Abstract
Purpose
To identify clinicopathological features for the differential diagnosis of appendiceal serrated lesions and polyps (SPs) and low-grade appendiceal mucinous neoplasm (LAMN) for the purpose of avoiding over‐diagnosis.
Methods
Clinical data and pathological features of 66 patients with SPs diagnosed at the Aerospace Center Hospital between January 2013 and January 2021 were collected and compared to 22 cases of LAMN.
Results
SPs, compared with LAMN, are likely to be associated with acute inflammation (SPs 53.0% vs. LAMN 18.2%), and may be located in the appendix partly, although with smaller diameter (average 9.6 vs. 27.2 mm); epithelial structures of serrated (100% vs. 22.7%) and filiform villous (47.0% vs. 18.2%) were often found in SPs. SPs occasionally show attenuated or flattened morphology (16.7% vs. 100%) and undulating or scalloped (7.6% vs. 40.9%) structures, and can also be accompanied by diverticulum (18.2% vs. 18.2%) and acellular mucin in the appendiceal wall (16.7% vs. 54.5%), which causes confusion with LAMN. The key point of the differential diagnosis is to observe whether the muscularis mucosa exists (loss, 0% vs. 100%) and fibrosis of the appendiceal wall (0% vs. 100%). SMA immunohistochemistry can assist in the diagnosis. Calcification is also indicative of LAMN.
Conclusions
The epithelial structure of SPs can appear flattened and focally scalloped, and can be accompanied by mucin in the appendiceal wall, which may appear as complex lesions, easily over-diagnosed as LAMN. Key differential diagnostic features are identifying the structure of lamina propria, determining whether the muscularis mucosa exists, and whether the appendiceal wall is fibrotic.
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Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- SL:
-
Serrated lesion without dysplasia
- SLD:
-
Serrated lesion with dysplasia
- SPs:
-
Appendiceal serrated lesions and polyps
- LAMN:
-
Low-grade appendiceal mucinous neoplasm
- PMP:
-
Peritoneal pseudomyxoma
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We thank Charlesworth Author Services (www.cwauthors.com) for its linguistic assistance during the preparation of this manuscript.
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The foundation of Aerospace Center Hospital (20190301-YN-16).
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Study concepts: YL, MJ; Study design: YL, MJ; Data acquisition: YL, HX, CQ; Quality control of data and algorithms: YL, MJ; Data analysis and interpretation: YL, CQ, MJ; Statistic analysis: YL, CQ; Manuscript preparation: YL, CQ, HX, MJ; Manuscript editing: YL, CQ, HX, MJ; Manuscript review: YL, MJ.
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This study had been approved by the Aerospace Center Hospital Institutional Review Board (Approval No: 20190301-YN-16).
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Lu, Y., Qi, C., Xu, H. et al. Differential diagnosis of appendiceal serrated lesions and polyps and low-grade appendiceal mucinous neoplasm: analysis of 88 cases. J Cancer Res Clin Oncol 148, 1761–1769 (2022). https://doi.org/10.1007/s00432-021-03757-6
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DOI: https://doi.org/10.1007/s00432-021-03757-6