结肠、直肠癌活检病理诊断的探讨

目的　结合WHO(2 0 0 0 )对结肠、直肠癌的诊断标准 ,对结肠、直肠内窥镜活检癌的临床病理诊断进行探讨。方法　对 12 15例结肠、直肠活检诊断癌的标本进行回顾性阅片 ,确定癌侵及黏膜下层的标准 ,并与相应的手术切除标本的病理诊断进行对照 ,进行手术前后的病理诊断分析。结果　将 12 15例活检诊断结肠、直肠癌的标本与手术切除标本对比 ,其中 1173例活检诊断结肠癌 ,其中不能肯定癌侵及黏膜下层者 74 2例 ,手术后标本均为浸润癌 ,4 2例为腺瘤癌变 ,手术后标本有 3例癌局限在黏膜内。结论　建议在结肠活检癌的病理诊断中对不能确定癌侵及黏膜下层的病例不使用黏膜内肿瘤诊断 ,因为事实上这些病例绝大多数已是浸润癌。黏膜内肿瘤诊断主要应用于腺瘤及腺瘤癌变。     

WHO结直肠癌诊断标准在术前活组织检查病理诊断中的应用

目的：探讨世界卫生组织（WHO）结直肠癌诊断标准在术前内镜活组织检查标本病理诊断中的应用价值.方法：根据WHO结直肠癌诊断标准,只有明确的黏膜肌层浸润,才能被诊断为癌.回顾性分析2005年1月-2011年12月经手术切除的52例结直肠癌患者的术前活组织检查病理切片,观察肿瘤浸润黏膜肌层的情况,并与其术后病理检查结果作比较.结果：32例（61.5％）有黏膜肌层浸润,诊断为结直肠癌,15例（28.9％）未见黏膜肌层浸润,诊断为高级别上皮内瘤变,其余5例（9.6％）腺体异型不明显,考虑受活组织检查取材影响,只能诊断为低级别上皮内瘤变.而52例（100％）的术后病理检查全部确诊为浸润性腺癌.结论：WHO结直肠癌诊断标准在术前活组织检查病理诊断中有较高的误诊率,应该引起足够的重视.这一标准尚需进一步完善.实际工作中对结直肠癌的活组织检查诊断,应结合肿瘤的大体类型、细胞形态、腺体结构及内镜检查结果进行综合分析判断,避免将癌诊断为高级别上皮内瘤变而延误治疗,后者只适用于手术切除标本的诊断.     

WHO新旧分类在结、直肠活检中对腺癌诊断的差异

结、直肠活检的病理诊断对于临床处理方式的选择至关重要。由于WHO(2000)新分类对结、直肠肿瘤的诊断名称、定义作了一些新的规定,其中有些规定与我国目前使用的诊断标准和分类有较大差异。本文探讨WHO结、直肠肿瘤新分类对结直肠活检中腺癌诊断的影响。1材料与方法1.1临床资料收集广州邮电医院2000—2004年的内镜活检病例,选取31例诊断为结、直肠腺癌并经手术确诊的、已浸润至黏膜下层或以下组织的活检病例。1.2病理组织学新分类全部活检切片依据WHO结、直肠肿瘤新分类重新评估。判断标准:必须存在通过黏膜肌层浸润到黏膜下层的特点才…     

胃镜活检诊断胃黏膜高级别上皮内瘤变78例临床讨论

目的探讨胃黏膜高级别上皮内瘤变(highgrade intracpithelial neoplasia,HGIEN)的临床病理学特点和手术前后病理诊断误差的原因。方法对78例胃镜活检胃黏膜HGIEN的临床病理学资料进行回顾性分析。结果本组术前胃镜活检组织标本中未见黏膜肌层43例,可见黏膜肌层35例。均成功行手术根治,其中仅4例(5.12%)经手术证实符合HGIEN诊断;74例(94.88%)诊断为胃癌,27例(34.6%)为早期胃癌,47例(60.2%)为进展期胃癌。结论病理医生在诊断HGIEN病变时,应密切结合胃镜所见及临床主诉诊断,对组织标本进行多切片取材,认真鉴别癌与HGIEN的病变特征,以减少手术前后病理诊断的误差。     

胃原发性淋巴瘤18例内窥镜活检病理观察

目的　探讨胃原发性淋巴瘤黏膜活检的病理诊断特点。方法　内窥镜胃黏膜活检标本和切除标本经常规石蜡包埋切片、HE染色和SP法免疫组化染色后光镜下观察。结果　活检组织中均呈现不同程度的异型淋巴细胞弥漫浸润 ,腺体数量减少或完全消失 ;7例出现淋巴上皮病变 ,4例出现可疑淋巴上皮病变 ;11例伴有炎症渗出坏死和组织挤压损伤。结论　异型淋巴细胞弥漫浸润是活检诊断的主要特征 ;活检组织中可能不出现淋巴上皮病变 ;常伴有其他组织学改变     

早期胆囊癌的肉眼特征及超声发现

凡癌肿仅累及粘膜或粘膜肌层,有或无浅表浸润,病变沿罗一阿氏窦侵入粘膜下层(TNM Ⅰ期)者称为早期胆囊癌。所有病例的整个切除标本行连续切片,以确定癌肿侵犯的深度,结果71例病人诊断为早期癌。肿瘤组织学诊断均为腺癌。男性23例(32%),女性48例(68%),平均年龄68.4岁(25—87岁)。45例(63%)伴胆囊结石。所有标本经甲醛溶液固定后确定其病理类型。     

转录调节因子Ets-1在结直肠癌组织中的表达

目的:研究Ets-1在结直肠组织中的表达,探讨其与结直肠癌发生和发展的关系。方法:采用免疫组织化学S-P法,检测Ets-1在80例病理活检和手术切除结直肠癌标本中的表达。结果:Ets-1蛋白在结直肠癌组织中的表达明显高于其正常黏膜组织(P<0.05),在癌深度浸润组的表达明显高于浅度浸润组(P<0.05),而与肿瘤的分化程度和淋巴结转移无关(P>0.05)。结论:Ets-1蛋白的高表达可能与结直肠癌的癌变及浸润的发生有关。     

结直肠上皮内瘤变的处理策略

目的探讨活检病理诊断为结直肠上皮内瘤变病人的处理策略。方法回顾性分析2009年9月~2010年7月收治的56例经内镜活检诊断为结直肠上皮内瘤变病人的临床资料。结果 1例再次活检证实为腺癌后保守治疗,1例内镜下切除,1例内镜切除后补行根治术,1例单纯剖腹探查,2例剖腹探查取活检,1例肠段切除,7例经肛门肿瘤局部切除,6例行姑息性肿瘤切除手术,余36例行根治性结直肠癌手术,除单纯剖腹探查的1例外,余55例经病理证实为结直肠腺瘤伴上皮内瘤变11例,腺瘤癌变3例,结直肠腺癌41例。结论活检诊断的结直肠上皮内瘤变涉及多种病变,对不同的病变应选择不同的处理策略。     

进展期胃癌胃壁浸润CT"分层征"的病理学基础

目的：探讨进展期胃癌胃壁浸润CT分层征象的病理学基础。方法：31例病理证实的进展期胃癌,均作了胃肠造影及螺旋CT扫描。术后胃标本牵拉固定后,放射状象限取材,作病理对照观察。结果：动脉期、非平衡期及平衡期可见病灶分层情况分别为35．5％、19．4％及12．9％。（1）病灶分两层,其低密带清晰,密度均一者有11例,系黏膜下层癌细胞浸润及纤维组织广泛增生,使黏膜下层致密、增厚,肌层结构完整,仅在肌束间有癌巢形成。（2）病灶虽分两层,但低密带不均,内可见条索影者7例,为黏膜下层坏死,肿瘤细胞分泌的黏液及少量纤维组织增生构成。（3）病灶分三层者2例,分四层者1例,CT表现为“靶征”,是癌组织树根状从黏膜下层浸润至肌层的肌纤维束之间所致。结论：进展期胃癌螺旋CT三期扫描可清楚地观察病灶分层,与病理对照,可提高对肿瘤T分期的准确性。     

结直肠黏液腺癌临床病理与MMR蛋白表达及KRAS、BRAF基因突变的相关性分析

目的 分析结直肠黏液腺癌临床病理因素与MMR蛋白表达及KRAS、BRAF基因突变的相关性。方法 回顾性分析2014-01—2022-01山东省东阿县人民医院手术切除的33例黏液腺癌和307例非黏液腺癌患者的临床病理资料，采用免疫组化法和扩增阻滞突变系统(ARMS)对340例结直肠癌标本石蜡组织的MMR蛋白表达及KRAS、BRAF基因突变状态检测，并对其进行相关性分析。结果 黏液腺癌占结直肠癌的9.7%(33/340),与肿瘤大小、病变部位、浸润深度、错配修复蛋白表达及BRAF基因突变等临床病理因素有相关性(P<0.05)。结论 黏液腺癌是结直肠癌的少见组织学亚型，分析临床病例特征与错配修复蛋白联合KRAS、BRAF突变检测可为患者预后评估及个体化治疗提供依据。     

Histopathology of ulcerative colitis in biopsy

For histologic diagnosis on biopsy specimens, we gave an outline of macroscopic and microscopic features of ulcerative colitis (UC), including differential diagnosis. The most important histologic features on biopsy are dense mixed inflammatory infiltrate in the lamina propria mucosae, mucosal architectural abnormality, and vascular change. Evidence of colorectal adenocarcinoma, dysplasia, and cytomegalovirus infection should also be taken into account. Although diagnostic criteria for UC are well understood, the biopsy diagnosis of UC is comparatively difficult. Thus the diagnosis of UC should be made mainly by clinical pictures, course of the illness, and radiological and endoscopic pictures.     

Biopsy of colorectal polyps is not adequate for grading of neoplasia

BACKGROUND AND STUDY AIM: Valid tissue sampling of colorectal adenomas is crucial for their management in terms of treatment and follow-up. The aim of this study was to assess the validity of a cold biopsy sample as representative for the whole polypectomy specimen, with regard to histopathological features. PATIENTS AND METHODS: As part of the Norwegian Colorectal Cancer Prevention trial, 442 participants (60% men) who fulfilled the criterion of colonoscopic recovery of adenoma that had been biopsied at flexible sigmoidoscopy, had their adenomas subsequently removed by polypectomy (snare resection) at colonoscopy. Logistic regression analysis was used to determine which variables contributed to the histopathological discrepancy between cold biopsy and polypectomy specimens. RESULTS: Among the 532 colorectal adenomas biopsied at flexible sigmoidoscopy and removed by colonoscopy, the assessment of intraepithelial neoplasia (dysplasia) status was changed in 51 adenomas (10%), and 38 (7%) of them had been underestimated at biopsy compared with polypectomy. Likewise, the assessment of villousness was changed in 45 adenomas (9%), being upgraded in 26 (6%) at polypectomy compared with biopsy. In a multivariate model, the diameter of neoplasia at polypectomy was positively associated with increased risk of the underestimation of intraepithelial neoplasia and/or villousness influencing a diagnosis of advanced colorectal neoplasia, when cold biopsy and polypectomy specimens were compared ( Ptrend=0.01). Among 56 cases of advanced neoplasia, 35 (63%) showed only low-grade intraepithelial neoplasia on biopsy. CONCLUSIONS: Biopsy-based diagnosis underestimated histopathological diagnosis in about 10% of colorectal adenomas detected by flexible sigmoidoscopy screening, but advanced neoplasia was underestimated in more than 60%. Efforts must be made to obtain polypectomy specimens to secure precise diagnosis.     

结直肠息肉样病变内镜活检和内镜切除术后病理差异分析*

目的探讨结直肠息肉样病变的内镜活检病理与内镜切除术后病理的差异,分析其相关危险因素以及内镜活检的局限性。方法回顾性分析结直肠息肉样病变52例,内镜活检病理包括增生性息肉、炎性息肉以及腺瘤伴低级别上皮内瘤变(LGIN)或高级别上皮内瘤变(HGIN)。所有患者根据内镜下分型及大小选择不同的内镜下切除方式:圈套器高频电切除术、内镜下黏膜切除术(EMR)以及内镜黏膜下剥离术(ESD)。统计患者的临床资料、镜下特点、活检病理及内镜切除术后的病理差异,分析病理结果发生显著差异的危险因素。结果52例患者中,24例的活检病理与内镜切除病理存在差异,总体差异率为46.2%。其中增生性息肉、炎性息肉、LGIN以及HGIN活检与内镜切除病理的差异率分别为20.0%、42.9%、44.4%及54.5%。直径大于2.0 cm和病变表面充血是影响病理学差异的关键因素(P<0.05)。结论内镜活检对于结直肠息肉样病变性质的判断有一定的局限性,应警惕其对结直肠癌前病变及癌变的延迟诊治以及漏诊。     

Recurrence of sigmoid colon cancer–derived anal metastasis: A case report and review of literature

BACKGROUNDDistant metastasis of colorectal cancer to the anus is very rare, with only 30 related cases published in PubMed thus far. Therefore, recurrence of colorectal cancer derived anus metastases is rarely seen and less presented. CASE SUMMARYHere we report an 80-year-old male patient who underwent radical resection for sigmoid colon cancer in January 2010 and another surgery for anal fistula resection in December 2010. Postoperative pathology of the anal fistula revealed a metastatic moderately differentiated adenocarcinoma. The patient subsequently received chemotherapy and radiotherapy. In May 2020, after the patient reported symptoms of anal swelling and pain, computed tomography and magnetic resonance imaging revealed a perianal abscess. Perianal mass biopsy was performed, and the postoperative pathological diagnosis was metastatic moderately differentiated adenocarcinoma. CONCLUSIONThis case highlights that there is a risk of recurrence of anal metastasis of colorectal cancer even after 10 years of follow-up. We also reviewed the literature and discuss potential mechanisms for anal metastasis of colorectal cancer, thus providing some suggestions for treatment of these cases.     

结直肠癌并梗阻穿孔的诊治体会(附16例报告)

目的：探讨结直肠癌性穿孔的诊治方法。方法：回顾分析总结16例结直肠癌性穿孔病例。结果：本组死亡5例，脓毒症、急性呼吸衰竭是最主要死因。结论：及时诊断、积极治疗可有效降低本病的死亡率。     

超声引导下细针穿刺胰腺腺癌基因诊断

目的：探讨超声引导下细针穿刺与基因检测相结合早期诊断胰腺癌的临床应用。方法：应用超声引导下细针穿刺技术对３８例可疑胰腺癌及其邻近器官占位性病变患者进行穿刺活检,同进采用聚合酶链反应－限制性酶切片段长度多态性技术,对所取得的标本ｃ－ｋｉ－ｒａｓ基因第１２密友子突变进行检测。应用于胰腺癌的诊断。结果：２２例胰腺癌中有２１例有ｃ－ｋｉ－ｒａｓ基因第１２密友子突变,多为ＧＧＴ变成ＧＡＴ、ＧＣＴ、ＧＴＴ,阳     

超声引导下细针穿刺在基因诊断胰腺癌中的应用

采用超声引导下细针穿刺方法将ＰＣＲ—ＲＦＬＰ技术对３２例胰腺及其邻近器官细针穿刺标本进行Ｃ—ｋｉ—ｒａｓ等１２密码子突变应用于临床胰腺癌诊断。在２０例胰腺癌中１９例有Ｃ—ｋｉ—ｒａｓ第１２密码子突变，阳性率达９５％，而５例慢性胰腺炎，４例壶腹癌、３例胰岛细胞瘤等均无Ｃ—ｋｉ—ｒａｓ第１２密码子突变。结果说明超声引导下细针穿刺基因检测是诊断和鉴别诊断胰腺癌的安全有效方法。     

隐匿性乳腺癌临床诊治分析

目的：分析隐匿性乳腺癌的诊断和治疗经过及其预后结果，总结其诊断和治疗经验和方法。方法：回顾性分析9例隐匿性乳腺癌诊断治疗方法以及各种治疗的效果。结果：9例隐匿性乳腺癌患者均经腋窝淋巴结切除行病理检查明确诊断，其中7例行根治或改良根治术，所有患者均行进一步化疗，4例行放疗。出院后随访，肿瘤转移导致死亡3例。结论：腋窝淋巴结切除活检和免疫组化检查对隐匿性乳腺癌诊断有重要意义，治疗宜选择根治术或改良根治术，并辅以化疗、放疗等综合治疗。     

低剂量CT仿真结肠镜结合增强扫描对结直肠疾病的诊断价值

目的:评估低剂量CT仿真结肠镜结合增强扫描对结直肠疾病的诊断价值。方法:对104例受检者进行低剂量CT仿真结肠镜及增强扫描检查,将检查结果与结肠镜活检病理结果进行比较,计算低剂量CT仿真结肠镜诊断病变的敏感度和特异度,并分别记录低剂量和常规剂量扫描的CT容积剂量指数(CT dose index volume,CTDI vol)。结果:104例受检者中,阳性病变者91例,阴性13例。其中低剂量CT仿真结肠镜检出阳性者89例(89/91,97.8%),低剂量CT的CT辐射指数较常规CT平均降低60.59%。与常规剂量CT相比,低剂量CT仿真结肠镜对肠壁浸润程度、病变定性及腹膜后淋巴结的显示均稍差,而增强扫描有助于弥补这些不足。结论:低剂量CT仿真结肠镜检查可以有效地发现结直肠病变,且较常规CT的X线辐射剂量低;增强扫描适用于结直肠癌术前分期,低剂量CT仿真结肠镜结合增强扫描对结直肠疾病的诊断有较高价值。