结直肠锯齿状腺瘤内镜和病理形态特征分析

目的 探讨锯齿状腺瘤（SA）内镜下形态和病理组织学特征.方法 回顾分析南方医院消化内镜中心2002年1月至2005年7月检出的大肠息肉病例,了解SA的检出率、内镜形态、腺管开口分型和病理组织学特征.结果 11894例肠镜检查共检出息肉病例1928例（2811枚）,检出率为16.21%,其中SA 61例（71枚）,检出率为0.51%,占息肉构成比为3.16%.SA直径＞1 cm者占39.44%,明显大于增生性息肉;内镜下表现为有蒂息肉所占的比例（26.76%）高于增生性息肉（13.25%）,但低于腺瘤性息肉（43.95%）.1815枚息肉进行腺管开口分型,SA多表现为Ⅲ型腺管开口（41.67%）,部分表现为Ⅳ型腺管开口（18.33%）,与腺瘤性息肉较接近.SA中度以上异型增生发生率介于管状腺瘤和绒毛状腺瘤之间,并有2.82%的癌变率.结论 SA内镜形态、腺管开口分型和病理学特点提示其本质上与增生性息肉不同,与肿瘤性息肉表现类似,具有恶变潜能.     

32例结直肠锯齿状腺瘤的内镜表现及病理学特征分析

目的探讨结直肠锯齿状腺瘤(SA)的内镜下形态和病理学特征。方法收集并分析1996年1月至2008年5月我院检出的32例SA的内镜和病理资料。结果 32例患者共检出SA60枚,其中35枚为隆起型(无蒂23枚,亚蒂7枚,有蒂5枚),25枚为扁平型。SA常见于乙状结肠及直肠(乙状结肠29枚,直肠11枚)。组织病理学上,管状、管状绒毛状和绒毛状SA分别为41枚、9枚、10枚;不典型增生程度,轻度48枚,中度7枚,重度5枚,其中4枚局部癌变。大于或等于10mmSA较10mm以下的SA不典型增生程度重(P0.01)。结论大于或等于10mm的SA较10mm以下的SA更易癌变,应引起临床及内镜工作者的重视。     

结直肠锯齿状腺瘤与传统腺瘤的内镜表现和病理学特征比较

目的通过分析结直肠锯齿状腺瘤（SA）和传统腺瘤的内镜和病理学特征的差异,加强对SA的认识。方法比较2008年6月至2013年10月天津医科大学总医院消化内镜中心检出的80例SA和160例传统腺瘤的一般情况、内镜表现和病理学特征。结果SA患者平均年龄比传统腺瘤患者小[（57．5±13．8）岁和（62．3±12．2）岁,P=0．0038],而男女性别构成,两组间差异无统计学意义（P〉0．05）。在内镜特征方面,SA主要发生于直乙结肠（60％）,传统腺瘤好发部位为直乙结肠（45％）、升结肠（20％）和降结肠（19％）,两组病变部位差异有统计学意义（P〈0．05）;在内镜形态分型（隆起型及表面型）和腺瘤大小方面比较,两组组间差异亦无统计学意义（P〉0．05）。在病理学方面,SA具有独特的锯齿状结构,传统腺瘤为管状、管状绒毛状和绒毛状结构。传统腺瘤的低级别瘤变率高于SA（P〈0．05）,但sA仍有约1．9％的局部恶变率。结论sA与传统腺瘤在年龄、发生部位和病理学特征方面存在差异,是一种独特的腺瘤类型,有一定恶变潜能,应引起临床和内镜医师的高度重视。     

结直肠锯齿状病变的临床研究进展

结直肠锯齿状病变是一类具有典型"锯齿状"形态特征的病变,因其具有恶变潜能,近年来学者们对它的关注度越来越高。虽然目前国内外对该病变的基础研究较多,但临床研究不多,此文就结直肠锯齿状病变的流行病学特征、癌变机制、内镜特征及处理策略等方面进行归纳总结,旨在提高对此类病变的认知及临床处理能力。     

109例结直肠锯齿状腺瘤临床及内镜特征分析

目的：探讨SSA及TSA的临床及内镜特征。方法：回顾性分析SSA、TSA的检出率及内镜特征,比较SSA、TSA、增生性息肉、管状腺瘤、管状绒毛状腺瘤、绒毛状腺瘤的恶变情况。结果：TSA的检出率为0.13%,SSA的检出率为0.07%。TSA、SSA在不同性别、不同年龄段、汉族和维吾尔族中的检出率差异无统计学意义（P均>0.05）。TSA、SSA均多为单发、无蒂或亚蒂。TSA多见于远端结肠,占82.86%,SSA多见于近端结肠,占58.97%,差异有统计学意义（χ2=20.11,P<0.01）。TSA大小平均为4.92±4.57mm,SSA平均为7.11±6.81mm,差异无统计学意义（t=-1.72,P=0.08）。SSA恶变者占25.64%,与管状绒毛状腺瘤、绒毛状腺瘤相似（P>0.05）,TSA恶变者占8.57%,与管状腺瘤相似（P>0.05）,SSA恶变发生率高于TSA,差异有统计学意义（χ2=5.83,P=0.02）。结论：TSA、SSA均多为单发、无蒂或亚蒂;TSA多见于远端结肠,SSA多见于近端结肠;SSA恶变发生率高于TSA。     

结直肠浅表锯齿状腺瘤的研究现状

浅表锯齿状腺瘤是2018年提出的一种新型锯齿状病变，具有独特临床病理和分子特征，表现出典型的混合性腺瘤和锯齿状特征。分子机制上，浅表锯齿状腺瘤病变表现为β‑连环蛋白的核积累和MYC过表达，提示WNT信号通路激活，同时浅表锯齿状腺瘤显示出与相关传统锯齿状腺瘤一致的KRAS突变和RSPO融合或过表达，提示浅表锯齿状腺瘤可能是KRAS突变的传统锯齿状腺瘤重要前体。本文重点讲述浅表锯齿状腺瘤的特点以引起内镜医师对该病变的重视。     

结直肠无蒂锯齿状病变的临床及内镜特征分析

[目的]分析并探讨结直肠无蒂锯齿状病变(sessile serrated lesions, SSL)与增生性息肉(hyperplastic polyp, HP)的临床与内镜的鉴别特征。[方法]回顾性分析经消化内镜发现，且病理诊断为SSL的83例患者(SSL组)以及确诊为HP的189例患者(HP组)的临床资料；对病例的性别、年龄、病变的大小、部位及病变是否具有内镜下特点进行单因素分析，并分析内镜下特点对SSL的诊断预测价值，总结SSL在临床及内镜下的特点，及其与HP的鉴别要点。[结果]单因素分析结果显示：SSL组与HP组患者的性别、年龄、巴黎分型比较均差异无统计学意义；但2组病变大小，部位分布，有无WLE黏液帽、WLE云状表面、WLE边界模糊、NBI血管扩张、NBI隐窝内黑点，以及NBI腺管开口形态比较均差异有统计学意义。内镜下特点中NBI下隐窝内黑点对于SSL的诊断准确性最高，为92.65%。将灵敏度最高的WLE边界模糊与其他形态特征相联合对SSL进行诊断预测时，合并NBI隐窝内黑点的诊断准确性最高，为85.44%;将特异度最高的NBI血管扩张与其他形态特征相联合对SSL进行诊断预测时...     

结直肠锯齿状病变的研究进展

结直肠锯齿状病变是一组隐窝上皮以“锯齿状”外观为特征的病变,以前认为这些病变没有恶变的风险,近年来发现它可以通过锯齿状通路进展为结直肠癌,故受到胃肠病学家的广泛关注。本综述介绍了结直肠锯齿状病变流行病学特征、内镜组织学特征、癌变分子机制、病变处理及与微生物群关联等方面,旨在提高对于该病变的认识及临床诊治能力。     

锯齿状腺瘤研究进展

锯齿状腺瘤（serrated adenoma，SA）是同时具有增生性息肉（hyperplasic polyp，HP）的锯齿状结构和传统腺瘤异型性上皮特征的一种新腺瘤类型。具有锯齿状结构的病变包括HP、HP腺瘤混合性息肉（admixed hyperplasic polyp／adenoma，HP／AD）和SA。近年临床病理学和分子生物学方面的研究认为，HP可能是一种结、直肠癌发生新途径的早期阶段，即“HP—SA-癌”途径。SA组织学发生、形态结构、分子遗传学改变等具特殊性。有研究表明，SA可在2年内发展为进展期大肠癌。因此HP和SA作为一种新的癌前病变值得我们深入研究。     

225例结直肠锯齿状腺瘤的临床、内镜及病理学特征分析

目的探讨结直肠锯齿状腺瘤(serrated adenoma,SA)的临床、内镜及病理学特征。方法回顾性分析北京军区总医院消化内镜中心2009年1月-2013年10月检出的225例结直肠SA的临床、内镜及病理学资料。结果全部患者中男148例,女77例,年龄19~89岁,平均年龄(53.5±14.3)岁。以单发型多见(87.1%)。在同期结肠镜中的检出率为2.1%。内镜下形态以扁平型和广基型居多(64.3%、20.0%),多数病变直径在10 mm以下(83.1%);左半结肠和右半结肠的病变大小和形态分布的差异均有统计学意义(χ2=14.2662、12.2168,P0.05)。全部病例中广基锯齿状腺瘤息肉(SSA/P)30例(13.3%),非广基锯齿状腺瘤(包括增生性息肉、传统锯齿状腺瘤)195例(86.7%)。SSA/P中有20例位于右半结肠(66.7%),平均直径13.3 mm。其中6例SSA/P呈侧向发育型息肉,均位于升结肠及回盲部。伴腺上皮异型增生12例,另有3例腺瘤癌变。结论结直肠SA临床相对少见,内镜下形态及分布部位有其自身特点,尤其是SSA/P。有必要对结直肠SA进行明确分类,并对其发展、转归做长期随访研究。     

Endoscopic and histologic characteristics of serrated lesions

In recent years , a second pathway for colonic carcinogenesis , distinct from the adenomatous pathway, has been explored. This is referred to as serrated pathway and includes three types of polyp,characterised by a serrated appearance of the crypts:hyperplastic polyps(HP),sessile serrated adenomas(SSA)or lesions,and traditional serrated adenomas.Each lesion has its own genetic,as well as macroscopic and microscopic morphological features.Because of their flat aspect,their detection is easier with chromoendoscopy(carmin indigo or narrow-band imaging).However,as we show in this review,the distinction between SSA and HP is quite difficult.It is now recommended to resect in one piece as it is possible the serrated polyps with a control in a delay depending on the presence or not of dysplasia.These different types of lesion are described in detail in the present review in general population,in polyposis and in inflammatory bowel diseases patients.This review highlights the need to improve characterization and understanding of this way of colorectal cancerogenesis.     

Clinico-pathological aspects of colorectal serrated adenomas

AIM: To study the association of colorectal serrated adenomas (SAs) with invasive carcinoma, local recurrence, synchronicity and metachronicity of lesions. METHODS: A total of 4536 polyps from 1096 patients over an eight-year period (1987-1995) were retrospectively examined. Adenomas showing at least 50% of serrated architecture were called SAs by three reviewing pathologists. RESULTS: Ninety-one (2%) of all polyps were called SAs, which were found in 46 patients. Invasive carcinomas were seen in 3 out of 46 (6.4%) patients, of whom one was a case of familial adenomatous polyposis (FAR). A male preponderance was noted and features of a mild degree of dysplasia were seen in majority (n=75, 83%) of serrated adenomas. Follow-up ranged 1-12 years with a mean time of 5.75 years. Recurrences of SAs were seen in 3 (6.4%) cases, synchronous SAs in 16 (34.8%) cases and metachronous SAs in 9 (19.6%) cases. CONCLUSION: Invasive carcinoma arising in serrated adenoma is rare, accounting for 2 (4.3%) cases studied in this series.     

Sessile serrated adenomas: Demographic, endoscopic and pathological characteristics

AIM:To study the demographic and endoscopic characteristics of patients with sessile serrated adenoma(SSA) in a single center.METHODS:Patients with SSA were identified by review of the pathology database of Mayo Clinic Arizona from 2005 to 2007.A retrospective chart review was performed to extract data on demographics,polyp characteristics,presence of synchronous adenomatous polyps or cancer,polypectomy methods,and related complications.RESULTS:One hundred and seventy-one(2.9%) of all patients undergoing co...     

A significant number of sessile serrated adenomas might not be accurately diagnosed in daily practice

Background/Aims

The diagnosis of hyperplastic polyps (HPs) may involve a conglomeration of subgroups of serrated polyps. The diagnosis of HPs may therefore be revisited if this is sessile serrated adenoma (SSA). The aim of this study was to determine clinically and endoscopically relevant information associated with reclassification to SSA.

Methods

After reviewing the data from 1,372 patients who underwent colonoscopic polypectomy, 49 HPs larger than 10 mm were analyzed in this study. Two gastrointestinal pathologists reclassified each of the original 49 HPs as conventional HPs, SSAs, and others.

Results

Among the 49 initially diagnosed HPs, 18.4% were reclassified into SSAs or mixed polyps. Overall architectural features were useful for the diagnosis of SSA, but cytological features were less useful. The patient and polyp characteristics did not differ between HPs with and without reclassification of the initial pathological diagnosis.

Conclusions

A significant number of SSAs might not be accurately diagnosed in daily clinical practice without any predilection for size, shape, and location. Therefore, when large HPs are diagnosed in clinical practice, it is necessary for physicians to have greater awareness of the diagnosis of SSA and to individualize subsequent surveillance.     

Evaluation of magnifying colonoscopy in the diagnosis of serrated polyps

AIM: To elucidate the colonoscopic features of serrated lesions of the colorectum using magnifying colonoscopy.METHODS: Broad division of serrated lesions of the colorectum into hyperplastic polyps (HPs), traditional serrated adenomas (TSAs), and sessile serrated adenomas/polyps (SSA/Ps) has been proposed on the basis of recent molecular biological studies. However, few reports have examined the colonoscopic features of these divisions, including magnified colonoscopic findings. This study examined 118 lesions excised in our hospital as suspected serrated lesions after magnified observation between January 2008 and September 2011. Patient characteristics (sex, age), conventional colonoscopic findings (location, size, morphology, color, mucin) and magnified colonoscopic findings (pit pattern diagnosis) were interpreted by five colonoscopists with experience in over 1000 colonoscopies, and were compared with histopathological diagnoses. The pit patterns were categorized according to Kudo’s classification, but a more detailed investigation was also performed using the subclassification [type II-Open (type II-O), type II-Long (type II-L), or type IV-Serrated (type IV-S)] proposed by Kimura T and Yamano H.RESULTS: Lesions comprised 23 HPs (23/118: 19.5%), 39 TSAs (39/118: 33.1%: with cancer in one case), 50 SSA/Ps (50/118: 42.4%: complicated with cancer in three cases), and six others (6/118: 5.1%). We excluded six others, including three regular adenomas, one hamartoma, one inflammatory polyp, and one juvenile polyp for further analysis. Conventional colonoscopy showed that SSA/Ps were characterized as larger in diameter than TSAs and HPs (SSA/P vs HP, 13.62 ± 8.62 mm vs 7.74 ± 3.24 mm, P < 0.001; SSA/Ps vs TSA, 13.62 ± 8.62 mm vs 9.89 ± 5.73 mm, P < 0.01); common in the right side of the colon [HPs, 30.4% (7/23): TSAs, 20.5% (8/39): SSA/P, 84.0% (42/50), P < 0.001]; flat-elevated lesion [HPs, 30.4% (7/23): TSAs, 5.1% (2/39): SSA/Ps, 90.0% (45/50), P < 0.001]; normal-colored or pale imucosa [HPs, 34.8% (8/23): TSAs, 10.3% (4/39): SSA/Ps, 80% (40/50), P < 0.001]; and with large amounts of mucin [HPs, 21.7% (5/23): TSAs, 17.9% (7/39): SSA/Ps, 72.0% (36/50), P < 0.001]. In magnified colonoscopic findings, 17 lesions showed either type II pit pattern alone or partial type II pit pattern as the basic architecture, with 14 HPs (14/17, 70.0%) and 3 SSA/Ps. Magnified colonoscopy showed the type II-O pit pattern as characteristic of SSA/Ps [sensitivity 83.7% (41/49), specificity 85.7% (54/63)]. Cancer was also present in three lesions, in all of which a type VI pit pattern was also present within the same lesion. There were four HPs and four TSAs each. The type IV-S pit pattern was characteristic of TSAs [sensitivity 96.7% (30/31), specificity 89.9% (72/81)]. Cancer was present in one lesion, in which a type VI pit pattern was also present within the same lesion. In our study, serrated lesions of the colorectum also possessed the features described in previous reports of conventional colonoscopic findings. The pit pattern diagnosis using magnifying colonoscopy, particularly magnified colonoscopic findings using subclassifications of surface architecture, reflected the pathological characteristics of SSA/Ps and TSAs, and will be useful for colonoscopic diagnosis.CONCLUSION: We suggest that this system could be a good diagnostic tool for SSA/Ps using magnifying colonoscopy.     

大肠锯齿状腺瘤基础与临床研究进展

由于中国人生活方式和饮食习惯的改变等原因，大肠癌的发病率也呈逐年上升趋势。目前普遍认同大肠腺瘤是大肠上皮从良性向恶性演变的重要环节，也是最具恶变潜能的癌前状态。国内外学者对大肠腺瘤进行着广泛而深入地研究。近年来大肠锯齿状腺瘤（serrated adenoma，简称锯齿状腺瘤）正日益受到关注。大肠锯齿状腺瘤独特的结构特征和细胞学特点由Goldman等于1970年最先报道，1990年Longacre等报道了110例，并首次将这类病例命名为大肠锯齿状腺瘤。据报道大约5％～10％的锯齿状腺瘤病灶内发生黏膜内癌。2000年世界卫生组织（WHO）正式将大肠锯齿状腺瘤定为大肠的第四种腺瘤病理形态（前三种是管状腺瘤、     

32例大肠锯齿状腺瘤临床、结肠镜及病理特点分析

目的探讨大肠锯齿状腺瘤患者的临床、结肠镜及病理特点。方法回顾性分析我院2008年4月-2009年12月消化内镜中心及病理科检出的32例大肠锯齿状腺瘤患者的临床、结肠镜及病理特点。结果32例大肠锯齿状腺瘤患者以腹痛就诊者20例（62．5％）,腹泻7例（21．7％）,便血2例（6．2％）,CEA升高体检2例（6．2％）,结肠癌术后复查1例（3．1％）;结肠镜检查病变位于直肠者18例（56．2％）,位于乙状结肠者3例（9．3％）,位于直乙交界处者5例（15．5％）,位于降结肠者2例（6．2％）,位于横结肠者3例（9．3％）,位于升结肠者1例（3．1％）;多发4例（12．5％）,单发28例（87．5％）;腺瘤直径多在1～6mm,最大直径20mm,平均直径9．5mm,32例大肠锯齿状腺瘤中广基息肉（Is）25例（77．3％）,亚蒂息肉（Isp）6例（19．6％）,有蒂息肉（Ip）1例（3．1％）。组织病理学检查为单纯锯齿状腺瘤8例（25．8％）,活检结果为锯齿状腺瘤,低级别上皮内瘤变22例（68．2％）,锯齿状腺瘤,局部高级别上皮内瘤变1例（3．1％）,锯齿状腺瘤,局部恶变1例（3．1％）,手术后病理证实为中分化腺癌。结论大肠锯齿状腺瘤作为一种独立的腺瘤形态与直结肠肿瘤密切相关,应引起重视。     

Hyperplastic polyposis associated with two asynchronous colon cancers

We report a patient with hyperplastic polyposis who had two asynchronous colon cancers, a combined adenoma-hyperplastic polyp, a serrated adenoma, and tubular adenomas. Hyperplastic polyposis is thought to be a precancerous lesion; and adenocarcinoma arises from hyperplastic polyposis through the hyperplastic polyp-adenoma-carcinoma sequence. Most polyps in patients with hyperplastic polyposis present as bland- looking hyperplastic polyps, which are regarded as non- neoplastic lesions; however, the risk of malignancy should not be underestimated. In patients with multiple hyperplastic polyps, hyperplastic polyposis should be identified and followed up carefully in order to detect malignant transformation in the early stage.