摘要：目的探讨克隆病(crohn’sdisease，CD)肠粘膜上皮增生、异型增生、癌变的临床病理特点及意义。方法收集5例CD患者的临床病理资料，光镜观察肠粘膜活检及手术肠切除的病理组织学特点，应用国际炎性肠病的分类标准对上皮增生进行分类，部分切片行CEA、PCNA免疫组化染色。结果3例肠粘膜活检未发现特异性病变。5例手术标本均可见非干酪样坏死肉芽肿或巨细胞；3例有典型裂隙状溃疡形成。4例次上皮有局灶未定型异型增生，2例有局灶异型增生，1例小灶癌变。结论本文报告的5例CD术前肠粘膜活检缺乏组织学特异性，需与UC及其他炎性肠病鉴别。伴发异型增生和癌变没有典型的肉眼特征，易与炎症及其他病变相混淆而忽略。炎性肠病异型增生的新分类，为CD患者的监护、治疗及预后提供了更为详细的病理学资料。“未定型异型增生”组织学标准、转归有待进一步观察研究。

分类号：R753.7文献标识码：A

文章编号：1007-8096(2000)02-0099-04

A Clinicopathological Analysis of Dysplasia and Carcinoma in Crohn’s Disease

wang Luping,Deng Yongjiang,Ding Huaye(Department of Pathology，General Hospital of Beijing Military Area，Beijing 100700)

Abstract：Objective To investigate the clinicopathological features of dysplasia and carcinoma in Crohn’s disease． Methods Clinical data，histologic characteristics，especially the degree of epithelial proliferation，and immunostainings of CEA and PCNA were analyzed in 5 cases of Crohn’s disease． Results Biopsies of colonic mucosa in 3 cases showed that severe inflammation and no specific lesions．Non-caseous granulomas and／or multinucleated giant cells were conspicuous in surgical resected specimen of all cases，with linear ulcers in 3 cases．Indefinable focal dysplasia was found in 3 cases，adenocarcinoma in one case．There were no differences in the expression of CEA and PCNA in the proliferative epithelia． Conclusion Crohn’s disease complicating dysplasia and carcinoma is short of typical macroscopic features and easily confused with inflammatory bowel diseases．The new classification of dysplasia in the disease would provide more useful information for surveillance，prognosis and treatment of the patients．

Keywords：Crohn’s disease Dysplasia Adenocarcinomas参考文献：

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［2］Klaus JL，Robert HR,Wilred MW．Gastrointestinal pathology and its clinical implications．New York：Igaku-shoin，1992，p949

［3］Gillen CD，Walmsley RS，Prior P，et al．Ulcerative colitis and Crohn’s disease：A comparison of the colorectal cancer risk in extensive colitis．Gut 1994,35:1590-1592

［4］Stahl TJ，Schoetz DJ Jr，Roberts PL，et al.Crohn’s disease and carcinoma：Increasing justification for surveillance?Dis Colon Rectum l992,35：850-856

［5］Noam Harpaz，Ian CT Colorectal cancer in idiopathic infiammatory bowel disease．Seminars in Diagnostic Pathology 1996,13:339-357

收稿日期：1999-08-17

修稿日期：1999-11-17