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Presented by Dr. Andres Matoso and prepared by Dr. Katelynn Davis
Adult with an appendiceal mass
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1. Question
Adult with an appendiceal mass
Correct
Correct: Sessile serrated adenoma
Histology: The appendix is dilated with mucin and there is mucin extravasation in the peri appendiceal soft tissue. The mucosal lining shows a serrated polyp without dysplasia. Some of the glands show dilatation at the base.
Discussion: Not every mucinous distension of the appendix is low grade mucinous neoplasm. In order for it to be a low-grade mucinous neoplasm, the epithelium must show low grade dysplasia. Mucin extravasation without epithelium does not have much clinical significance although sampling is important to completely exclude a LAMN. Once there is disseminated peritoneal disease, the grade of the epithelium is important for the diagnosis: low grade epithelium and mucin is called “disseminated peritoneal adenomucinosis-DPAM; high grade epithelium and mucin is “peritoneal mucinous carcinomatosis-PMCA.”
References:
Ballentine, S.J., Carr, J., Bekhor, E.Y. et al. Updated staging and patient outcomes in low-grade appendiceal mucinous neoplasms. Mod Pathol (2020). https://doi.org/10.1038/s41379-020-0628-7Figueroa-Rivera IM, Santiago-Rivera L, Magno P. Sessile Serrated Adenoma of the Appendix in an Asymptomatic Patient. Clin Gastroenterol Hepatol. 2018;16(4):A27. doi:10.1016/j.cgh.2017.07.014
Incorrect
Correct: Sessile serrated adenoma
Histology: The appendix is dilated with mucin and there is mucin extravasation in the peri appendiceal soft tissue. The mucosal lining shows a serrated polyp without dysplasia. Some of the glands show dilatation at the base.
Discussion: Not every mucinous distension of the appendix is low grade mucinous neoplasm. In order for it to be a low-grade mucinous neoplasm, the epithelium must show low grade dysplasia. Mucin extravasation without epithelium does not have much clinical significance although sampling is important to completely exclude a LAMN. Once there is disseminated peritoneal disease, the grade of the epithelium is important for the diagnosis: low grade epithelium and mucin is called “disseminated peritoneal adenomucinosis-DPAM; high grade epithelium and mucin is “peritoneal mucinous carcinomatosis-PMCA.”
References:
Ballentine, S.J., Carr, J., Bekhor, E.Y. et al. Updated staging and patient outcomes in low-grade appendiceal mucinous neoplasms. Mod Pathol (2020). https://doi.org/10.1038/s41379-020-0628-7Figueroa-Rivera IM, Santiago-Rivera L, Magno P. Sessile Serrated Adenoma of the Appendix in an Asymptomatic Patient. Clin Gastroenterol Hepatol. 2018;16(4):A27. doi:10.1016/j.cgh.2017.07.014
