1、阑尾上皮肿瘤病理Epithelial Tumor 上皮肿瘤Premalignant lesions 癌前病变Adenoma（腺瘤）:tubular,tubulovillous and villousDysplasia（不典型增生）:Intraepithelial neoplasia（上皮内瘤）,LG and HGSerrated lesions（锯齿状病变）:HP,SSA/P and TSACarcinomaAdenocarcinomaMucinous adenocarcinoma 粘液腺癌Low grade appendiceal mucinous neoplasm 低级别阑尾粘液肿瘤Sig
2、net ring cell carcinoma 印戒细胞癌Non-mucinous adenocarcinoma 非粘液腺癌Undifferentiated carcinomaNeuroendocrine Neoplasm 神经内分泌肿瘤NET(G1,G2)NEC:large and small cellMixedGoblet cell 杯状细胞Tubular carcinoid 管状EC cell,L cell etcWHO classification of appendiceal tumor（阑尾肿瘤分类）Hyperplastic lesions（增生性病变）Polyp（息肉）:unco
3、mmon diffuse hyperplasia（弥散性增生）Sessile serrated adenoma/polyp（无蒂锯齿状）Same histological criteriaSerrated lesions（锯齿状病变）Hyperplastic polypDiffuse hyperplastic changesSessile Serrated Adenoma Tends to be villous growth pattern（绒毛）No mucin dissection,limited above mucosa muscularis（没有切割，在粘膜肌层上）Commonly c
4、ause lumen dilatation:cystadenoma;clinically mucoceleAdenoma/cystadenoma（囊腺瘤）Tubular Adenoma/LG dysplasiaTubular Adenoma with HG dysplasiaTubular Adenoma with HG dysplasia Definition:invasion beyond muscularis mucosa Incidence:0.1-0.2%of appendectomy;0.2 per 100,000 Elder patients Etiology:unknown m
5、ay associated with UC and tumor in large intestineAdenocarcinoma of appendix Non-mucinous:Similar to colorectal adenocarcinoma Mucinous adenocarcinoma accounts for 50%Low grade and high grade CK20,CDX2,and variable CK7 5 yrs survival 40-50%Signet ring cell carcinomaClassification of AdenocarcinomaNo
6、n-mucinous ADC阑尾粘液癌分类GradeTMN classificationArchitectureCellular featuresMucinMitosisLow grade(LAMN)Mucinous,LGresembling adenoma or SSA;“broad front invasion”:no desmoplasticLow grade dysplasia or bland cytologyLarge mucin vacuoleRareMucinous ADCMucinous,HGSimilar to colorectal ADC,desmoplastic HG
7、dysplasiaVariable;may see signet ring cellcommonWHO classifications of tumor:of digestive system:p121Mucinous ADC,HG 占粘液肿瘤大多数 是腺癌腺癌 Could cause pseudomyxoma peritonei（腹膜假粘液瘤）(could be acellular mucin dissection)Have well differentiated epithelial lining,minimum cytological atypiaLow grade appendicea
8、l mucinous neoplasm(LAMN)LAMNLAMNLAMN Clinical term（临床诊断）:mucinous ascites or mucinous deposits in the peritoneal cavity（粘液腹水或粘液结节在腹腔内）Causes:Most due to appendiceal neoplasm Other GI and GYN tract neoplasms Benign rupture:perforation of diverticula and appendixPsuedomyxoma peritonei（腹膜假粘液瘤）Case Num
9、ber appendicealOvarian tumor presentconclusionYoung et alN=222222Appendiceal primary,ovary secondarySeidman et aln=2522 of 2511/25Independent origin of ovary and appendixPrayson et asF/M 9/1019/194 of 994%from appendixCautrecause et alN=5N=5583%have identitical k-ras mutationK-Ras mutationChauqua et
10、 al121212Appendix primary75%LOH chromosome 5 and 17腹膜假粘液瘤哪里来?Intact laminar propria和阑尾憩室鉴别Muscle or Schwann cell proliferationClassification of psuedomyxoma peritoneiGradeTMN classificationArchitectureCellular featuresMucinMitosisLow gradeMucinous,LGCells form strips or small island;scantly and/or a
11、cellular mucinSingle layers,papillary tufting;nuclei small and regularVariableRareHigh gradeMucinous,HGStrips,small islands or cribriform.High cellularity;invasion into other organsHG dysplasiaVariable;may see signet ring cellcommonWHO classifications of tumor:of digestive system:p123如果肿瘤细胞没有穿透粘膜肌层：
12、腺瘤;预后好，完全切除后治愈(submit the appendix entirely)肿瘤细胞过粘膜肌层：腺癌LG and HG肿瘤细胞在粘膜，但又粘液(acellular or scant cellularity,bland cytology)deposit 在粘膜外LGMN(有细胞）mucin dissection limited in the appendiceal wall:cured by excisionAcellular mucin:controversial,differentiate from rupture;clear cut adenoma,LGMNTMN stagin
13、g:T4a,serosal 右下腹;M1a,PMP beyond right quadrantPrognosis associated with the histological grade and/or invasion deep to the peritoneal surfaceDebulking of peritoneal mucus prolong survival,particular in LGMNNotes for WHO classificationThree-tiered system(mucinous adenocarcinoma):Low grade,grade G1,w
14、ell differentiatedHigh grade，grade G2(moderately)or grade G3(poorly)No defined histological criteriaT3:non-continuous tumor nodule or tumor depositT4a and T4bPeritoneal involvement limited to right quadrant:T4M1a(PMP)and M1b:N,M,GStage IVa:Any T,N0,M1a,G1Stage IVb:Any T,N0,M1a,G2,G3 Any T,N1/2,M1a,a
15、ny GStage IVc:Any T,Any N,M1b,any GOverman 2014:stage IV,moderately and poorly differentiated mucinous adenocarcinomas have distinctly different prognosisAJCC classification(7th edition)经常没有原位肿瘤,可以发生于粘膜下层或深部粘膜:大小比浸润深度意义大 T stage:T1:2 cmT2:2 cm to 4cm or extension to cecumT3:more than 4cm or to the i
16、leumT4:directly invades adjacent organsHistological grade:as other neuroendocrine tumor:G1,G2,G3Goblet cell carcinoid uses adenocarcinoma criteriaSerum chromogranin:A prognostic markerNeuroendocrine tumor内分泌肿瘤 Goblet cell carcinoid 杯状细胞类癌:主要在粘膜下层 一般不侵犯粘膜 不形成明显肿块 Small round,signet ring like cells Ne
17、uroendocrine markers positive;CEA,CK19,CK20 and MUC2 Mixed carcinoma Signet ring or poorly differentiated carcinoma from existing goblet cell carcinoid Expressing P53,MUC1,and loss of MUC2 Mucosal rarely involvedGoblet cell carcinoid/Mixed neuroendocrine carcinomaNeuroendocrine TumorGoblet cell carcinoid18 yr female abdominal pain and diarrhea
