阑尾锯齿状病变及息肉临床病理学分析

Clinicopathologic features of appendiceal serrated lesions and polyps

目的探讨阑尾锯齿状腺瘤及息肉(SL/Ps)的临床病理学特征。方法回顾2013-1-2022-8北京航天中心医院手术切除的93例SL/Ps患者的临床病理学资料。结果93例SL/Ps中增生性息肉(HPs)5例,锯齿状病变(SLs)54例,锯齿状病变伴异型增生(SLDs)34例。阑尾全部取材后,SL/Ps发病率为5.8%,病变累及盲端66例。SL/Ps上皮形态除锯齿状结构外,48例呈丝状乳头,13例呈短簇状,16例呈扁平;38例伴急性化脓性炎,15例伴憩室,14例伴壁内/外黏液。SLDs组在盲端累及、扁平结构、伴急性炎及壁内/外黏液的发生率上均高于SLs组,差异具有统计学意义(P<0.05)。结论全部取材有利于客观评价阑尾SL/Ps的流行病特征。病理诊断上,需同炎性刺激的黏膜反应性增生、低级别阑尾黏液性肿瘤及憩室等鉴别。

Objective To explore the clinicopathologic features of appendiceal serrated lesions and polyps(SL/Ps).Methods The clinicopathologic features of 93 patients with SL/Ps,who were diagnosed at the Beijing Aerospace Central Hospital between January 2013 and August 2022 were retrospectively analyzed.Results Among the 93 cases of SL/Ps,5 were hyperplastic polyps(HPs),54 were serrated lesions(SLs),and 34 were serrated lesions with dysplasia(SLDs).After sampled in toto,the incidence rate increased to 5.8%.The blind end of the appendix was involved in 66 cases.In addition to the serrated structure,48 cases showed filamentous papillary structure,13 cases showed short clusters,and 16 cases showed flat of epithelium;38 cases were associated with acute suppurative inflammation,15 cases with diverticulum,and 14 cases with intramural/extramural mucus.The incidence of blind end involvement,flat structure,acute inflammation,and intramural/extramural mucus in SLDs group were higher than those in SLs group,and the difference was statistically significant(P<0.05).Conclusion Sampling in toto is helpful to objectively evaluate the epidemic characteristics of the appendical SL/Ps.Pathologically,it should be differentiated from mucosal reactive hyperplasia stimulated by inflammation,low-grade appendix mucinous neoplasms and diverticulum.