Journal of Surgery Concepts & Practice ›› 2021, Vol. 26 ›› Issue (01): 21-27.doi: 10.16139/j.1007-9610.2021.01.005
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YANG Ping, XIONG Bin(
)
Received:2020-11-25
Online:2021-01-25
Published:2022-07-28
CLC Number:
YANG Ping, XIONG Bin. Diagnosis and treatment of appendiceal mucinous neoplasm[J]. Journal of Surgery Concepts & Practice, 2021, 26(01): 21-27.
| 术语 | 分级 | 组织学特征 |
|---|---|---|
| 腺瘤 | 低/高度发育异常 | 局限于黏膜,黏膜肌层完整 |
| 锯齿状息肉 | 低/高度或无发育异常肿瘤 | 锯齿状特征,局限于黏膜,黏膜肌层完整 |
| LAMN | 低级别 | 具有低级别细胞学的黏液性肿瘤和以下特征中的任何一种： 固有层和黏膜肌层缺失 黏膜下层纤维化 呈“推挤性”模式进入阑尾壁,膨胀性或憩室样生长方式 无细胞的黏液切割入阑尾壁内 黏液和(或)肿瘤性黏液上皮位于阑尾壁外 |
| HAMN | 高级别 | 伴高级别细胞学（至少局灶存在）的黏液性肿瘤且无浸润性生长 |
| 黏液性腺癌 | 高/中/低分化 | 黏液瘤,包含>50%的细胞外黏蛋白,呈浸润性生长 |
| 印戒细胞低分化 （黏液性）腺癌 | 低分化 | ≤50%的印戒细胞成分 |
| （黏液性）印戒细胞癌 | 低分化 | >50%的印戒细胞成分 |
| 腺癌 | / | / |
| 分化程度 | 组织学标准 |
|---|---|
| 高分化G1 | 低级别细胞学 |
| 中分化G2 | 高级别细胞学,无印戒细胞,常伴有浸润 |
| 低分化G3 | 高级别细胞学,伴印戒细胞和浸润 |
| 分期 | T | N | M | G |
|---|---|---|---|---|
| 0期 | Tis | N0 | M0 | |
| 0期 | Tis(LAMN) | N0 | M0 | |
| Ⅰ期 | T1 | N0 | M0 | |
| Ⅰ期 | T2 | N0 | M0 | |
| ⅡA期 | T3 | N0 | M0 | |
| ⅡB期 | T4a | N0 | M0 | |
| ⅡC期 | T4b | N0 | M0 | |
| ⅢA期 | T1 | N1 | M0 | |
| ⅢA期 | T2 | N1 | M0 | |
| ⅢB期 | T3 | N1 | M0 | |
| ⅢB期 | T4 | N1 | M0 | |
| ⅢC期 | 任何T | N2 | M0 | |
| ⅣA期 | 任何T | N0 | M1a | |
| ⅣA期 | 任何T | 任何N | M1b | G1 |
| ⅣB期 | 任何T | 任何N | M1b | G2、G3、Gx |
| ⅣC期 | 任何T | 任何N | M1c | 任何G |
| 分期 | 描述 | |
|---|---|---|
| 原发肿瘤（T） | ||
| Tx | 原发肿瘤无法评价 | |
| T0 | 无原发肿瘤的证据 | |
| Tis | 原位癌(黏膜内癌;侵入固有层;侵犯黏膜肌,但未穿透黏膜肌层) | |
| Tis(LAMN) | LAMN,局限于固有肌层的。黏液或黏液上皮可侵入固有肌层。 注：T1和T2不适用于LAMN,黏液或黏液上皮进入浆膜下层或浆膜层时应分到T3或T4a | |
| T1 | 肿瘤侵及黏膜下层（穿透黏膜肌层,未达到固有肌层） | |
| T2 | 肿瘤侵及固有肌层 | |
| T3 | 肿瘤穿透固有肌层,侵及浆膜下或阑尾系膜 | |
| T4 | T4a | 肿瘤侵犯腹膜脏层,包括黏液或黏液上皮侵入阑尾浆膜或阑尾系膜 |
| T4b | 肿瘤侵犯邻近组织及器官 | |
| 区域淋巴结（N） | ||
| Nx | 淋巴结不能评价 | |
| N0 | 无淋巴结转移 | |
| N1 | N1a | 1枚淋巴结转移 |
| N1b | 2~3枚淋巴结转移 | |
| N1c | 无淋巴结阳性,但浆膜下或肠系膜处可见癌细胞 | |
| N2 | ≥4枚淋巴结转移 | |
| 远处转移（M） | ||
| M0 | 无远处转移 | |
| M1 | 有远处转移 | |
| M1a | 腹膜内的无细胞黏液,在腹膜播散性的黏液中未见明确肿瘤细胞 | |
| M1b | 仅腹膜内转移,包括腹膜黏液中见肿瘤细胞 | |
| M1c | 腹膜外转移 | |
| 分化程度（G） | ||
| Gx | 无法评估分化程度 | |
| G1 | 高分化 | |
| G2 | 中分化 | |
| G3 | 低分化,未分化 | |
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