Barrett食道与Barrett食管腺癌的临床病理诊断及发生关系的研究(1)
[摘要]目的探讨Barrett食管与Barrett食管腺癌的临床病理诊断及发生关系。方法 收集我科Barrett食管31例，其中6例具有腺癌结构，根据纤维胃镜所见，组织学观察和粘液组化分析，结合临床资料进行分析。结果 31例Barrett食管AB-PAS、HID-AB粘液染色均呈阳性；6例食道腺癌中，5例癌旁有肠上皮化生，均为不完全型，肠型吸收上皮及贲门柱状上皮AB-PAS染色以红色和蓝色为主，HID-AB染色以黑色和蓝色为主。结论 本文认为慢性胃液返流使食管粘膜鳞状上皮长期受损，修复中，部分病例食管鳞状上皮由邻接耐酸性较强、增殖更活跃的胃贲门上皮向上异位生长而代替形成Barrett食管，长期非特异性刺激附加致癌因素，修复增生转变为渐近性异型增生，最终导致癌变。
[关键词]Barrett食管;Barrett食管腺癌； 粘液组化
[中图分类号] R73[文献标识码]A [文章编号] 1005-0515(2010)-10-001-01
, 百拇医药
Research of Barrett esophagus and barrett esophageal adenocarcinoma in
Clinical and Pathological Diagnosis and Correlation occurred
Luo xianyong,Zhang jiankun,Pang guolian,Li shengqiang
(Department of Pathology, First People's Hospital of Qujing city, Qujing city 655000)
[Abstract]ObjectiveTo investigate the clinical and pathological diagnosis and relationship occurred in Barrett esophagus and Barrett esophageal adenocarcinoma.Methods The samples of 31 patients for Barrett esophagus were collected from Department of Pathology of First People's Hospital of Qujing city.There are 6 patients with the structure of adenocarcinoma,Seen in the fiber gastroscope, Analyzed in histological, in mucus staining and clinical data.Results AB-PAS/HID-AB mucus were both positive in Barrett esophagus for 31 patients;In 6 cases of esophageal adenocarcinoma,there are 5 cases with intestinal metaplasia in adjacent,Are Incomplete type, absorption of AB-PAS staining mainly are red and blue,HID-AB staining mainly are black and blue on epithelial intestinal absorption and cardiac columnar epithelium.ConclusionThis paper argues that chronic gastric reflux damaged in esophageal squamous epithelium of esophageal mucosa for the long-term, repair, In some cases, esophageal squamous epithelium are insteaded of ectopic gastric cardia epithelial growth upward of the adjacent strong acid, added more active, to led to the formation of Barrett esophagus,non-specific stimulation for long-term caused additional carcinogenic factors, repair hyperplasia changed Into progressive dysplasia,eventually lead to cancer.
, 百拇医药
[Keywords] Barrett esophagus; Barrett esophageal adenocarcinoma; Mucus staining
自1950年Barrett[1]首次报告柱状上皮覆盖的食管病变以来，其组织发生一直存在先天性或后天性来源之争，近年研究倾向于后天性，特别是与返流性食管炎有关[2，3]。部分学者曾强调Barrett食管(BE)是食管腺癌(BA)的癌前病变[3]但尚缺乏详细分析及结论。本文通过对纤维胃镜、病理形态、粘液组织化学染色观察进行综合分析，探讨BE和BA的诊断标准及两者之间的发生关系，为BE和BA的诊断和发生关系提供依据。
1 材料和方法
1.1 标本收集及取材 材料为我科1994年至2009年15年间纤维胃镜活检(取材部位均在距门齿36-40cm处)及外科手术标本共31例，其中6例伴有BA。手术标本沿纵轴切取包括癌组织全长及至少1cm癌旁粘膜，组织块长4-5cm，厚0.3cm，。
, 百拇医药
1.2 固定及染色10%福尔马林固定，常规石蜡色埋，切片原3-4cm，HE染色、BA标本也作AB-PAS及HID-AB(高铁双胺)粘液组化染色。
2 结果
2.1 年龄和性别男性19例，女性12例，年龄24-75岁，平均年龄51岁。
2.2 临床表现所有患者均有不同程度的临床症状，主要表现为上腹及胸骨下疼痛，反酸，夜间伴发性呛咳，吞咽困难等。
2.3 纤维胃镜观察其主要表现为食管粘膜粗糙、糜烂、呈颗粒样增生，粘膜充血或苍白，合并BA的患者出现溃疡、息肉斑块状隆起。
2.4 病理组织学观察所有标本均在食管、胃粘膜交界线2cm以上或距门齿36-40cm病变处取材。病变部位均见鳞状上皮被柱状上皮取代现象，BE上皮多呈细乳头状，也有部分病列乳头较低、较粗。所有病例均有轻重不等的食管炎，12例有不同程度的腺上皮异型增生，其中5例可见Ⅱ-Ⅲ级异型增生乃至以癌过渡，部分病例可见柱状上皮前端突破粘膜表面而代替鳞状上皮，炎症轻者，腺上皮大多呈单纯性增生或Ⅰ级异型增生，炎症重者，主呈Ⅱ-Ⅲ级异型增生。
2.5 BA及癌旁柱状上皮粘液组化观察6例BA中5例癌旁有肠上皮化生，均为不完全型，AB-PAS染色均呈红色(中性粘液)或蓝色(酸性粘液)，异型增生上皮着色减弱或消失。HID-AB染色，肠型上皮均呈黑色为主，说明分泌硫酸粘液，部分病例兼黑色与蓝色，说明同时分泌唾液酸粘液。BE上皮表现分泌中性粘液或因异型增生而粘液分泌减少或消失，BA成份也表现分泌中性粘液，AB-PAS、HID-AB均呈阳性，由此可见BE上皮来源的腺癌粘液组化特点与癌旁上皮表现相同，二者分泌同一性质粘液。, 百拇医药
[关键词]Barrett食管;Barrett食管腺癌； 粘液组化
[中图分类号] R73[文献标识码]A [文章编号] 1005-0515(2010)-10-001-01
, 百拇医药
Research of Barrett esophagus and barrett esophageal adenocarcinoma in
Clinical and Pathological Diagnosis and Correlation occurred
Luo xianyong,Zhang jiankun,Pang guolian,Li shengqiang
(Department of Pathology, First People's Hospital of Qujing city, Qujing city 655000)
[Abstract]ObjectiveTo investigate the clinical and pathological diagnosis and relationship occurred in Barrett esophagus and Barrett esophageal adenocarcinoma.Methods The samples of 31 patients for Barrett esophagus were collected from Department of Pathology of First People's Hospital of Qujing city.There are 6 patients with the structure of adenocarcinoma,Seen in the fiber gastroscope, Analyzed in histological, in mucus staining and clinical data.Results AB-PAS/HID-AB mucus were both positive in Barrett esophagus for 31 patients;In 6 cases of esophageal adenocarcinoma,there are 5 cases with intestinal metaplasia in adjacent,Are Incomplete type, absorption of AB-PAS staining mainly are red and blue,HID-AB staining mainly are black and blue on epithelial intestinal absorption and cardiac columnar epithelium.ConclusionThis paper argues that chronic gastric reflux damaged in esophageal squamous epithelium of esophageal mucosa for the long-term, repair, In some cases, esophageal squamous epithelium are insteaded of ectopic gastric cardia epithelial growth upward of the adjacent strong acid, added more active, to led to the formation of Barrett esophagus,non-specific stimulation for long-term caused additional carcinogenic factors, repair hyperplasia changed Into progressive dysplasia,eventually lead to cancer.
, 百拇医药
[Keywords] Barrett esophagus; Barrett esophageal adenocarcinoma; Mucus staining
自1950年Barrett[1]首次报告柱状上皮覆盖的食管病变以来，其组织发生一直存在先天性或后天性来源之争，近年研究倾向于后天性，特别是与返流性食管炎有关[2，3]。部分学者曾强调Barrett食管(BE)是食管腺癌(BA)的癌前病变[3]但尚缺乏详细分析及结论。本文通过对纤维胃镜、病理形态、粘液组织化学染色观察进行综合分析，探讨BE和BA的诊断标准及两者之间的发生关系，为BE和BA的诊断和发生关系提供依据。
1 材料和方法
1.1 标本收集及取材 材料为我科1994年至2009年15年间纤维胃镜活检(取材部位均在距门齿36-40cm处)及外科手术标本共31例，其中6例伴有BA。手术标本沿纵轴切取包括癌组织全长及至少1cm癌旁粘膜，组织块长4-5cm，厚0.3cm，。
, 百拇医药
1.2 固定及染色10%福尔马林固定，常规石蜡色埋，切片原3-4cm，HE染色、BA标本也作AB-PAS及HID-AB(高铁双胺)粘液组化染色。
2 结果
2.1 年龄和性别男性19例，女性12例，年龄24-75岁，平均年龄51岁。
2.2 临床表现所有患者均有不同程度的临床症状，主要表现为上腹及胸骨下疼痛，反酸，夜间伴发性呛咳，吞咽困难等。
2.3 纤维胃镜观察其主要表现为食管粘膜粗糙、糜烂、呈颗粒样增生，粘膜充血或苍白，合并BA的患者出现溃疡、息肉斑块状隆起。
2.4 病理组织学观察所有标本均在食管、胃粘膜交界线2cm以上或距门齿36-40cm病变处取材。病变部位均见鳞状上皮被柱状上皮取代现象，BE上皮多呈细乳头状，也有部分病列乳头较低、较粗。所有病例均有轻重不等的食管炎，12例有不同程度的腺上皮异型增生，其中5例可见Ⅱ-Ⅲ级异型增生乃至以癌过渡，部分病例可见柱状上皮前端突破粘膜表面而代替鳞状上皮，炎症轻者，腺上皮大多呈单纯性增生或Ⅰ级异型增生，炎症重者，主呈Ⅱ-Ⅲ级异型增生。
2.5 BA及癌旁柱状上皮粘液组化观察6例BA中5例癌旁有肠上皮化生，均为不完全型，AB-PAS染色均呈红色(中性粘液)或蓝色(酸性粘液)，异型增生上皮着色减弱或消失。HID-AB染色，肠型上皮均呈黑色为主，说明分泌硫酸粘液，部分病例兼黑色与蓝色，说明同时分泌唾液酸粘液。BE上皮表现分泌中性粘液或因异型增生而粘液分泌减少或消失，BA成份也表现分泌中性粘液，AB-PAS、HID-AB均呈阳性，由此可见BE上皮来源的腺癌粘液组化特点与癌旁上皮表现相同，二者分泌同一性质粘液。, 百拇医药