目的:Cronkhite-Canada综合征(CCS)是一种罕见的非遗传性胃肠道错构瘤性息肉综合征,具有很高的结直肠癌发生风险。从宏观上区分腺瘤与非肿瘤性结直肠息肉具有挑战性。本研究旨在探讨CCS中结直肠息肉不同组织病理学模式的内镜特征。
方法:在结肠镜检查期间,对23例CCS患者的67个病变进行了前瞻性活检或切除,以进行组织病理学分析。进行了Fisher精确检验和多变量逻辑分析,以揭示具有低度异型增生(LGD)和腺瘤的CCS息肉的预测性内镜特征。
结果:有7个(10.4%)腺瘤,20(29.9%)CCS-LGD,40例(59.7%)非肿瘤性CCS息肉。无腺瘤息肉较大(>20mm),30.0%的CCS-LGD息肉,和2.5%的非肿瘤性CCS息肉(P<0.001)。对于71.4%的腺瘤,息肉的颜色发白,10.0%的CCS-LGD息肉,15.0%的非肿瘤性CCS息肉(P=0.004)。在42.9%的腺瘤中检测到了息肉,45.0%的CCS-LGD息肉,非肿瘤性CCS息肉占5.0%(P<0.001)。工藤分类中IV型和VI型的比例为42.9%,95.0%,腺瘤中的35.0%,CCS-LGD,和非肿瘤性CCS息肉,分别(P=0.002)。对于71.4%的腺瘤,内镜下活动缓解,5.0%的CCS-LGD息肉,非肿瘤性CCS息肉占10.0%(P<0.001)。
结论:内窥镜特征,包括尺寸,颜色,同理,工藤的息肉坑模式分类,和内窥镜活动,帮助确定CCS中结直肠息肉的组织病理学模式。
OBJECTIVE: Cronkhite-Canada syndrome (CCS) is a rare nonhereditary gastrointestinal hamartomatous polyposis syndrome with a high risk of colorectal cancerogenesis. It is challenging to discriminate adenomas from nonneoplastic colorectal polyps macroscopically. This study aimed to explore the endoscopic features of different histopathological patterns of colorectal polyps in CCS.
METHODS: Sixty-seven lesions from 23 CCS patients were prospectively biopsied or resected during the colonoscopic examination for histopathological analysis. The Fisher\'s exact test and multivariate logistical analysis were conducted to reveal the predictive endoscopic features of CCS polyps with low-grade dysplasia (LGD) and adenomas.
RESULTS: There were seven (10.4%) adenomas, 20 (29.9%) CCS-LGD, and 40 (59.7%) nonneoplastic CCS polyps. Polyps were large (>20 mm) in none of the adenomas, 30.0% of CCS-LGD polyps, and 2.5% of nonneoplastic CCS polyps (P < 0.001). The color of the polyps was whitish for 71.4% of adenomas, 10.0% of CCS-LGD polyps, and 15.0% of nonneoplastic CCS polyps (P = 0.004). Pedunculated polyps were detected in 42.9% of adenomas, 45.0% of CCS-LGD polyps, and 5.0% of nonneoplastic CCS polyps (P < 0.001). The proportions of types IV and VI in the Kudo classification were 42.9%, 95.0%, and 35.0% in adenomatous, CCS-LGD, and nonneoplastic CCS polyps, respectively (P = 0.002). The endoscopic activity was in remission for 71.4% of adenomas, 5.0% of CCS-LGD polyps, and 10.0% of nonneoplastic CCS polyps (P < 0.001).
CONCLUSIONS: Endoscopic features, including the size, color, sessility, Kudo\'s pit pattern classification of polyps, and endoscopic activity, help identify the histopathological patterns of colorectal polyps in CCS.