大肠癌及其癌前病变.ppt

大肠癌及其癌前病变Colorectal Carcinoma and Its Precursor Lesions;Precursor Lesions of the large intestine;精品资料; 你怎么称呼老师？ 如果老师最后没有总结一节课的重点的难点，你是否会认为老师的教学方法需要改进？ 你所经历的课堂，是讲座式还是讨论式？ 教师的教鞭 “不怕太阳晒，也不怕那风雨狂，只怕先生骂我笨，没有学问无颜见爹娘 ……” “太阳当空照，花儿对我笑，小鸟说早早早……”;polyps ; 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; 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 ;Villous adenoma typicallly sessile fine fingerlets or villi that project perpendicularly from the muscularis mucosae to the outer tip of the adenoma;Tubulovillous adenoma Mixture of tubular and villous structure Ratio between 1:4~4:1;*;Serrated adenoma most commonly in the rectosigmoid colon Saw-tooth configuration dysplasia;Grade Depending on the degree of glandular or villous complexity, extent of nuclear straitification, severity of abnormal nuclear morphology;Familial adenomatous polyposis (FAP);Diagnostic criteria ≥100 adenoma Germline mutation of APC gene Family history of FAP and epidermoid cysts or osteomas or desmoid tumor;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;*;Inactivation of the other APC gene.β-catenin translocates to the nucleus;Non-neoplastic polyps;Non-neoplastic polyps are not considered precancerous unless they occur in polyposis syndrome;Hyperplastic (metaplastic) polyps;Hyperplastic polyps;Diagnostic criteria At least 5 hyperplastic polyps proximal to the sigmoid colon of which two are greater than 1cm in diameter Any number of hyperplastic polyp