消化系统疾病|Gastrointestinal Pathology（十一）

显微镜下，急性阑尾炎的粘膜炎症和坏死非常明显。

Microscopically, acute appendicitis is marked by mucosal inflammation and necrosis.

粘膜显示有溃疡和广泛的中性粒细胞渗出物引起的破坏。

Here, the mucosa shows ulceration and undermining by an extensive neutrophilic exudate.

急性阑尾炎病例中，中性粒细胞弥漫浸润阑尾壁。临床上，病人常表现为右下腹疼痛。体格检查显示有反跳痛。常有白细胞计数增加。

Neutrophils extend into and through the wall of the appendix in a case of acute appendicitis. Clinically, the patient often presents with right lower quadrant abdominal pain. Rebound tenderness is noted on physical examination. An elevated WBC count is usually present.

小腺瘤性息肉（管状腺瘤）。称为管状腺瘤是因为形成的腺体是圆的。有光滑的表面、散在分布。成年人多见。小管状腺瘤本质上常是良性的。那些大于2厘米的腺瘤经过数年可能有 APC、DCC、K-ras和p53基因的累积突变，常有发展成癌的危险。

A small adenomatous polyp (tubular adenoma) is seen here. This lesion is called a "tubular adenoma" because of the rounded nature of the neoplastic glands that form it. It has smooth surfaces and is discreet. Such lesions are common in adults. Small ones are virtually always benign. Those larger than 2 cm carry a much greater risk for development of a carcinoma, having collected mutations in APC, DCC, K-ras, and p53 genes over the years.

直肠息肉的结肠镜检查证明有管状腺瘤。

The colonoscopic appearance of rectal polyps that proved to be tubular adenomas are seen here.

小腺瘤息肉（管状腺瘤）带有小蒂，镜下可见它比正常的结肠黏膜有更多的拥挤的无组织的腺体。杯状细胞减少，沿着息肉的腺体细胞有着色过深的细胞核。然而，它仍然是分化良好的和较局限的，蒂没有被破坏,是良性的。

This small adenomatous polyp (tubular adenoma) on a small stalk is seen microscopically to have more crowded, disorganized glands than the normal underlying colonic mucosa. Goblet cells are less numerous and the cells lining the glands of the polyp have hyperchromatic nuclei. However, it is still well-differentiated and circumscribed, without invasion of the stalk, and is benign.

小息肉两次结肠镜检证明是管状腺瘤。

Two colonoscopic views of a small polyp that proved to be a tubular adenoma is seen here.

腺瘤息肉表面出血（这就是为什么他们经常以血便就诊），有一条长而窄的蒂。息肉超过2厘米时提示恶性的可能性大。但是，这个息肉证明是良性的。

This adenomatous polyp has a hemorrhagic surface (which is why they may first be detected with stool occult blood screening) and a long narrow stalk. The size of this polyp--above 2 cm--makes the possibility of malignancy more likely, but this polyp proved to be benign.

盲肠的多发性腺瘤息肉。回肠末段的在一小部分右边。

Here are multiple adenomatous polyps of the cecum. A small portion of terminal ileum appears at the right.

家族性息肉病，结肠黏膜表面长满了小腺瘤息肉。当然，即使它们现在很小，但随着时间的推移也有100%的危险发展成腺癌的，因此，通常20岁前作全结肠切除术。

This is familial polyposis in which the mucosal surface of the colon is essentially a carpet of small adenomatous polyps. Of course, even though they are small now, there is a 100% risk over time for development of adenocarcinoma, so a total colectomy is done, generally before age 20.

	显微镜下，急性阑尾炎的粘膜炎症和坏死非常明显。 Microscopically, acute appendicitis is marked by mucosal inflammation and necrosis.
	粘膜显示有溃疡和广泛的中性粒细胞渗出物引起的破坏。 Here, the mucosa shows ulceration and undermining by an extensive neutrophilic exudate.
	急性阑尾炎病例中，中性粒细胞弥漫浸润阑尾壁。临床上，病人常表现为右下腹疼痛。体格检查显示有反跳痛。常有白细胞计数增加。 Neutrophils extend into and through the wall of the appendix in a case of acute appendicitis. Clinically, the patient often presents with right lower quadrant abdominal pain. Rebound tenderness is noted on physical examination. An elevated WBC count is usually present.
	小腺瘤性息肉（管状腺瘤）。称为管状腺瘤是因为形成的腺体是圆的。有光滑的表面、散在分布。成年人多见。小管状腺瘤本质上常是良性的。那些大于2厘米的腺瘤经过数年可能有 APC、DCC、K-ras和p53基因的累积突变，常有发展成癌的危险。 A small adenomatous polyp (tubular adenoma) is seen here. This lesion is called a "tubular adenoma" because of the rounded nature of the neoplastic glands that form it. It has smooth surfaces and is discreet. Such lesions are common in adults. Small ones are virtually always benign. Those larger than 2 cm carry a much greater risk for development of a carcinoma, having collected mutations in APC, DCC, K-ras, and p53 genes over the years.
	直肠息肉的结肠镜检查证明有管状腺瘤。 The colonoscopic appearance of rectal polyps that proved to be tubular adenomas are seen here.
	小腺瘤息肉（管状腺瘤）带有小蒂，镜下可见它比正常的结肠黏膜有更多的拥挤的无组织的腺体。杯状细胞减少，沿着息肉的腺体细胞有着色过深的细胞核。然而，它仍然是分化良好的和较局限的，蒂没有被破坏,是良性的。 This small adenomatous polyp (tubular adenoma) on a small stalk is seen microscopically to have more crowded, disorganized glands than the normal underlying colonic mucosa. Goblet cells are less numerous and the cells lining the glands of the polyp have hyperchromatic nuclei. However, it is still well-differentiated and circumscribed, without invasion of the stalk, and is benign.
	小息肉两次结肠镜检证明是管状腺瘤。 Two colonoscopic views of a small polyp that proved to be a tubular adenoma is seen here.
	腺瘤息肉表面出血（这就是为什么他们经常以血便就诊），有一条长而窄的蒂。息肉超过2厘米时提示恶性的可能性大。但是，这个息肉证明是良性的。 This adenomatous polyp has a hemorrhagic surface (which is why they may first be detected with stool occult blood screening) and a long narrow stalk. The size of this polyp--above 2 cm--makes the possibility of malignancy more likely, but this polyp proved to be benign.
	盲肠的多发性腺瘤息肉。回肠末段的在一小部分右边。 Here are multiple adenomatous polyps of the cecum. A small portion of terminal ileum appears at the right.
	家族性息肉病，结肠黏膜表面长满了小腺瘤息肉。当然，即使它们现在很小，但随着时间的推移也有100%的危险发展成腺癌的，因此，通常20岁前作全结肠切除术。 This is familial polyposis in which the mucosal surface of the colon is essentially a carpet of small adenomatous polyps. Of course, even though they are small now, there is a 100% risk over time for development of adenocarcinoma, so a total colectomy is done, generally before age 20.