回fangg老师：抱歉！再表示感谢！今天才看到老师的提问。

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。

明天找片子再多发低倍图。

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？

 腺癌

图9可见明显浸润

 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.

我更倾向于 腺瘤伴肌层假浸润

 肠梗阻和肠套叠是引起假浸润的最常见原因。本例肿块4cm，的确应当考虑这一点。

本例中，先撇开浸润与否不谈，腺体起码为高度上皮内瘤变。按照常识，肿瘤越大、时间越长，发生癌变或浸润性癌的几率就越高。本例中那些横断平滑肌的腺体应该引起高度重视。

目前，凭上图判断是否浸润，确实难度很大。

请仔细寻找有无筛网状结构和促纤维反映，有无脉管神经的侵犯，仔细观察平滑肌束的走向，来判断是否浸润。标本应该全部取材。建议再多给些低倍图。

还有一点非常关键，基底切缘有没有病变组织残留？