大肠锯齿状腺瘤的内镜表现和癌胚抗原表达

目的探讨大肠锯齿状腺瘤（SA）的内镜特征和癌胚抗原的表达情况。方法选择2005年6月-2008年7月在消化内镜室检出的SA患者27例（SA组），另选择同期检出的进展期结直肠腺癌（ACC）患者共26例（ACC组）。结肠镜检查发现大肠息肉后用0．4％靛胭脂溶液进行喷洒染色并判断息肉的腺管开口，采用活检钳钳咬、高频电切除术、EMR等方法摘除息肉，对大肠癌等病灶则采用活检钳钳咬组织。上述标本进行病理组织学常规检查和腺体组织癌胚抗原（CEA）免疫组化染色。结果SA组锯齿状腺瘤47枚，其它类型息肉27枚。SA形态以隆起亚蒂型多见，2枚最大径≥10mm，45枚最大径在3～8mm。SA腺管开口较常见到Ⅱ型pit与ⅢL型pit的混合表现，Ⅱ型pit也占一定比例，好发部位均在左半结肠。SA的腺瘤性腺体CEA阳性表达明显强于其增生性腺体CEA阳性表达（P〈0．01）。结论SA是一种独特的大肠腺瘤类型，其瘤细胞已有较强合成CEA能力，具备一定的恶变潜能，临床医师应予以高度重视。

Endoscopic features and earcinoembryonic antigen expressions of colorectal serrated adenomas

Objective To explore the endoscopic features and careinoembryonic antigen (CEA) ex-pressions of colorectal serrated adenomas (SA). Methods From June 2005 to July 2008, 27 patients with colorectal polyps and 26 cases of advanced colorectal cancer (ACC) were enrolled in the study. The pit pat-tern of the suspected lesions were observed with 0. 4% indigo carmine sodium stain and classified according to Kudo classification. The polyps were removed by biopsy, high-frequency electrical excision or endoscopic mucosa resection and the samples of ACC were collected with biopsy forceps. All specimens underwent rou-tine pathological examination and CEA expression was detected by immunohistochemistry. Results There were 47 SAs and 27 other types of polyps in polyp group. Most SAs located in left-side colon and were char-acterized by the bulge semipedunculation. The diameters of 45 serrated adenomas ranged from 3 to 8ram, and the maximal diameter of other 2 were more than 10ram. The most common type of pit pattern in SA was mixed type Ⅱ and ⅢL, with type Ⅱ predominant in a certain percentage. Expression of CEA in SA glands was significantly higher than that in proliferative polyps (P < 0. O1). Candnsion SA is an unique type of colorectal adenoma, which is capable of expressing CEA, and displays malignant potential and deserves great attention.