阑尾低级别黏液性肿瘤临床病理特征  

Clinicopathologic features of low-grade appendiceal mucinous neoplasm

作　　者：于兰[1] 高逸群 陈文换[3] 丁会珍 路平 崔立红[1] YU Lan;GAO Yi-qun;CHEN Wen-huan;DING Hui-zhen;LU Ping;CUI Li-hong(Department of Gastroenterology,the Sixth Medical Center of PLA General Hospital,Beijing100048,China;Department of Pathology,the Sixth Medical Center of PLA General Hospital,Beijing100048,China;Department of Pathology,Zhuozhou Hospital,Baoding072750,China)

机构地区：[1]解放军总医院第六医学中心消化科,北京100048 [2]解放军总医院第六医学中心病理科,北京100048 [3]涿州市医院病理科,河北保定072750

出　　处：《诊断病理学杂志》2023年第5期451-454,463,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨阑尾低级别黏液性肿瘤(LAMN)临床病理特征。方法根据最新诊断标准,重新评估存档切片,筛查出87例LAMN,回顾性分析临床、影像学及内镜检查和随访资料。结果男性41例,女性46例,年龄26~88岁,平均61岁。51例(58.6%)伴有临床症状,腹痛最为常见。61例行阑尾单纯性切除,26例行右半结肠切除术。71例(81.6%)阑尾增粗、管腔扩张、黏液积聚,肿瘤最大径0.5~3.5 cm,平均2.5 cm。所有病例均伴有黏膜上皮轻度异型增生和管壁内黏液,82%黏膜脱失,99%黏膜肌缺失,79.3%黏膜下纤维化,63.3%钙化或骨化。8例切缘阳性病例,2例扩大手术,其中1例阑尾断端发现残留肿瘤性上皮。80例随访资料显示33例pTis、42例pT3和1例pT4a均未见肿瘤复发,4例pT4b,1例未见肿瘤复发,3例带瘤生存。结论LAMN具有独特形态学特征,广泛取材对病理诊断和鉴别诊断是必要的,及时治疗预后较好。局限性病变单纯切除即可治愈,黏液阳性切缘要密切随访,不建议广泛结肠切除及淋巴结清扫。Objective To investigate the clinicopathological features of low-grade mucinous tumor of the appendix(LAMN).Methods The archived sections were reevaluated according to the latest diagnostic criteria,87 cases of LAMN were screened,and the clinical,imaging,endoscopic and follow-up data were analyzed retrospectively.Results Among 87 patients with LAMN,41 were male and 46 were female,with an average age of 61 years.51 cases(58.6%)were accompanied by clinical symptoms,most of which were abdominal pain.61 patients underwent simple appendectomy and 26 patients underwent right hemicolectomy.71 patients(82%)showed obvious enlargement of appendix,dilation of lumen and accumulation of mucus.The maximum diameter of tumor was 0.5-3.5 cm,with an average of 2.5 cm.All patients were accompanied by mild dysplasia of mucosal epithelium and mucus in the tubular wall,82%mucosa loss,99%mucosal muscle loss,79.3%submucous fibrosis,and 63.3%calcification or ossification.Of the 8 cases with positive margins of simple appendectomy,only 2 cases underwent extended surgery,and residual neoplastic epithelium was found at the broken end of the appendix in one case.The follow-up data of 80 cases showed that 33 cases of pTis,42 cases of pT3 and 1 case of pT4a had no tumor recurrence,4 cases of pT4b,1 case of no tumor recurrence,and 3 cases of survival with tumor.Conclusion LAMN has unique morphological characteristics.Extensive sampling is necessary for pathological diagnosis and differential diagnosis.Local lesions can be cured by simple resection,mucus positive margin,close follow-up,and extensive colectomy and lymph node dissection are not recommended.

关 键 词：阑尾 低级别黏液性肿瘤 腹膜假黏液瘤 病理学 

分 类 号：R735.3[医药卫生—肿瘤]