摘要目的：探讨在结直肠黏膜活检标本中可提示已经存在黏膜下浸润癌的病理形态学特征。方法选取2006至2012年间有手术标本对照的结直肠黏膜活检标本432例，其中手术标本诊断为浸润性腺癌366例，诊断为高级别上皮内瘤变66例。观察两组活检标本的HE染色病理形态学特点，并进行统计学分析。结果在浸润性腺癌组中出现腺体的筛状结构、锐角形腺体以及腺性结构消失呈弥漫生长的比例分别为61畅2％（224／366）、33畅8％（124／366）、7畅4％（27／366）。在高级别上皮内瘤变组出现筛状结构比例为6畅0％（4／66），而锐角形腺体及弥漫生长均无一例出现。此3个指标在两组病例差异均有统计学意义（ P＜0畅01）。两组病例出现腺体分支出芽的比例分别为89畅9％（329／366）、66畅7％（44／66），差异无统计学意义。两组中细胞异型程度达到Ⅲ级的比例差异无统计学意义。85畅5％（313／366）浸润性腺癌存在纤维组织增生，而高级别上皮内瘤变组均无纤维组织增生，差异有统计学意义（ P＜0畅01）。仅在少数浸润性腺癌的活检标本中可见到瘤性腺体同大的淋巴管、脂肪组织、神经节细胞密切接触。结论结直肠活检标本中肿瘤性病变出现筛状结构、锐角形腺体、腺性结构消失呈弥漫浸润、间质纤维化及瘤性腺体同厚壁血管密切接触高度提示已存在黏膜下浸润癌。

abstractsObjective To observe and summarize the morphologic features that may suggest submucosal invasive adenocarcinoma in colorectal mucosa biopsy specimens .Methods The study cohort included 432 colorectal biopsy specimens were obtained from 2006 to 2012.All the cases had radical surgery.Basing on the pathologic diagnoses , the cases were divided into 366 invasive adenocarcinoma (IAC) and 66 high-grade intraepithelial neoplasms (HGIN).These two groups were compared.Results In the IAC group, the percentage of tumor forming cribriform structures , acute angle-shaped glands, diffuse carcinoma cell proliferation was 61.2%(224/366), 33.8%(124/366) and 7.4%(27/366), respectively.In the HGIN group, cribriform gland structures appeared in 6.0%(4/66)of the cases, while no acute angle-shaped gland or diffuse carcinoma cell proliferation was detected.The difference of these three characteristics in the two group was statistically significant ( all P<0.01 ).Glandular branching was detected in 89.9%(329/366) of IAC cases and 66.7%(44/66)of HGIN cases;this difference was not significant.There was no difference in cellular atypia between the two groups.Interstitial fibrosis was detected more frequently in the IAC group (85.5%,313/366 in IAC versus 0 in HGIN, P<0.01).In biopsy specimens of IAC , a few cases showed neoplastic glands in close contact with large lymphatics , adipose tissue , and ganglion.Conclusions In colorectal biopsy specimen , the five features that suggest submucosal invasion of the neoplastic glands including the formation of cribriform structure , angular gland , diffuse carcinoma cells , interstitial fibrosis and neoplastic glands in close contact with the thick-walled vessels.