本帖最后由 pathology 于 2014-9-10 13:50 编辑
本周病例（2014.8.25—2014.8.31）
1、你考虑什么诊断？
管状绒毛状腺瘤伴微小类癌（Tubulovillous adenoma with microcarcinoid）
Syn
Microcarcinoids within adenomatous polyps of the colon have only recently been described. They range up to 1.5 mm in size, and are located between the crypts and the muscularis mucosae. They are composed of nests, cords, tubules and clusters of large epithelial cells with abundant cytoplasm, usually eosinophilic and granular, and round central nuclei with stippled or dusty chromatin. There is no desmoplasia, no atypia and no mitotic activity. Tumor cells are immunoreactive for chromogranin, synaptophysin, neuron-specific enolase or other neuroendocrine markers. Microcarcinoids have previously been described in ulcerative colitis and other chronic inflammatory disorders, where they may be due to reactive hyperplasia of colonic endocrine cells. Microcarcinoids may be interpreted as incipient composite glandular-carcinoid tumors, particularly if the polyp exhibits high grade dysplasia. Due to their incidental nature, the microcarcinoids may be underdiagnosed.
2、需要做什么鉴别诊断？
管状绒毛状腺瘤癌变、高级别上皮内瘤变、混合性腺神经内分泌肿瘤
3、本病预后如何？
本病生物学行为似乎为良性，目前尚未见复发和转移，由于本病目前仅有个别病例报道，尚需积累更多临床资料。
Ref：
Microcarcinoids in large intestinal adenomas. Am J Surg Pathol. 2006 Dec;30(12):1531-6.
http://www.ncbi.nlm.nih.gov/pubmed/17122508
Multiple microcarcinoids in a patient with long standing ulcerative colitis. J Clin Pathol. 2003 Dec;56(12):963-5.
http://www.ncbi.nlm.nih.gov/pubmed/14645360
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本期病例比较少见，一旦考虑到本病的存在，辅以免疫组化不难诊断。综合回答思路，rattlebox累积半分，刘定强、派瑞松、fusuyong鲜花鼓励！
希望大家一如既往的支持病理每周一题， | 
发表于 2014-8-26 10:14
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发表于 2014-8-27 16:09
pathology
