结肠、直肠内窥镜活检癌的临床病理诊断研究

目的结合WHO诊断标准，对直肠、结肠内窥镜活检癌临床病理诊断进行研究。方法选择浙江省桐乡市中医医院2010年1月-2013年1月收治的结肠、直肠活检诊断并进行手术切除的患者资料330例。对所有患者的诊断癌标本进行回顾性分析，以确定患者黏膜下层标准，并将其与切除手术病理诊断进行对照，对患者手术前后病理诊断的结果进行分析。结果患者组织学类型为腺癌308例，印戒细胞癌4例，类癌2例，黏液腺癌16例，308例腺癌患者中．66例患者在显微镜下不能确定其黏膜下层及癌侵。但手术根治标本能够证实活检的判断。患者组织学特征主要表现为：①黏液腺癌。肿瘤特征是肿瘤组织中出现大量黏液。②腺癌。肿瘤特征是腺管状腺泡状分化。③类癌。特征是：癌细胞形态、大小、染色较为均匀，典型的形状为多边形，染色不深，有多种结构。④印戒细胞癌。肿瘤特征是由弥漫成片的印戒细胞构成，细胞核深染，偏向胞浆侧面。结论由于大多数病例是浸润癌，因而在对结肠、直肠进程活检中．应对不能确定的黏膜下层、癌侵等，患者不使用黏膜内肿瘤对其进行诊断。对于黏膜内肿瘤的诊断则主要应用于腺瘤癌变及腺瘤。

Research on clinical pathological diagnosis of cancer by biopsy of colorec-tal endoscopy

Objective To study the clinical pathological diagnosis of cancer by biopsy of colorectal endoscopy according to WHO criteria. Methods 330 patients who were given biopsy of colorectal endoscopy and resection from January 2010 to Jan-uary 2013 in Tongxiang Hospital of Traditional Chinese Medicine were selected for researching, All these samples were retro- spectively analyzed for confirming the submucosa standard which were compared with pathological diagnosis of resection, and the pathological diagnosises before and after surgery were compared. Results The number of histological type of adenocarci- noma, signet ring cell carcinoma, carcinoid and mucinous adenocarcinoma was 308, 4, 2 and 16 respectively. Among 308 adenocarcinoma patients, 66 patients could not be confirmed tunica submucosa with cancer invasion by microscopic, while samples from radical surgery could confirm the judgment from biopsy. The main characters of patient＇s histology were follow- ing： ①mucinous adenocarcinoma, there were large mucus in tumor tissue; ②adenocarcinoma, there was ductlike and acinar differentiation; ③carcinoid, the shape, volume and staining of cancer cells were uniform, the typical shape was polygons, non deep staining and several structures; ④signet ring cell carcinoma, signet ring cells which nuclear with deep staining was bias to cytosolic side were diffused in tumor tissue. Conclusion Because of most of these cases are invasive carcinomas, mucosal tumor should not be used for diagnosis for unconfirmed cancer invasion of submucosa by biopsy of colorectal endoscopy. And the diagnosis of mucosal tumor should be used mainly for adenoma canceration and adenoma.