外科病理学实践:诊断过程的初学者指南 | 第8章 结肠
Margins: When an entire polyp is plucked off the colon, ideally it is cross sectioned so that you can see the stalk. Ink on the stalk is helpful, but cautery also identifies your margin. If there are identifiable margins, mention whether or not the dysplasia (adenomatous epithelium) extends to the margin.
切缘:当一个完整的息肉从结肠摘除时,最好沿息肉的长轴包埋并切片,这样你就能看到息肉的蒂。蒂涂抹墨汁是有用的,但烧灼痕迹也能帮助你识别切缘。如果能识别切缘,要说明异型增生(腺瘤性上皮)是否延伸至切缘。
Dysplasia: By definition, low-grade dysplasia is present. However, high-grade dysplasia is equivalent to carcinoma in situ and must be noted. The diagnosis of high-grade dysplasia is made on the basis of architecture rather than cytology. The glands should become cribriform, fused, or back to back (Figure 8.3). Usually the term high-grade dysplasia is reserved for areas that look so complex you are worried about carcinoma but cannot prove invasion. High-grade dysplasia is also usually accompanied by ugly cytology: total loss of nuclear polarity, significant pleomorphism, atypical mitoses, and large nucleoli.
异型增生:根据定义,存在低级别异型增生。然而,高级别异型增生相当于原位癌,必须注意。高级别异型增生的诊断是基于结构而不是细胞学。腺体应变为筛状、融合或背靠背(图8.3)。通常,高级别异型增生这个术语只适用于那些看起来非常复杂的区域,以致你可能会担心癌,但无法证明浸润。高级别异型增生通常伴有丑陋的细胞学表现:核极性完全丧失、显著的多形性、非典型核分裂象和大核仁。
Carcinoma: All adenomas are considered at least premalignant lesions; sometimes you will find carcinoma arising in a polyp on biopsy. To diagnose carcinoma (as opposed to high-grade dysplasia), you must demonstrate cancer crossing the basal lamina, that is, into the lamina propria. Clues to invasion include a jagged interface with the lamina propria, individual infiltrating cells, desmoplastic response, and a pinking up of the invasive cells (Figure 8.4).
癌:所有腺瘤至少认为是癌前病变;有时活检会发现息肉中的癌。要诊断癌(而不是高级别异型增生),必须证实癌穿过基底层,即,进入固有层。浸润的线索包括固有层的界面不规则、呈锯齿状(译注:即基底膜破损)、单个浸润细胞、促结缔组织增生性反应和浸润细胞的变得更红(图8.4)。
Invasion: Invasion into the lamina propria alone is called intramucosal carcinoma. This may happen in a large polyp, and excision is still curative. Within the lamina propria, cancer has no metastatic potential. However, once malignant cells cross the muscularis mucosa into the submucosa, there is at least theoretical risk of metastasis. The extent of invasion must be noted in the diagnosis.
浸润:仅浸润固有层时,称为粘膜内癌。这种情况可能发生在巨大息肉中,切除仍可能治愈。在固有层内,癌没有转移潜能。然而,一旦恶性细胞穿过粘膜肌层进入粘膜下层,至少在理论上存在转移风险。诊断时必须注意浸润的范围。
(译注:结肠腺癌的定义性特征是癌穿透黏膜肌层并进入黏膜下层。)
Polys, polys, spot the polys: neutrophils in the crypt epithelium = cryptitis.
寻找中性粒细胞,重复三遍:隐窝上皮中的中性粒细胞=隐窝炎。
Neutrophils in the crypt lumen = crypt abscesses.
隐窝腔中的中性粒细胞=隐窝脓肿。
Erosions and ulcers and pus are also consistent with active lesions.
糜烂、溃疡和脓肿也符合活动性病变。
Crypt distortion (branching, tortuous, or sideways crypts; test tubes warped)
隐窝扭曲变形(分枝、弯曲或侧向隐窝;试管弯曲)
Crypt loss (test tubes missing)
隐窝丢失(试管丢失)
Crypt atrophy (test tubes too short)
隐窝萎缩(试管太短)
Basal plasmacytosis (test tubes pushed up by a dense layer of chronic inflammation)
基底部浆细胞增多(一层致密的慢性炎症把试管向上推)
Paneth cell metaplasia (Paneth cells in the left colon)
Paneth细胞化生(左结肠Paneth细胞)
Patchy mucosal involvement with skip areas
斑片状粘膜受累伴跳跃区
Granulomas and/or histiocytes (Figure 8.11)
肉芽肿和/或组织细胞(图8.11)
On colectomy, transmural inflammation, cobblestoning, fissures, fistulas, and creeping fat
结肠切除术标本,透壁炎症、鹅卵石、裂缝、瘘管和爬行脂肪
Predominantly distal involvement or pancolonic (no skip areas)
主要累及远端结肠或全结肠(无跳跃区)
Diffuse mucosal inflammation, many polys
弥漫性粘膜炎症,多发性息肉
A lack of chronic changes (no crypt distortion, no basal plasmacytosis)
缺乏慢性改变(无隐窝扭曲变形,无基底部浆细胞增多)
A predominantly top-heavy lymphocytic infiltrate
主要是顶部重度淋巴细胞浸润
Intraepithelial lymphocytes
上皮内淋巴细胞
Evidence of damage to the epithelium (loss of cells)
上皮损伤的证据(细胞丢失)
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