以阑尾炎起病的阑尾上皮性肿瘤15例临床病理分析

摘要

目的:探讨以阑尾炎起病的阑尾上皮性肿瘤的临床病理学特征.方法:对15例以阑尾炎起病的阑尾上皮性肿瘤的临床病理资料进行回顾性分析.结果:15例以阑尾炎起病的阑尾上皮性肿瘤中,6例为低级别阑尾黏液性肿瘤(low-grade appendiceal mucinous neoplasm,LAMN),其余9例为前驱病变,包括8例锯齿状病变及1例绒毛状-管状腺瘤,其中锯齿状病变为6例无蒂锯齿状腺瘤/息肉(sessile serrated adenoma/polyp,SSA/P)及2例传统型锯齿状腺瘤(traditional serrated adenoma,TSA).14例以"急性阑尾炎"起病,1例以"慢性阑尾炎"起病.SSA/P镜下见锯齿状结构、隐窝扩张呈L或倒T形;TSA见显著的锯齿状轮廓和异位隐窝,具有细胞异型性;锯齿状病变的黏膜肌层完整.LAMN内衬轻度异性的黏液性上皮,管壁纤维化或破裂,管壁内及浆膜见无细胞性黏液池.9例获得随访包括5例前驱病变及4例LAMN,随访时间1.0~81.5个月,患者均无病生存.结论:阑尾锯齿状病变及LAMN均可因急性阑尾炎起病,锯齿状病变大多数为镜下偶然发现.外科医生应提高对这些病变的认识,以避免医源性穿孔导致的腹膜假黏液瘤.病理医生应将该类阑尾病变标本全部取材以便于鉴别诊断,报告阑尾切缘情况.%Objective: To investigate the clinicopathologic features of epithelial appendiceal neoplasm presented with appendicitis. Methods: Specimens from 15 patients of epithelial appendiceal neoplasm associated with appendicitis were retrospectively analyzed using clinicopathological method. Results: Fifteen cases were evaluated, including 9 precursor lesions (8 serrated lesions and 1 villous tubular adenoma) and 6 low-grade appendiceal mucinous neoplasms (LAMN). Serrated lesions were subclassified as 6 sessile serrated adenoma/polyps (SSA/P) and 2 traditional serrated adenomas (TSA). Fourteen cases presented with acute appendicitis, while 1 case with symptoms of chronic appendicitis. Microscopically, sawtooth structure, basal crypt dilation and L- or inverted T-shaped crypt was observed in SSA/Ps. TSAs demonstrated obvious serration, ectopic crypt and cellular dysplasia. The muscularis mucosae was intact in serrated lesions. LAMNs were characterized by mildly atypical mucinous epithelium, fibrosis or rupture of the wall and acellular mucin in the wall and serosa. Follow-up was available in 9 cases, including 5 precursor lesions and 4 LAMNs. The follow-up interval ranged from 1.0 to 81.5 months. All patients were alive without disease. Conclusion: Appendiceal serrated lesions and LAMNs may be presented with symptoms of acute appendicitis, serrated lesions are usually detected as incidental lesions on microscopy. Appendiceal epithelial tumors should be keep in mind to avoid iatrogenic perforation causing peritoneal pseudomyxoma. Specimens of the appendix should be entirely submitted in order to differential diagnosis and assess the status of margin.