大肠癌及其癌前病变【病理系】.pptVIP

医学资料 大肠癌及其癌前病变Colorectal Carcinoma and Its Precursor Lesions 北大医学部病理系 2004.7 Precursor Lesions of the large intestine Adenoma: the main precursor lesions Non-neoplastic polyps occur in polyposis syndrome Inflammatory bowel diseases polyps Polyp is a clinical term or gross description of any circumscribed tumor or growth that projects above the surrounding mucosa Adenoma Definition An intraepithelial neoplasia, histologically characterized by hypercellularity with enlarged, hyperchromatic nuclei, varying degrees of nuclear stratification and loss of polarity Adenoma Incidence Age related: 40y 20%-30% 40y 40%-50% Familial predisposition: a four-fold greater risk among first degree relatives Location: 66%-77% in rectosigmoid Correlations with CRC 80% sporadic CRC arise from adenomas Four-fold greater risk for CRC Adenoma Macroscopy Elevated Flat Depressed Adenoma Histopathology Tubular Villous Tubulovillous Serrated Others Tubular adenoma Usually protruding, spherical and pedunculated or non-pedunculated Tubular adenoma adenomatous epithelium showing gland or tubule formation Tubulovillous adenoma Mixture of tubular and villous structure Ratio between 1:4~4:1 Adenoma Grade Depending on the degree of glandular or villous complexity, extent of nuclear straitification, severity of abnormal nuclear morphology Familial adenomatous polyposis (FAP) A autosomal dominant disorder Relatively rare ( 1 in 8000 individuals ) Numerous adenomatous colorectal polyps Have an intrinsic tendency to progress to adenocarcinoma Account for 1% of CRC Caused by a germline mutation in Adenomatous Polyposis Coli (APC) gene on 5q21-22 Serve as the model for the APC/β-catenin pathway of carcinogenesis in the large bowel Non-neoplastic polyps Represent about 90% of all epithelial polyps in the large intestine Found in more than half of all persons 60y Types Most are hyperplastic (metaplastic) polyps Juvenile polyps Peutz-jegh