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目的探讨大肠小扁平腺瘤的形态学特征及p53、p21、雌激素受体(estrogen receptor, ER)、孕激素受体(progesterone receptor,PR)表达的生物学意义。方法用Olympus CF240型电子结肠镜及Olympus BX41光学显微镜观察50例大肠小扁平腺瘤形态学特征。用免疫组化二步法检测50 例小扁平腺瘤及其腺瘤旁组织、26例大肠癌及其癌旁组织、15例正常人大肠黏膜中p53、p21、ER、PR 的表达情况。结果小扁平腺瘤发生于大肠任何部位,其发病率依次以横结肠、乙状结肠、直肠为多见;肠镜下见病灶呈圆形或椭圆形,扁平状,基底宽,体积≤1cm。光镜下小扁平腺瘤呈管状腺瘤样图像,上皮具有不同程度的异型增生。小扁平腺瘤中p53、p21、ER、PR的表达率分别为58%(29/50)、56%(28/50)、12%(6/50)、10%(5/50)。随着小扁平腺瘤异型增生程度的增高,p53、p21、ER、PR的表达率也逐渐升高(P<0.05)。大肠癌中的表达最高(P<0.05)。结论大肠小扁平腺瘤有其独特的形态学特征,p53、p21、ER、PR的表达与大肠小扁平腺瘤的发生发展有密切关系。
Objective To investigate the morphological characteristics of small flat adenoma and the biological significance of the expression of p53, p21, estrogen receptor (ER) and progesterone receptor (PR). Methods The morphological characteristics of 50 cases of small flat adenoma were observed with Olympus CF240 electron microscope and Olympus BX41 light microscope. The expression of p53, p21, ER and PR in colorectal mucosa of 50 cases of small flat adenoma and its adjacent tissues, 26 cases of colorectal cancer and its adjacent tissues and 15 cases of normal human was detected by immunohistochemical two-step method. Results small flat adenoma occurred in any part of the large intestine, the incidence followed by transverse colon, sigmoid colon, rectum is more common; colonoscopy showed lesions were round or oval, flat, wide basal, volume ≤ 1cm. Small flat adenoma under light microscope was tubular adenoma-like images, the epithelium has varying degrees of dysplasia. The expression rates of p53, p21, ER and PR in small flat adenoma were 58% (29/50), 56% (28/50), 12% (6/50) and 10% (5/50) respectively. With the increase of dysplasia of small flat adenoma, the expression rates of p53, p21, ER and PR also gradually increased (P <0.05). Colorectal cancer had the highest expression (P <0.05). Conclusions Small flat adenoma of large intestine has its unique morphological characteristics. The expression of p53, p21, ER and PR is closely related to the occurrence and development of small flat adenoma.