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- 经典病例学习-腹腔假粘液瘤
•男，56岁，腹痛三月余，腹腔手术探查见肠系膜、大网膜布满大小不一的半透明结节，未见明显腹腔器官肿块。取肠系膜结节活检。肉眼，灰红色结节，4X3X1厘米，部分呈胶冻状，切面灰红，质软。
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本帖最后由 xclbljys 于 2011-10-30 18:08:00 编辑
- 许春雷
×参考诊断
Based on the images provided, the tumor is very well-differentiated and lacks obvious malignant features. Therefore, I personally favor DPAM. Recommend more sampling to rule out focal or diffuse areas of real high-grade tumor, i.e., PMCA-I or PMCA.
In focal areas of this case, there are small individual glands, which may mimic invasive carcinoma. Actually, they are entrapped glands with inflammatory stromal reaction, not the desmoplastic type stromal reaction, which is usually seen in invasive carcinoma. The tumor cells from DPAM only implant on the surface of omentum or abdominal organs without deep invasion or metastasis to lymph nodes or other organs.
This case is not goblet carcinoid. Typical goblet carcinoid does not form glands with lumen, and the tumor cells infiltrate individually or as small solid nests consisting of mucocytes and neuroendocrine cells.
My resident center has 80-100 PMP cases every year, including 10-20 goblet carcinoid tumors. I have seen patients with DPAM recover very well after treatment.
- 稳扎稳打，稳中求胜
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panzenggang 离线
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This case shouldn't be simply diagnosed as "carcinoma" or "metastatic carcinoma". Most of such cases occur due to rupture of low-grade appendiceal neoplasms with subsequent implantation on the omental surface and no invasion or metastasis to other organs; these cases are called disseminated peritoneal adenomatosis (DPAM), one type of PMP. These patients with DPAM usually have good prognosis after debulking surgery and intraoperative chemotherapy. Less commonly, PMP may present as mucinous adenocarcinoma due to invasive adenocarcinoma from appendix, and these tumors, so call peritoneal mucinous adenocarcimatosis (PMCA), tend to act like classic adenocarcinoma with poor prognosis. Another very rare appendiceal tumor is goblet carcinoid.
学习了，谢谢各位老师。
翻译panzenggang老师的回复：这个病例不应该简单的诊断为“癌”或“转移癌”。大部分这种病例的发生是由于阑尾低级别肿瘤破裂后植入到网膜表面,未侵犯或转移到其他器官，这种病例称为弥漫性腹膜腺粘液蛋白病(DPAM)，是腹膜假粘液瘤(PMP)的一个类型。患有DPAM的病人在接受外科切除和化疗后通常有较好的预后。罕见的是, 由于阑尾的浸润性腺癌，腹膜假粘液瘤(PMP)可能表现为粘液性腺癌，因此这类肿瘤被称为腹膜粘液蛋白癌病(PMCA),倾向于表现为较差预后的经典型腺癌。还有一个非常罕见的阑尾肿瘤是杯状细胞类癌。
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Based on the images provided, the tumor is very well-differentiated and lacks obvious malignant features. Therefore, I personally favor DPAM. Recommend more sampling to rule out focal or diffuse areas of real high-grade tumor, i.e., PMCA-I or PMCA.
In focal areas of this case, there are small individual glands, which may mimic invasive carcinoma. Actually, they are entrapped glands with inflammatory stromal reaction, not the desmoplastic type stromal reaction, which is usually seen in invasive carcinoma. The tumor cells from DPAM only implant on the surface of omentum or abdominal organs without deep invasion or metastasis to lymph nodes or other organs.
This case is not goblet carcinoid. Typical goblet carcinoid does not form glands with lumen, and the tumor cells infiltrate individually or as small solid nests consisting of mucocytes and neuroendocrine cells.
My resident center has 80-100 PMP cases every year, including 10-20 goblet carcinoid tumors. I have seen patients with DPAM recover very well after treatment.
