文档介绍：结直肠锯齿状息肉最新报道 Update on serrated polyps of the colorectum
2014-03-19
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简要介绍锯齿状病变专家共识推荐规范
增生***肉(MVHP)与SSA/P的新认知
传统型锯齿状腺瘤(TSA)伴异型增生
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简要介绍锯齿状病变专家共识推荐规范
2010年在Cleveland举行,由美国胃肠病学会(ACG)支持、美国国立卫生研究院(NIH)赞助
专家组成员:endoscopy, surgery, pathology, epidemiology, and/or molecular aspects of
serrated lesions and/or serrated polyposis.
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经与会专家组讨论15年MEDLIAN文献,形成共识报告,目的是总结锯齿状息肉病理、分子病理和内镜特征,提高这种疾病威胁的意识,描述内镜特征,强调该疾病精确探查和完全切除的重要性,提供有关该病切除后处理的推荐规范。
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Key conclusions and mendations of the consensus group
Pathology
1 Serrated lesions of the colorectum should be classified histologically as hyperplastic polyp (HP), sessile serrated adenoma/polyp(SSA/P) with or without cytologic dysplasia, or traditional serrated adenoma (TSA). Exceptions and subcategories are discussed in the text. Clinicians and pathologists within institutions should work collaboratively to achieve mon usage and understanding of terminology of serrated lesions.
2 SSA/P and TSA are pre-cancerous lesions. SSA/P is the principal precursor of hypermethylated colorectal cancers (cancers with the CpG Island Methylator Phenotype – CIMP). This pathway occurs primarily in the proximal colon.
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3 SSA/P is distinguished from HP pathologically by findings of crypt distortion, particularly in the crypt base, in SSA/P. We mend that a single unequivocal architecturally distorted, dilated, and/or horizontally branched crypt, particularly if it is associated with inverted maturation, is sufficient for a diagnosis of SSA/P. Most large serrated lesions in the proximal colon are SSA/Ps.
4 SSA/P with cytological dysplasia is a more advanced lesion in the progression to pared to SSA/P without cytological
dysplasia.
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序言(introduction)
锯齿状病变(serrated lesions)的真正发病率,尤其是结肠近段,可能高于先前的报道;相当数量的内镜医师漏掉了半数以上的锯齿状病变。
流行病学尸解研究显示25-50%的白种***有一个及以上锯齿状病变。内镜检出率很低。锯齿状病变最常见于乙状结肠和直肠,其分布依据组织学类型变化,70-95%的锯齿状病变为HPs,左半结肠为主;SSA/Ps占5-25%,右半结肠为主,TSA少于SSA/Ps,左半结肠常见。
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结直肠锯齿状病变是1/3结直肠癌的前驱病变(癌前病变)。
源于锯齿状病变的癌常发生于近端结肠。
结直肠锯齿状病变根据WHO标准病理学分三大类,即增生***肉(HPs)、广基型锯齿状