结肠腺瘤性息肉伴黏膜下淋巴腺复合体

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  淋巴腺复合体(lymphoglandular complex,LGC)是指紧邻黏膜肌层或黏膜下层的淋巴结内含有肠黏膜。少见情况下,结直肠腺瘤会包含有黏膜下LGC,似浸润性腺癌伴有黏膜下淋巴聚集,成为诊断陷阱。本研究旨在明确黏膜下LGC和真性浸润特定的组织学特征。我们选用7例腺瘤(6例为管状/管状绒毛状腺瘤,其中4例伴有高级别上皮内瘤变,1例伴有灶性黏膜内腺癌,以及1例无蒂锯齿状腺瘤),其中右侧5例,左侧2例。7例腺癌,其中右侧3例,左侧2例,直肠/直肠乙状结肠2例。腺瘤的黏膜下LGC通常位于固有层,其LGC与表面腺瘤具有连续性,腺体呈圆形且包含在淋巴组织内,缺乏“假浸润”的主要特征;其中1例表现为伴有黏膜肌层疝样突出。腺癌至少具有以下特征之一:出现单个细胞/小团簇细胞浸润(n=5),腺体发育不良、融合和不规则(n=2),实性肿瘤细胞巢形成(n=1),促结缔组织增生性反应(n=5)、管腔内坏死(n=3)或淋巴血管浸润(n=1)。相比之下,腺瘤不具有这些特征。腺癌无疝样突出,但其浸润部分与黏膜面的腺癌有一定的延续性(n=5)。5例浸润性腺癌浸润到黏膜下层,超出淋巴浸润范围。综上所述,腺瘤伴LGC 比较罕见、临床病理学上是一种特殊的假浸润,与浸润性腺癌相似,其组织学特征是淋巴组织内腺体轮廓呈完整的钝圆形,无单细胞/小团簇细胞浸润,无腺体不良、融合和不规则腺体,无实性肿瘤细胞巢,无促结缔组织增生性反应和淋巴血管浸润。
Am J Surg Pathol 2018;42:1083-1089
美国外科病理学杂志中文版2019年第一期摘要NO.8
昝丽坤 翻译 郗彦凤 审校
  The American Journal of Surgical Pathology中文版声明:
  ©2018 Wolters Kluwer Health
  The material is published by Wolters Kluwer Health with the permission of American Journal of Surgical Pathology.No part of this publication may be reproduced in any form,stored in a retrieval system or transmitted in any form,by any means,without prior written permission from Wolters Kluwer Health.Opinions expressed by the authors and advertisers are not necessarily those of the American Journal of Surgical Pathology, its affiliates,or of the Publisher.The American Journal of Surgical Pathology,its affiliates,and the Publisher disclaim any liability to any party for the accuracy,completeness,efficacy,or availability of the material contained in this publication (including drug dosages) or for any damages arising out of the use or non-use of any of the material contained in this publication.
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