摘要目的 研究结直肠腺癌中含有的浸润性微乳头状癌(IMPC)成分与脉管侵犯及淋巴结转移的关系.方法 应用HE染色及免疫组织化学SP法染色,观察131例含有IMPC成分的结直肠腺癌的主要病理学特征、IMPC在肿瘤中所占的比率、脉管侵犯及淋巴结转移的情况,并与296例不含IMPC成分的普通型结直肠腺癌进行比较.结果 含有IMPC成分组的肿瘤最大径明显小于普通型组,肿瘤分化程度、淋巴结转移率、转移淋巴结的平均个数、检出脉管内癌栓的病例数均明显高于普通型组,两组差异具有统计学意义(P=0.000).手术时的远处转移率,含有IMPC成分组(14.5％)高于普通型组(10.8％),但两组差异无统计学意义(P =0.278).含有IMPC成分组中,随着IMPC成分在整个肿瘤中所占比率的增加,淋巴结转移率呈现明显递增趋势；普通型组、IMPC成分≤10％组、IMPC成分＞10％组的淋巴结转移率分别为53.0％ (157/296)、67.7％(42/62)和85.5％ (59/69),三组间的差异具有统计学意义(P =0.000).结论 与普通型腺癌相比,结直肠IMPC具有高脉管侵犯率、高淋巴结转移率及远处转移率.肿瘤中IMPC所占的比率与淋巴结转移率高度相关.结直肠腺癌中含有的IMPC成分及肿瘤分化程度是肠系膜淋巴结转移的预测因素.

abstractsObjective To investigate the relationship between colorectal adenocarcinoma with invasive micropapillary carcinoma (IMPC) component,lymphovascular invasion,and lymph node metastasis.Methods One hundred and thirty one cases of colorectal adenocarcinoma with invasive micropapillary carcinoma component were evaluated by H&E and immunohistochemical staining.The main pathological features,percentage of IMPC component,lymphovascular invasion,and lymph node metastasis were assessed and compared to 296 cases of conventional colorectal adenocarcinoma.Results The maximum diameter of the tumors of the IMPC group was significantly lower than the conventional group.The degree of differentiation,the lymph node metastatic rate,the average number of metastatic lymph nodes,the number of cases with lymphovascular tumor emboli were significantly higher in the IMPC group (P =0.000).The rate of distant metastasis at operation was higher in the IMPC group(14.5％)compared to the conventional group(10.8％) even though statistical significance was not achieved (P =0.278).In IMPC group,as the IMPC component increased,the rate of lymph node metastasis also showed an increasing trend.The rate of lymph node metastasis were 53.0％ (157/296),67.7％ (42/62) and 85.5％ (59/69) " respectively" for conventional adenocarcinoma,adenocarcinoma with ≤ 10％ IMPC component and adenocarcinoma with ＞10％ IMPC component; the difference was statistically significant (P =0.000).Conclusions Compared to conventional colorectal adenocarcinomas,the colorectal carcinomas with IMPC component show a significantly higher rate of lymphovascular invasion,lymph node metastasis and distant metastasis.The percentage of IMPC component in colorectal adenocarcinoma is significantly correlated to the rate of lymph node metastasis.Therefore,presence of IMPC component and degree of tumor differentiation are predicting factors of lymph node metastasis.