.
10王续,刘月平,杨会钗,等.结肠锯齿状病变临床病理分析[J/CD].中华结直肠疾病电子杂志,2016,5(5):413-418.
11 Longacre TA,Fenoglio-Preiser CM.Mixed hyperplastic adenomatous polyps/serrated adenomas.A distinct form of colorectal neoplasia[J].Am J Surg Pathol,1990,14(6):524-537.
12 Fu X,Qiu Y,Zhang Y.Screening,management and surveillance for the sessile serrated adenomas/polyps[J].Int J Clin Exp Pathol,2014,7(4):1275-1285.
13 Suzuki D,Matsumoto S,Mashima H.A Case with Serrated Polyposis Syndrome Controlled by Multiple Applications of Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection[J].Am J Case Rep,2017,18:304-307.
14 Cao HL,Chen X,Du SC,et al.Detection Rate,Distribution,Clinical and Pathological Features of Colorectal Serrated Polyps[J].Chin Med J(Engl),2016,129(20):2427-2433.
15张浩,田怡,陈永其,等.结直肠锯齿状腺瘤52例临床、内镜及病理特点分析[J].蚌埠医学院学报,2012,37(11):1294-1295,1297.
16 Kimura T,Yamamoto E,Yamano HO,et al.A novel pit pattern identifies the precursor of colorectal cancer derived from sessile serrated adenoma[J].Am J Gastroenterol,2012,107(3):460-469.
17 East JE,Atkin WS,Bateman AC,et al.British Society of Gastroenterology position statement on serrated polyps in the colon and rectum[J].Gut,2017,66(7):1181-1196.