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目的:探讨纤维绒毛锯齿状腺瘤(FSA)的临床病理学特征以及免疫组织化学特征的意义。方法:收集病理诊断为结直肠各类息肉和腺瘤切片5347例,从中筛选出FSA共18例,同时收集临床相关资料并观察病理学特征。对FSA11例、非纤维绒毛锯齿状腺瘤(NFSA)20例〔其中传统锯齿状腺瘤(TSA)15例、广基锯齿状腺瘤/息肉(SSA/P)5例〕、增生性息肉(HP)20例及绒毛管状腺瘤(VTA)20例分别进行免疫组化Ki-67、p53、-βCatenin、CK7、CK20及CDX-2染色。结果:FSA多发于左半结肠,组织学显示肿物表面可见许多细长丝状或绒毛状的突起,隐窝被覆异型增生的上皮细胞,伴有典型锯齿状改变,该类突起形似绒毛管状腺瘤,但其长度比绒毛管状腺瘤长。多数病例突起末端间质水肿明显(12/18),严重者可膨大呈“球茎”状改变(7/18)。FSA异型增生程度较NFSA和VTA要高,差异有统计学意义,P<0.05。在FSA中p53和Ki-67的表达与其他各组比较差异有统计学意义,P<0.05。结论:FSA是一种较少见的特殊类型锯齿状腺瘤,以其“长绒毛”的典型特征区别于其他锯齿状病变,异型增生程度重,可能具有更高的恶变潜能。
Objective: To investigate the clinicopathological features and the significance of immunohistochemical features of fibroids serrated adenomas (FSA). Methods: A total of 5347 cases of colorectal polyps and adenomas were collected and pathologically diagnosed. A total of 18 cases of FSA were screened out. Clinical data and pathological features were also collected. Of FSA11 cases, 20 cases of non-fibroid serosa (NFSA) [including 15 cases of traditional serrated adenomas (TSA), 5 cases of wide-base serrated adenomas / polyps (SSA / P)], proliferative polyps 20 cases of HP and 20 cases of villus tubular adenoma (VTA) were immunohistochemically stained for Ki-67, p53, -βCatenin, CK7, CK20 and CDX-2. RESULTS: FSA was frequently found in the left colon. Histologically, many elongated filamentous or villous processes were observed on the surface of the tumor. The crypts were coated with dysplastic epithelial cells with typical jagged changes. These processes were similar to villous tubular glands Tumor, but its length is longer than villous tubular adenoma. In most cases, the terminal interstitial edema was prominent (12/18). In severe cases, the edema was “bulbar” (7/18). FSA dysplasia than NFSA and VTA higher, the difference was statistically significant, P <0.05. The expression of p53 and Ki-67 in FSA was significantly different from other groups (P <0.05). Conclusions: FSA is a rare and special type of serrated adenoma. It is distinguished from other serrated lesions by its typical features of “long hair”, and may have higher malignant potential.