title: The relationship between cyclooxygenase-2 expression and characteristics of malignant transformation in human colorectal adenomas.
abstract: OBJECTIVE
  Cyclooxygenase 2 (COX-2) is a target of aspirin and other non-steroidal anti-inflammatory drugs and is implicated in the pathogenesis of colorectal cancer. The objective of this study was to evaluate the extent of COX-2 in pre-malignant colorectal polyps and to assess the relationship between COX-2 and the level of dysplasia in these lesions.
  
  
  METHODS
  Whole polypectomy specimens were retrieved from 123 patients by endoscopic or surgical resection. Following formalin fixation and paraffin embedding, the polyps were evaluated histologically for size, type and grade of dysplasia. The extent of COX-2 expression was measured by the avidin-biotin immunohistochemical technique using a monoclonal COX-2 antibody. The extent of COX-2 expression was graded according to percentage epithelial COX-2 expression.
  
  
  RESULTS
  The polyps were of the following histological types: 10 hyperplastic, 35 tubular adenomas, 61 tubulovillous adenomas and 17 villous adenomas. Twenty showed mild dysplasia, 65 moderate dysplasia, and 28 focal or severe dysplasia (including eight with focal invasion). The average polyp size was 1.7 cm. Nine hyperplastic polyps were COX-2-negative and one was COX-2-positive. COX-2 expression was more extensive in larger polyps and in polyps with a higher villous component. There was a significant increase in the extent of COX-2 protein with increasing severity of dysplasia. Within a polyp, there was a focal corresponding increase in COX-2 expression within epithelium showing a higher grade of dysplasia.
  
  
  CONCLUSIONS
  COX-2 expression is related directly to colorectal adenomatous polyp size, type and grade of dysplasia. This suggests that the role of COX-2 in colorectal cancer may be at an early stage in the adenoma-to-carcinoma sequence and supports the suggestion that inhibition of COX-2 may be useful chemoprevention for this disease.
authors.affiliation: Department of Pathology, Epidemiology and Clinical Pharmacology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland. katherinesheehan@hotmail.com
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Sheehan
authors.forename: Fionnuala
authors.initials: F
authors.lastname: O'Connell
authors.forename: Anthony
authors.initials: A
authors.lastname: O'Grady
authors.forename: Ronan M
authors.initials: RM
authors.lastname: Conroy
authors.forename: Mary B
authors.initials: MB
authors.lastname: Leader
authors.forename: Michael F
authors.initials: MF
authors.lastname: Byrne
authors.forename: Frank E
authors.initials: FE
authors.lastname: Murray
authors.forename: Elaine W
authors.initials: EW
authors.lastname: Kay
mesh_terms: D000236:Adenoma / Q000201:enzymology* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002471:Cell Transformation, Neoplastic / Q000378:metabolism* / Q000473:pathology; D003106:Colon / Q000201:enzymology / Q000473:pathology; D015179:Colorectal Neoplasms / Q000201:enzymology* / Q000473:pathology; D051546:Cyclooxygenase 2; D018450:Disease Progression; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000201:enzymology / Q000473:pathology; D007124:Immunoenzyme Techniques; D007527:Isoenzymes / Q000378:metabolism*; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D011230:Precancerous Conditions / Q000201:enzymology / Q000473:pathology; D011451:Prostaglandin-Endoperoxide Synthases / Q000378:metabolism*
chemical_list: D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases