LARGE BOWEL ADENOMAS CONTAINING CARCINOMA - A DIAGNOSTIC AND THERAPEUTIC APPROACH
LARGE BOWEL ADENOMAS CONTAINING CARCINOMA - A DIAGNOSTIC AND THERAPEUTIC APPROACH
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DOI：
10.1007/bf01649684
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发表时间：
1988-01-01
影响因子：
2.8
通讯作者：
CAVALLERO, M
中科院分区：
文献类型：
--
作者：
ROSSINI, FP;FERRARI, A;CAVALLERO, M
大肠腺瘤包含浸润性癌形成了大多数早期结直肠癌。结论早期结直肠癌的组织学诊断取决于两个条件：第一，必须检查整个病变，第二，切除边缘必须毗邻健康组织。某些组织病理学特征的存在使得有可能区分具有淋巴结转移的高风险和低风险的病例。本文报告了66例含有浸润性癌的腺瘤。它们占同期结肠镜息肉切除术切除的2，095个腺瘤的3.15%。5例失访。49例被认为淋巴结转移风险较低的患者仅接受内镜息肉切除术治疗，并定期进行严格的随访，包括CEA评估、超声检查和全结肠镜检查。在平均3年的随访检查中，没有发现远处转移。其中2例发生异时性结直肠癌，15例（30.5%）发生异时性腺瘤。两个低风险的病人没有发现肿瘤的手术标本进行了重大手术切除。10例高危病例已被转诊接受大手术，其中4例（40%）发现淋巴结转移。在所有4例淋巴结受累的高危患者中均发现此结果，强调了对淋巴结和静脉浸润进行仔细组织学检查的必要性。
Adenomas containing invasive carcinoma of the large bowel form the majority of early colorectal cancers. Conclusive histological diagnosis of early colorectal cancer depends on two conditions; first, the whole lesion must be examined and second the resection margin must border on healthy tissue. The presence of certain histopathological features makes it possible to distinguish between cases with high and low risk of having lymph node metastases. Sixty-six adenomas containing invasive carcinoma are reported. They comprised 3.15% of 2,095 adenomas removed by colonoscopic polypectomy during the same period. Five cases were lost to follow-up. Forty-nine patients considered to be at low risk of having lymph node metastases have been treated by endoscopic polypectomy only with a rigorous follow-up regime including CEA estimation, ultrasonography and total colonoscopy at regular intervals. In none have distant metastases been found on follow-up examinations at a mean duration of 3 years. Two of these cases have developed a metachronous colorectal carcinoma and 15 (30.5%) have metachronous adenomas. Two low risk patients with no tumour found in the operative specimen have undergone major surgical resection. Ten high risk cases have been referred for major surgery and lymph node metastases have been found in four (40%). The need for careful histological examination for lymphatic and veinous invasion is stressed by the presence of this finding in all four high risk patients with involved lymph nodes.