以溃疡性结肠炎为背景的管状静脉腺瘤(临床病例)

E. Semichev, E. Gereng, Т. N. Chekisheva, M. A. Kyazimova
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摘要

考虑到腺体上皮中存在鳞状化生灶,本文描述了一例发生管状静脉腺瘤并伴有中度上皮发育不良(高级别)的临床病例。文章中介绍的病理根据 ICD-O 编码为 8263/2。患者于 2020 年接受了初次结肠镜检查,被诊断为慢性回肠炎和结肠炎,炎症活动度为中度,部分区域炎症活动度较高,这是非特异性溃疡性结肠炎的最大特征。患者接受了消化科医生的治疗。2021 年 12 月,她接受了结肠镜检查和组织学取样。内镜结论:溃疡性结肠炎,全病变,恶化期。当将装置插入直肠 13 厘米处时,发现了一个肿瘤,粘膜苍白、发亮,当试图将装置穿过接触易损粘膜的狭窄处时,用器械触诊,形成的粘连物移位,进行了多碎片活检。在对直肠乙状结肠交界处的组织学制片进行研究时,考虑到腺体上皮存在鳞状化生灶,确定为中度上皮发育不良(高级别)的管状静脉腺瘤。根据文献资料,溃疡性结肠炎影响几乎整个结肠超过 10 年,结肠癌形成的风险会增加(10%),并且每年增加 2-5%。在溃疡性结肠炎病程超过 20 年的患者中,有 10%-20%存在恶性肿瘤的可能性。其他研究人员认为,在已发现的低度发育不良病例中,29%-54%会发展为高度发育不良和癌变。对患有这种病变的患者进行研究时,应使用高科技验证方法对大肠进行彻底的现代制备,并在对活检标本进行合格评估的情况下进行多段活检。
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Tubular-villous adenoma against the background of ulcerative colitis (clinical case)
A clinical case of the development of tubular-villous adenoma with moderate epithelial dysplasia (high grade) is described, taking into account the presence of foci of squamous metaplasia in the epithelium of the glands. The pathology presented in the article according to ICD-O has code 8263/2.Description of the clinical case. The patient had an initial colonoscopy in 2020 and was diagnosed with chronic ileitis and colitis with moderate and in some areas high inflammation activity, which is most characteristic of nonspecific ulcerative colitis. The patient was treated by a gastroenterologist. In December 2021, she had a follow-up colonoscopy with the histological material sampling. Endoscopic conclusion: ulcerative colitis, total lesion, exacerbation phase.Results and discussion. When the device was inserted into the rectum at a distance of 13 cm, a neoplasm was visualized, the mucosa was pale, shiny, when trying to pass the device through the narrowing of the contact-vulnerable mucosa, with instrumental palpation, the formation was displaced by a conglomerate, a polyfragmentary biopsy was taken. In the study of histological preparations of the recto-sigmoid junction, a tubular-villous adenoma with moderate epithelial dysplasia (high grade) is determined, taking into account the presence of foci of squamous metaplasia in the epithelium of the glands. According to the literature, with ulcerative colitis affecting almost the entire colon for more than 10 years, there is an increased risk of colon cancer formation (10 %), which increases by 2–5 % annually. The possibility of malignancy is present in 10–20 % of patients with ulcerative colitis for more than 20 years. Other researchers describe the identified low-grade dysplasia as progressing to high-grade dysplasia and carcinoma in 29–54 % of cases.Conclusions. The study of patients with this pathology should be carried out against the background of thorough preparation of the large intestine with modern preparations using high-tech verification methods and polyfragmental biopsy with a qualified assessment of biopsy specimens.
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