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首页> 外文期刊>American Journal of Surgical Pathology >Histologic and molecular analyses of colonic perineurial-like proliferations in serrated polyps: perineurial-like stromal proliferations are seen in sessile serrated adenomas.
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Histologic and molecular analyses of colonic perineurial-like proliferations in serrated polyps: perineurial-like stromal proliferations are seen in sessile serrated adenomas.

机译：锯齿状息肉中结肠会尿神经样增生的组织学和分子分析：无柄锯齿状腺瘤中可见会尿神经样间质增生。

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摘要

Colonic perineuriomas are recently described benign mucosal polyps that are composed of a bland spindle cell proliferation surrounding crypts that often demonstrate hyperplastic/serrated epithelial changes. However, the origin of this unique stromal proliferation is still unclear, and the association with serrated polyps, including sessile serrated adenomas, has not been fully described. We evaluated the pathologic and molecular features of colonic polyps associated with perineurial-like proliferations in 2 retrospective cohorts: (1) a series of 198 consecutive sessile serrated adenomas and (2) 20 colonic polyps diagnosed as a perineurioma irrespective of the presence of serrated colonic crypts. Thirteen of 198 (6.5%) sessile serrated adenomas demonstrated a perineurial-like stromal proliferation, with most (12 of 13, 92%) involving the right (9 cases) and transverse colon (3 cases). In all 13 cases, the perineurial-like proliferation surrounded serrated colonic crypts and typically involved only a small area of the sessile serrated adenoma (average 9% of polyp size; range, 2% to 19%). All 11 polyps evaluated for epithelial membrane antigen (EMA) expression demonstrated stromal EMA staining limited to the perineurial-like proliferation. Twelve of 13 (92%) sessile serrated adenomas with perineurial-like proliferations demonstrated a pV600E BRAF mutation. Of the 20 colonic polyps diagnosed as a perineurioma, 18 (90%) demonstrated serrated crypts intimately associated with the perineurial-like proliferation. In 13 of 18 polyps with associated serrated crypts, all serrated crypts were invested with the perineurial proliferation. In 5 cases, serrated crypts were seen away from the perineurial proliferation. Of these 18 polyps, the majority (16 of 18, 89%) were microvesicular hyperplastic polyps involving the left colon. However, 2 (11%) polyps in the right colon demonstrated histologic features diagnostic of sessile serrated adenoma. All 18 polyps with serrated crypts demonstrated a pV600E BRAF mutation. In contrast, the 2 polyps not associated with serrated crypts were negative for a BRAF mutation. Our results show for the first time that perineurial-like stromal proliferations frequently occur in sessile serrated adenomas. The presence of focal perineurial-like stromal proliferations in sessile serrated adenomas and the common finding of serrated crypts in colonic perineuriomas are likely indicative of an epithelial-stromal interaction, possibly related to some factor elaborated by the serrated epithelium.
机译：结肠神经鞘瘤最近被描述为良性粘膜息肉，其由隐窝周围平淡的梭形细胞增殖组成，隐窝通常表现出增生/锯齿状上皮改变。然而，这种独特的基质增生的起源尚不清楚，与锯齿状息肉（包括无柄锯齿状腺瘤）的关联尚未得到充分描述。我们在两个回顾性队列中评估了与会尿神经样增生相关的结肠息肉的病理学和分子特征：（1）一系列连续的198例无柄锯齿状腺瘤;（2）20例被诊断为尿道神经瘤的结肠息肉，而与锯齿状结肠无关地穴。 198例无蒂锯齿状腺瘤中有13例表现为神经尿样样间质增生，其中大多数（13例中有12例，占92％）涉及右侧（9例）和横结肠（3例）。在所有的13例病例中，神经元样增生都围绕着锯齿状结肠隐窝，并且通常仅涉及无柄锯齿状腺瘤的一小部分（平均息肉大小的9％;范围为2％至19％）。评估上皮膜抗原（EMA）表达的所有11个息肉均显示基质EMA染色仅限于神经周样增殖。十二个（92％）无柄锯齿状腺瘤伴尿道神经样增生表明pV600E BRAF突变。在被诊断为尿道神经瘤的20例结肠息肉中，有18例（90％）显示出锯齿状隐窝与尿道神经样增生密切相关。在18例息肉伴有锯齿状隐窝的息肉中，所有带锯齿状隐窝的投资都伴随着神经周增生。在5例中，看到锯齿状隐窝远离会阴部增生。在这18个息肉中，大多数（18个息肉中有16个，占89％）是涉及左结肠的微囊增生性息肉。但是，右结肠中有2个（11％）息肉表现出可诊断为无蒂锯齿状腺瘤的组织学特征。所有18个带有锯齿状隐窝的息肉均显示pV600E BRAF突变。相反，与锯齿状隐窝无关的2个息肉对BRAF突变呈阴性。我们的研究结果首次表明，无柄锯齿状腺瘤中经常发生尿道样间质增生。固着性锯齿状腺瘤中存在局灶性的尿道神经样基质增生以及结肠神经周神经瘤中锯齿状隐窝的常见发现可能表明上皮间质相互作用，这可能与锯齿状上皮形成的某些因素有关。

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