结直肠锯齿状息肉.pptxVIP

结直肠锯齿状息肉结直肠锯齿状息肉锯齿状息肉(serrated polyps)一组异质性病变，具有不同的大体、组织学和分子遗传学特征；通过serrated pathway发展为癌上皮成分以锯齿状(燕尾状或星状)结构为特征WHO分类：增生性息肉(hyperplastic polyps,HPs) 广基锯齿状腺瘤/息肉(sessile serrated adenoma/polyp,SSA/P)with or without cytological dysplasia 传统型锯齿状腺瘤(traditional serrated adenoma,TSA)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 锯齿状病变专家共识推荐规范Pathology1、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). 2、SSA/P and TSA are pre-cancerous lesions.3、SSA/P is distinguished from HP pathologically by findings of crypt distortion, particularly in the crypt base, in SSA/P. SSA/p。We recommend that a single unequivocal architecturally distorted, dilated, and/or horizontally branched crypt, 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 cancer compared to SSA/P without cytological dysplasia.结直肠锯齿状息肉锯齿状病变(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。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，即增生性息肉(HPs)、广基型锯齿状腺瘤/息肉(SSA/P)伴或不伴细胞异型增生及传统型锯齿状腺瘤(TSA)。近年来对SSA/P的诊断阈值趋向降低，认为在MVHP背景中即使是有1个确定的结构扭曲、扩张和/或水平分支的SSA/P样隐窝，也可以诊断SSA/P(Am J Gastroenterol.2012, 107(9): 1315–1330)。结直肠锯齿状息肉SSA/P和TSA是恶性前病变，而SSA/P是结直肠癌主要的锯齿状前驱病变。结直肠锯齿状病变的内镜表现独特，一般不如经典腺瘤性息肉易发现。近端至乙状结肠病变或所有直乙状结肠病变＞5mm，应完全切除。锯齿状息肉切除后随访监测，减少间隔性结直肠癌。目录一、增生性息肉(HPs)二、广基锯齿状腺瘤/息肉(SSA/P)三、传统锯齿状腺瘤(TSA)临床表现增生性息肉(HPs)结肠远端（左半结肠）最常见，占锯齿状息肉的75%，可以单发或多发，常发生于直肠乙状结肠。为广基病变，通常＜0.5cm,罕见超过1cm内镜下珠状晶莹透明，扁平状组织病理学增生性息肉(HPs)三种类型具有分布和分子学的差异可分为3中类型，即微泡型、富于杯状细胞型及黏液减少型，这些亚型无临床意义，常规诊断不要求细分。GCHP总是左半结肠，而MVHP左半最常见，但全结肠均可见结直肠锯齿状息肉细胞学“成熟”，隐窝拉长伴程度不等的锯齿状隐窝笔直拉长，增生区位于下三分之一