Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press28710.17650/2220-3478-2019-9-2-16-22LITERATURE REVIEWОБЗОР ЛИТЕРАТУРЫMorphological characteristics of mucinous adenocarcinoma of the colon and its embryogenetic premisesМорфологические особенности муцинозной аденокарциномы толстой кишки и их эмбриогенетические предпосылкиhttps://orcid.org/0000-0002-8080-904XKornevaYu. S.КорневаЮ. С.
Russian Federation

Department of Pathological Anatomy SSMU; Department of Clinical Pathology No. 2 named after Prof. V.G. Molotkov SRIP.

28Krupskoy St., Smolensk 214019; 27 Prospekt Gagarina, Smolensk 214020

Юлия Сергеевна Корнева - кафедра патологической анатомии СГМУ; отделение клинической патологии № 2 им. проф. В.Г. Молоткова СОИП.

214019 Смоленск, ул. Крупской, 28; 214020 Смоленск, проспект Гагарина, 27

ksu1546@yandex.ruhttps://orcid.org/0000-0002-0590-1399UkrainetsR. V.УкраинецР. В.
Russian Federation

Department of Pathological Anatomy.

28Krupskoy St., Smolensk 214019

Кафедра патологической анатомии СГМУ.

214019 Смоленск, ул. Крупской, 28

Smolensk State Medical University, Ministry of Health of RussiaФГБОУВО «Смоленский государственный медицинский университет» Минздрава РоссииSmolensk Regional Institute of PathologyОГБУЗ Смоленский областной институт патологии160620199216221606201916062019Copyright ©; 2019, Korneva Y.S., Ukrainets R.V.Copyright ©; 2019, Корнева Ю.С., Украинец Р.В.2019Korneva Y.S., Ukrainets R.V.Корнева Ю.С., Украинец Р.В.https://creativecommons.org/licenses/by/4.0https://onco-surgery.info/jour/article/view/287

This review reveals the anatomical, physiological and embryogenetic features of the proximal colon to explain the reasons for such frequent localization of mucinous phenotype of adenocarcinoma (MAC) here. It was shown that later differentiation in embryogenesis causes relative insufficiency of the proximal part as a structure of the digestive and immune systems. Physiologically lower lymphoid tissue (GALT) density here leads to the formation of a certain composition of the intestinal microbiota, which is different from that in the distal part, which is a significant link in the etiopathogenesis of proximal colon cancer. It is confirmed also by different composition of biofilms on the surface of epithelial tumors in the right and left halves of the colon, as well as differences in the molecular mechanisms of carcinogenesis, depending on the location of the cancer. Common for proximal part genetic changes, called as CIMP-phenotype, microsatellite instability and BRAF proto-oncogene mutation lead to excessive secretion of specific mucin fractions (mainly MUC2 and MUC5AC), the imbalance of its composition and the formation of MAC. An earlier age of onset, frequent association with hereditary non-polypous colorectal carcinoma, the predominance of MUC2 and MUC5AC fractions, similar to the embryonic period, as well as a higher level of cancer-embryonic antigen in patients with MAC indicate the influence of anatomical, physiological and embryogenetic features of the proximal colon on carcinogenesis long before its formation. Thus, a detailed understanding of MAC carcinogenesis is necessary for an adequate assessment of its effective prevention in time, as well as dealing with it as with specific nosological unit requiring specific treatment principles.

Данный обзор раскрывает анатомо-физиологические и эмбриогенетические особенности проксимального отдела толстой кишки, обосновывая причины столь частой локализации там муцинозной аденокарциномы (МАК). Показано, что более поздняя дифференцировка в эмбриогенезе обусловливает относительную недостаточность проксимального отдела как структуры пищеварительной и иммунной систем. Физиологически более низкая плотность лимфоидной ткани (GALT) здесь приводит к формированию определенного состава кишечной микробиоты, отличного от такового в дистальном отделе, что является значимым звеном в этиопатогенезе злокачественных новообразований проксимального отдела толстой кишки. Подтверждают это различный состав биопленок на поверхности эпителиальных опухолей в правой и левой половинах толстой кишки и различия в молекулярно-генетических механизмах канцерогенеза в зависимости от локализации рака. Характерные для проксимального отдела изменения в виде CIMP-фенотипа, микросателлитной нестабильности и мутаций протоонкогена BRAF приводят к избыточной секреции отдельных фракций муцина (преимущественно MUC2 и MUC5AC), дисбалансу его состава и формированию МАК. Более ранний возраст ее манифестации, частая ассоциация с наследственным неполипозным колоректальным раком, сходное с эмбриональным периодом преобладание фракций MUC2 и MUC5AC, а также более высокий уровень раково-эмбрионального антигена у пациентов с МАК указывают на влияние анатомо-физиологических и эмбриогенетических особенностей проксимального отдела толстой кишки на канцерогенез. Таким образом, детальное понимание канцерогенеза МАК необходимо для адекватной оценки возможностей своевременной и эффективной профилактики ее возникновения, а также рассмотрения ее в качестве самостоятельной нозологической единицы с определенными принципами лечения.

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