诊断讨论太好了，学习啦！
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- 请问各位老师，这个阑尾的粘液上皮是正常的吗？肌层没有，只是在粘膜层
本例出现黏液上皮的明显增生，并可见隐窝基底部膨胀和T形结构，细胞异型性不显著（但需要注意图5左侧居中的那几个上皮，看其它区域有无类似上皮，核拉长，位置上移），无蒂锯齿状息肉要考虑，再低倍镜看看有无更加典型的锯齿状结构？
阑尾锯齿状病变参见大肠锯齿状病变，参考文献：
Am J Clin Pathol. 2010 Apr;133(4):623-32.
Serrated lesions of the appendix: a morphologic and immunohistochemical appraisal.
Bellizzi AM, Rock J, Marsh WL, Frankel WL.
Dept of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
Comment in:
Abstract
We performed a histologic and immunohistochemical assessment of 53 noninvasive appendiceal epithelial proliferations, appropriating terminology and using markers shown useful in differentiating serrated colorectal polyps. These were classified as hyperplastic polyp (HP), sessile serrated adenoma (SSA), mixed serrated and adenomatous lesion (MSAL), mucinous cystadenoma (MCA), or conventional adenoma (CAD). Immunohistochemical analysis for cytokeratin (CK) 20, Ki-67, MUC6, and beta-catenin was performed. Diagnoses were as follows: HP, 6; SSA, 12; HP vs SSA, 3; MSAL, 16; MCA, 14; and CAD, 2. All HPs showed expanded (beyond surface) CK20 and expanded or normal (base) Ki-67; 1 was MUC6+. Most SSAs and MSALs were CK20-expanded or expanded with random expression in deep crypts (Ex/I) and Ki-67-expanded, Ex/I (expanded with asymmetry), or normal. All SSAs and 8 of 16 MSALs were MUC6+. CADs were CK20-Ex/I, Ki-67-Ex, and MUC6-; 1 showed nuclear beta-catenin expression. Serrated appendiceal lesions can be categorized using colorectal terminology. MUC6 is associated with SSA morphologic features. Similar immunohistochemical patterns in SSA and MSAL suggest a link between these lesions.
- 境随心转
| 以下是引用年华似水在2010-9-15 22:05:00的发言：
首先需要排除阑尾无蒂增生性息肉（类似于结肠的锯齿状病变，无细胞异型性），再考虑低度恶性阑尾粘液性肿瘤（无蒂锯齿状腺瘤通常隐窝底部与粘膜肌层平行，或呈倒T或反L型，细胞的异型性轻度，通常不累及表面上皮）。因为具有发展为腹膜播散性粘液瘤病（即腹膜假粘液瘤）的潜能，因此任何不伴有明显细胞异型的阑尾粘液性肿瘤都至少考虑低度恶性。只是现在还没发展为腹膜的粘液播散，阑尾切除了即治愈；但这不能改变这个肿瘤充分发展后腹膜播散潜能的生物学行为。
Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH. Appendiceal |
- Stop walking today and you'll have to run tomorrow.
| 以下是引用年华似水在2010-9-15 22:05:00的发言：
首先需要排除阑尾无蒂增生性息肉（类似于结肠的锯齿状病变，无细胞异型性），再考虑低度恶性阑尾粘液性肿瘤（无蒂锯齿状腺瘤通常隐窝底部与粘膜肌层平行，或呈倒T或反L型，细胞的异型性轻度，通常不累及表面上皮）。因为具有发展为腹膜播散性粘液瘤病（即腹膜假粘液瘤）的潜能，因此任何不伴有明显细胞异型的阑尾粘液性肿瘤都至少考虑低度恶性。只是现在还没发展为腹膜的粘液播散，阑尾切除了即治愈；但这不能改变这个肿瘤充分发展后腹膜播散潜能的生物学行为。
Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH. Appendiceal |
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本帖最后由 于 2010-09-15 22:29:00 编辑
首先需要排除阑尾无蒂增生性息肉（类似于结肠的锯齿状病变，无细胞异型性），再考虑低度恶性阑尾粘液性肿瘤（无蒂锯齿状腺瘤通常隐窝底部与粘膜肌层平行，或呈倒T或反L型，细胞的异型性轻度，通常不累及表面上皮）。因为具有发展为腹膜播散性粘液瘤病（即腹膜假粘液瘤）的潜能，因此任何不伴有明显细胞异型的阑尾粘液性肿瘤都至少考虑低度恶性。只是现在还没发展为腹膜的粘液播散，阑尾切除了即治愈；但这不能改变这个肿瘤充分发展后腹膜播散潜能的生物学行为。
Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH. Appendiceal
mucinous neoplasms: a clinicopathologic analysis of 107 cases. Am J Surg Pathol.
2003;27(8):1089–1103.
- stay hungry,stay foolish.
