肿瘤
词汇介绍
拓展阅读
解析
Dysplasia 英 /dɪs'pleɪzɪə/
释 义 n. 发育不良;发育异常;异常结构;异型增生;不典型增生
例 句 Objective: To investigate the relationship between gonad dysplasia and abnormal chromosome karyotypes. 研究目的:研究性腺发育异常与染色体异常的相关性。
概述
概述
异型增生,又称为非典型增生或不典型增生,有的称之为间变。异型增生是一种以细胞学和机构异常为特征的癌前病变。细胞学异常包括细胞核增大、不规则、核仁明显、核浆比例增大、核分裂象增多;结构异常包括细胞排列紊乱、极向消失。依据细胞学和结构异常的程度通常可分为轻度、中度和重度异型增生。
胃粘膜上皮异型增生
以胃为例,胃黏膜上皮异型增生和腺瘤由异型增生上皮构成。有学者提出,当异型增生上皮形成扁平病变,应用术语胃上皮异型增生(gastricepithelial dysplasia);当异型增生上皮形成隆起性病变则称之为“腺瘤”;内镜下病变与周围正常胃黏膜无明显区别,组织学表现为异型增生上皮,也应用术语胃上皮异型增生。胃粘膜上皮异型增生主要发生在肠化的基础上,也有一部分发生于胃小凹上皮等处。按照异型增生分化程度和范围分为轻、中、重三级,即轻度是指炎症性及再生性良性异型增生病变;中度是指异型化较为明显,接近胃癌的“临界性病变”;重度是指异型化更为明显,形态上难以和分化型癌相区别的异型增生。但良性的轻度异型改变与临界性异型增生,以及恶性异型病变之间常是一种逐渐移行、转化的过程,有时难以明确划分。近年来的研究对异型增生进行了进一步分类,按照组织来源可分为:腺瘤型异型增生;隐窝型异型增生;再生型异型增生。异型增生是一动态过程,可以由轻度向重度发展,但也可以保持不变或逆转,而重度异型增生则不易逆转,可以发展成胃癌。
更名
也有学者认为,广义的“不典型增生”就是上皮内瘤变;狭义来讲,不典型增生不完全等同于上皮内瘤变,因为细胞学上的不典型可以是反应性或修复性改变,也可以是肿瘤性改变。“异型增生”可以看做是上皮内瘤变的同一词,但是异型增生侧重于形态学改变,上皮内瘤变更强调肿瘤演进的过程。上皮内瘤变的范围比异型增生更广泛。WHO早在2000年出版的《国际肿瘤组织学分类》中明确对包括胃、结直肠在内,还有子宫颈、阴道、泌尿道、前列腺、乳腺等器官中肿瘤统一采用“上皮内瘤变”取代原来所用“异型增生”的名词。直到2006年WHO才正式提议用上皮内瘤变替代异性增生,并将上皮内瘤变分为2级,即为低级别上皮内瘤变和高级别上皮内瘤变,低级别上皮内瘤变相当于轻度、中度异性增生;高级别上皮内瘤变相当于重度异型增生或原位癌。
上皮内瘤变与异型增生涵义相同
在结直肠肿瘤中主要分为二级,即低级别上皮内瘤变和高级别上皮内瘤变。原来的轻度和中度异型增生归属低级别上皮内瘤变,重度异型增生则属高级别上皮内瘤变。高级别上皮内瘤变与重度异型增生、原位癌、局灶癌、黏膜内癌、还有其他癌疑、癌变趋势等等都是一回事,就是高级别上皮内瘤变。对于上皮内瘤变的治疗建议是:低级别上皮内瘤变应该进行随访,必要时可以进行内镜下切除;高级别上皮内瘤变应结合胃镜所见确定内镜下治疗或手术治疗。
接受监测的炎症性肠病患者中不稳定发育与晚期肿瘤的相关性
发表时间:2019-08-12
影响指数:8.0
作者: Remi Mahmoud
期刊:Clin. Gastroenterol. Hepatol
We conducted a retrospective cohort analysis of patients with IBD undergoing colonoscopic surveillance between January 2001-December 2017 at a tertiary IBD referral center (The Mount Sinai Hospital (MSH), New York, NY, United States of America). Eligible patients were identified as described previously. Inclusion criteria were: an endoscopically and histologically confirmed diagnosis of IBD (Crohn’s disease [CD], ulcerative colitis [UC] or IBD-unclassified [IBD-U]); at least left-sided colonic involvement (UC patients, Montreal classification E2 or E3) or >30% involvement of colonic mucosa (CD, IBD-U); disease duration of > 8 years, or any disease extent or duration in patients with concomitant PSC; an “index” surveillance colonoscopy (defined below) that was followed at least 3 months later by a procedure that allowed for colonic histologic assessment (i.e. at least one subsequent surveillance colonoscopy or colectomy specimen, or any type of procedure yielding a diagnosis of IND or CRN) and; histology analyzed by specialized IBD pathologists at MSH. Patients were excluded if ACRN or colectomy occurred prior to or within 3 months of the index colonoscopy. Patients with a history of IND or LGD prior to the index colonoscopy (henceforth referred to as “prior dysplasia”) were not excluded.
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