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| ==Mucinous tumours of the appendix== | | ==Mucinous tumours of the appendix== |
| {{ Infobox external links | | {{Main|Mucinous tumours of the appendix}} |
| | Name = Mucinous tumours of the appendix | | This grouping includes ''mucinous cystadenoma'' and ''mucinous cystadenocarcinoma''. |
| | EHVSC = 10183
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| | pathprotocols =
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| | wikipedia =
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| | pathoutlines =
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| }} | |
| :''Benign appendiceal [[mucocele]]'' and ''appendiceal mucocele'' redirect here.
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| ===General===
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| *There are many classifications and they are controversial.<ref name=pmid21970481>{{Cite journal | last1 = Panarelli | first1 = NC. | last2 = Yantiss | first2 = RK. | title = Mucinous neoplasms of the appendix and peritoneum. | journal = Arch Pathol Lab Med | volume = 135 | issue = 10 | pages = 1261-8 | month = Oct | year = 2011 | doi = 10.5858/arpa.2011-0034-RA | PMID = 21970481 }}</ref>
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| **The controversy centres on whether to call all mucinous tumours outside of the appendix ''adenocarcinoma'' - regardless of whether they have atypia & show invasion.
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| *''Panarelli and Yantiss'' created a nice summary table - that compare the classifications - see: [http://www.archivesofpathology.org/action/showFullPopup?id=i1543-2165-135-10-1261-t01&doi=10.5858%2Farpa.2011-0034-RA comparison of classifications (archivesofpathology.org)].<ref name=pmid21970481/>
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| *In women - an ovarian primary must be excluded.
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| **Concurrent ''bilateral'' ovarian tumours suggests the tumour originated from the appendix and spread to the ovaries.
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| *[[Onlinepathology]] prefers the classification of Misdraji,<ref name=pmid12883241>{{cite journal |author=Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH |title=Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases |journal=Am. J. Surg. Pathol. |volume=27 |issue=8 |pages=1089–103 |year=2003 |month=August |pmid=12883241 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=27&issue=8&spage=1089}}</ref> as it is the least complicated
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| ====Misdraji classification====
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| *Benign - ''low grade mucinous tumour''.
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| *Borderline - ''mucinous tumour of uncertain malignant potential'' or ''borderline mucinous tumour''.
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| *Malignant - ''[[mucinous adenocarcinoma]]''.
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| Five year survival (in a series of 107 cases) as per Misdraji classification:<ref name=pmid12883241/>
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| {| class="wikitable sortable"
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| !Tumour
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| !Five year survival
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| |-
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| |LAMN
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| |100%
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| |-
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| |LAMN extra-appendiceal spread
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| |86%
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| |-
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| |MACA
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| |44%
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| |-
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| |}
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| *LAMN = low-grade appendiceal mucinous neoplasm.
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| *LAMN extra-appendiceal = low-grade appendiceal mucinous neoplasm with extra-appendiceal spread.
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| *MACA = mucinous adenocarcinoma of the appendix.
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| ====World Health Organization classification====
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| WHO classification:
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| *Adenoma with low-grade dysplasia.
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| *Adenoma with high-grade dysplasia.
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| *Low-grade invasive mucinous adenocarcinoma
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| **Confined to the appendiceal wall.
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| **Outside of the appendix.
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| *High-grade invasive mucinous adenocarcinoma.
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| ====Comparison between Misdraji and WHO classification====
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| Adapted from ''Panarelli and Yantiss'':<ref name=pmid21970481>{{Cite journal | last1 = Panarelli | first1 = NC. | last2 = Yantiss | first2 = RK. | title = Mucinous neoplasms of the appendix and peritoneum. | journal = Arch Pathol Lab Med | volume = 135 | issue = 10 | pages = 1261-8 | month = Oct | year = 2011 | doi = 10.5858/arpa.2011-0034-RA | PMID = 21970481 }}</ref>
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| {| class="wikitable sortable"
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| ! Stage
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| ! Cytologic dysplasia
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| ! Misdraji
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| ! World Health Organization
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| |-
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| | Confined to the mucosa
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| | low-grade
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| | low-grade appendiceal mucinous neoplasm (LAMN)
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| | mucinous adenoma, negative for high-grade dysplasia
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| |-
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| | Confined to the mucosa
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| | high-grade
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| | non-invasive mucinous cystadenocarcinoma of the appendix
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| | mucinous adenoma with high-grade dysplasia
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| |-
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| | At least into the submucosa, confined to the appendix
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| | low-grade
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| | low-grade appendiceal mucinous neoplasm (LAMN)
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| | invasive mucinous adenocarcinoma, low-grade
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| |-
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| | At least into the submucosa, confined to the appendix
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| | high-grade
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| | mucinous adenocarcinoma of the appendix (MACA)
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| | invasive mucinous adenocarcinoma, high-grade
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| |-
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| | Extra-appendiceal spread
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| | low-grade
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| | low-grade appendiceal mucinous neoplasm (LAMN)
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| | invasive mucinous adenocarcinoma, low-grade
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| |-
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| | Extra-appendiceal spread
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| | high-grade
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| | mucinous adenocarcinoma of the appendix (MACA)
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| | invasive mucinous adenocarcinoma, high-grade
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| |}
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| ===Microscopic===
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| ====Low-grade appendiceal mucinous neoplasm====
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| *[[AKA]] ''benign mucinous tumour of the appendix''.
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| Microscopic:
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| *Single layer of epithelium with ''tufts''.
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| **Vaguely resemble ''serrations'', i.e. the ''saw-tooth'' pattern in hyperplastic polyps of the colon.
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| *Mucin contained (inside appendix only).
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| *No marked nuclear atypia.
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| Note:
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| *May be deceptively bland appearing from a cytologic perspective.
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| Images:
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| *[http://www.nature.com/modpathol/journal/v17/n12/fig_tab/3800212f1.html LAMN - low mag. (nature.com)].<ref name=pmid15354187/>
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| *[http://www.nature.com/modpathol/journal/v17/n12/fig_tab/3800212f3.html LAMN - high mag. (nature.com)].<ref name=pmid15354187>{{Cite journal | last1 = Misdraji | first1 = J. | last2 = Burgart | first2 = LJ. | last3 = Lauwers | first3 = GY. | title = Defective mismatch repair in the pathogenesis of low-grade appendiceal mucinous neoplasms and adenocarcinomas. | journal = Mod Pathol | volume = 17 | issue = 12 | pages = 1447-54 | month = Dec | year = 2004 | doi = 10.1038/modpathol.3800212 | PMID = 15354187 }}</ref>
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| *[http://pathlabmed.typepad.com/surgical_pathology_and_la/2012/02/digital-case-simple-mucocele-of-the-appendix.html Appendiceal mucocele (pathlabmed.typepad.com)].
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| ====Low-grade appendiceal mucinous neoplasm with extra-appendiceal spread====
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| *[[AKA]] ''mucinous borderline tumour of the appendix''.
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| Microscopic:
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| *Same as LAMN but mucin outside of the appendix.
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| *Cells in mucin, i.e. cellular mucin.
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| ====Mucinous adenocarcinoma of the appendix====
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| *[[AKA]] ''malignant mucinous tumour of the appendix''.
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| Microscopic:
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| *Marked nuclear pleomorphism.
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| *Invasion into the appendiceal wall.
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| ===Sign out===
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| ====LAMN====
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| <pre>
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| VERMIFORM APPENDIX, APPENDECTOMY:
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| - LOW-GRADE APPENDICEAL MUCINOUS NEOPLASM.
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| - ACUTE APPENDICITIS.
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| - ACUTE PERIAPPENDICITIS.
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| </pre>
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| <pre>
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| VERMIFORM APPENDIX AND CECUM, APPENDECTOMY WITH CECAL CUFF:
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| - LOW-GRADE APPENDICEAL MUCINOUS NEOPLASM (MUCINOUS CYSTADENOMA).
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| - MARGINS NEGATIVE FOR MUCINOUS NEOPLASM.
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| COMMENT:
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| No extra-appendiceal mucin is identified. There is no invasion into the appendiceal wall.
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| </pre>
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| <pre>
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| APPENDIX, APPENDECTOMY:
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| - APPENDICEAL MUCINOUS CYSTADENOMA WITH EXTENSIVE CALCIFICATION.
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| -- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
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| - NEGATIVE FOR MALIGNANCY.
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| </pre>
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| ==Goblet cell carcinoid== | | ==Goblet cell carcinoid== |