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以下是引用librahsu在2008-7-2 3:59:00的发言:
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以下是引用mingfuyu在2008-7-1 9:35:00的发言:
A few points in determing the diagnosis of this case: I am sure this is at least adenocarcinoma in-situ. I saw neoplastic glands acrossing smooth muscle bundles. If you are sure those are muscularis mucosae and the neoplastic glands have invaded through muscularis mucosae into submucosa, then the diagnosis is well differentiated invasive adenocarcinoma. Then you decide the depth of invasion (to superficial or deep muscularis propria? to serosa?). The muscle bundles shown here are thin, and i doudt these are muscularis propria. If you are not sure the neoplastic glands have invaded though muscularis mucosae, then the diagnosis is intramucosal adenocarcinoma which means that the tumor has invaded to the lamina propria but not to submucosa.. I am not sure about the value of the intraoperative touch prep. In colon precancerous lesions and cancer, sometimes the cytology does not decide the lesion is invasive or not and depth of invasion. It is the location of the glands that determines the final diagnosis. Maybe something i have not learned, please let me know. One picture shows periglandular cleft, be very careful to call that lymphovascular invasion. Sometimes it is artifact. |
衷心感谢mingfuyu老师!谢谢您作了详细的讲解。
本例息肉状突出有蒂,粘膜肌伸到息肉状肿物内,粘膜肌层的腺体(就2团)周围还是粘膜固有层的间质,无纤维组织反应,也没找到血管和神经侵犯,基底部无病变残留,我感觉像假浸,但不确定,发的是腺瘤伴高级别内瘤变,建议密切随访。
请问:这样报告合适吗?