这里有这么多好的老师和病例，真是太好了！！！

 受教了

 学习了,谢谢指点.

 锯齿状腺瘤癌变第一次看到。谢谢椰子树老师。

以下是引用 在2006-11-30 10:07:00的发言：  感觉图太小，看的不是很清楚，感觉不象腺瘤，倾向增生性息肉。

请单图点击就会放大了.

以下是引用慧眼 在2006-12-5 23:07:00的发言：  锯齿状腺瘤癌变第一次看到。谢谢椰子树老师。

呵呵椰子树老师，这个名字起的和慧眼一样的有特色．那我以后也叫他椰子树老师啦

以下是引用慧眼 在2006-12-5 23:07:00的发言：  锯齿状腺瘤癌变第一次看到。谢谢椰子树老师。

  椰子树，很好听的名字，我喜欢，谢谢。

  serrated adenoma 锯齿状腺瘤

 临床与实验病理学杂志2007年01期P6上，南京大学医学院附属鼓楼医院病理科黄勤教授和张丽华博士对该病有详细的报道。很值得一看！

该病在常规工作中我们已经诊断过不少病例。

 反复阅读，很有收获！感谢各位老师！

 Histopathology. 2007 Jan;50(1):131-50.

Colorectal serrated adenocarcinoma.

• Makinen MJ.

 
Colorectal cancer (CRC) ranks among the three most common cancers in terms of both cancer incidence and cancer-related deaths in most Western countries. Serrated adenocarcinoma is a recently described, distinct variant of CRC, accounting for about 7.5% of all CRCs and up to 17.5% of most proximal CRCs. It has been postulated that about 10-15% of sporadic CRCs would have their origin in serrated polyps that harbour a significant malignant potential. These lesions include hyperplastic-type aberrant crypt foci, hyperplastic polyps, sessile serrated adenomas, admixed polyps and serrated adenomas, and constitute the so-called 'serrated pathway', which is distinct from both the conventional adenoma-carcinoma pathway and the mutator pathway of hereditary non-polyposis CRC and is characterized by early involvement of oncogenic BRAF mutations, excess CpG island methylation (CIM) and subsequent low- or high-level DNA microsatellite instability (MSI). Methylation of hMLH1 is likely to explain the increased frequency of high-level MSI (16%) and methylation of MGMT is postulated to explain the low-level MSI (29%) in serrated adenocarcinomas. Reproducible histopathological criteria for serrated adenocarcinoma have recently been established and they have been qualified by DNA expression analysis for 7928 genes, showing clustering of serrated adenocarcinomas into a molecular entity apart from conventional adenocarcinoma, and representing with distinct down-regulation of EPHB2, PTCH and up-regulation of HIF1alpha.

 

锯齿状腺瘤癌变第一次看到。谢谢椰子树老师。

 谢谢zhanglei老师讲解

 谢谢fangg  

 锯齿状腺瘤，学习！！

  锯齿状腺瘤

 管状－绒毛状腺瘤。

以下是引用zhanglei 在2006-11-30 0:47:00的发言：  锯齿状腺瘤的诊断有两个条件： 一是具有增生性息肉的组织构型，二是有管状腺瘤的细胞学特点，如嗜酸性胞浆，增大的细胞核，假复层或复层排列。本例上述条件完全符合。

 谢谢  zhanglei  老师的解释，附加一点就是：在显微镜下息肉的上皮细胞浆红，杯状细胞明显减少，应考虑锯齿状腺瘤，及易与增生性息肉相混淆，应注意。

这是锯齿状腺瘤中发生腺癌的病例。

 典型的锯齿状腺瘤。

组织学与增生性息肉相同，但细胞学上不同：异型性，极性，核。

增生性息肉和幼年性息肉均可以有锯齿状结构。

发生癌的几率比腺瘤性息肉高。

 经典！谢谢提供！