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Very nice image. The gross description is that of a mucoceole. This lesion appears to be pushing into the inner muscular wall. An entity of Mucinous Neoplasm of Uncertain Malignant Potential (M-UMP) has been described for mucinous cystadenomas which (amongst other criteria) have epithelium in the appendiceal wall but not clearly being invasive. Do you think this qualifies? I think it might.

----Comment by: Iago on 8/22/2008 4:12:46 PM

Iago - Interesting. The classification of mucinous tumors of the appendix is controversial. Several authors propose different classification schemes. None are perfect for predicting malignant behavoir. I have included a reference from the proponents of a binary 'low grade appendiceal mucinous neoplasm (LAMN) vs. mucinous adenocarcinomas (MACAs)' people [Ref #1] . If you've got a reference for the M-UMP I would enjoy reading it. I seem to remember that ambiguity regarding invasion was a major factor (as you suggest). I think the image above is a straight forward mucinous cystadenoma. I don't see any stray glands and from way up here there doesn't seem to be any striking atypia.

----Comment by: Pathdoc15 on 8/24/2008 1:03:43 PM

This reference discusses appendiceal mucinous neoplasms in the context of pseudomyxoma peritonei. Adv Anat Pathol  Volume 12, Number 6, November 2005

----Comment by: Iago on 8/24/2008 7:11:14 PM

I have uploaded a higher power view of this lesion which demonstrates no cytologic atypia.

----Comment by: CarrieOType on 8/25/2008 6:41:49 AM

A Higher Power View [Ref #1] and Iago's reference [Ref #2]

----Comment by: PathDoc15 on 8/25/2008 8:32:52 AM

     

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