消化道息肉性病变-2010-3图文.pptVIP

* Aberrant Crypt Foci. Left, methylene blue stained colonic mucosal sheet viewed under dissecting microscope. Crypt lumens are viewed on end, and appear as white spots. Aberrant crypt foci (arrows) have dilated diameters, increased staining, and slit-like lumens. Right, histologic examination of these aberrant crypt foci reveals dysplasia. These tiny microscopic adenomas are associated with bi-allelic inactivation of the APC gene * In this portion of the adenomatous polyp the dysplastic changes are sharply segregated from the normal goblet cells. * Microscopic appearance of villoglandular polyp. There is an admixture of villous and glandular structures. * Pseudoinvasion in an adenomatous polyp. The fibrosis, focal collections of hemosiderin-laden macrophages, and the cystic dilatation of glands are clues to the diagnosis Sometimes clusters of atypical glands beneath muscularis mucosae: may lead to misdiagnosis of malignant transformation84 not uncommon features that allow recognition of atypical glands:85 cytologic features similar to those in surface surrounded by: inflamed loose stroma and scattered bundles of muscularis mucosae instead of desmoplastic reaction associated with carcinoma abundant hemosiderin granules (Fig. 20Fig. 20: Pseudoinvasion in an adenomatous polyp. The fibrosis, focal collections of hemosiderin-laden macrophages, and the cystic dilatation of glands are clues to the diagnosis. ) some glands may become cystic, rupture, and result in formation of mucin lakes this pseudocarcinomatous invasion may result from repeated twisting of stalk85 similar changes observed as result of biopsy procedure may be mild to moderate inflammatory infiltrate in stroma * Malakoplakia within the stroma of an adenomatous polyp, a most unusual event * Histology of villous adenoma. Fingerlike projections stretching from the surface of a polyp downward with minimal branching. Histology of villous adenoma. Low-grade dysplasia with loss of mucin, prominent nucleoli, and