Orta Lurmag, Trindade Arvind J, Luo Jean, Harpaz Noam
Department of Pathology, Mount Sinai School of Medicine, New York, New York 10029, USA.
Inflamm Bowel Dis. 2009 Mar;15(3):415-21. doi: 10.1002/ibd.20764.
IBD is a risk factor for development of colorectal neoplasia. Although IBD frequently involves the appendix microscopically, it is uncertain whether it also predisposes to appendiceal neoplasia.
We performed a retrospective case-control study of incidental appendiceal neoplasms in colectomy specimens of adults with and without IBD (cases and controls, respectively) based on surgical pathology records spanning 54 months. To minimize referral bias, patients were excluded if they had preoperative clinical evidence or a principal pathologic diagnosis of appendiceal disease. The pathologic diagnoses were confirmed retrospectively.
Eleven appendiceal cystadenomas and 6 appendiceal carcinoid tumors were identified among 705 IBD cases (377 ulcerative colitis, 317 Crohn's disease, 11 indeterminate colitis) and 498 non-IBD controls meeting our inclusion criteria. There was no significant difference in prevalence of cyst adenomas between the cases and controls (9/705 [1.3%] versus 2/498 [0.4%], respectively, OR 3.2 [95% CI 0.7-14.9]). However, cyst adenomas were 15-fold more prevalent among cases with synchronous colorectal neoplasia compared with controls (4/69 [5.8%] versus 2/498 [0.4%], OR 15.3 [95% CI 2.7-85]) and 8-fold higher compared with cases without synchronous neoplasia (4/69 [5.8%] versus 5/636 [0.8%], OR 7.8 [95% CI 2.0-29.6]). Appendiceal carcinoids were equally prevalent in cases and controls (4/705 [0.6%] versus 2/498 [0.4%], OR 1.4 [95% CI 0.3-7.8]), cases with synchronous neoplasia and controls (1/69 [1.4%] versus 2/498 [0.4%], OR 3.6 [95% CI 0.3-40.8]), and cases with and without synchronous colorectal neoplasia (1/69 [1.4%] versus 3/636 [0.5%], OR 3.1 [95% CI 0.3-30.2]).
IBD with synchronous colorectal dysplasia or cancer is a risk factor for development of appendiceal cystadenomas, implicating this tumor as a neoplastic complication of IBD. IBD does not predispose to the development of appendiceal carcinoids.
炎症性肠病（IBD）是结直肠肿瘤发生的一个危险因素。虽然IBD在显微镜下常累及阑尾，但尚不确定它是否也易导致阑尾肿瘤。
我们基于54个月的手术病理记录，对有IBD和无IBD的成年患者（分别为病例组和对照组）在结肠切除标本中偶然发现的阑尾肿瘤进行了一项回顾性病例对照研究。为尽量减少转诊偏倚，如果患者术前有阑尾疾病的临床证据或主要病理诊断，则将其排除。病理诊断进行了回顾性确认。
在符合我们纳入标准的705例IBD患者（377例溃疡性结肠炎、317例克罗恩病、11例未定型结肠炎）和498例非IBD对照中，鉴定出11例阑尾囊腺瘤和6例阑尾类癌肿瘤。病例组和对照组的囊腺瘤患病率无显著差异（分别为9/705 [1.3%] 对2/498 [0.4%]，比值比3.2 [95%可信区间0.7 - 14.9]）。然而，与对照组相比，伴有同步结直肠肿瘤的病例中囊腺瘤的患病率高15倍（4/69 [5.8%] 对2/498 [0.4%]，比值比15.3 [95%可信区间2.7 - 85]），与无同步肿瘤的病例相比高8倍（4/69 [5.8%] 对5/636 [0.8%]，比值比7.8 [95%可信区间2.0 - 29.6]）。阑尾类癌在病例组和对照组中的患病率相同（4/705 [0.6%] 对2/498 [0.4%]，比值比1.4 [95%可信区间0.3 - 7.8]），伴有同步肿瘤的病例和对照组中相同（1/69 [1.4%] 对2/498 [0.4%]，比值比3.6 [95%可信区间0.3 - 40.8]），有和无同步结直肠肿瘤的病例中也相同（1/69 [1.4%] 对3/636 [0.5%]，比值比3.1 [95%可信区间0.3 - 30.2]）。
伴有同步结直肠发育异常或癌症的IBD是阑尾囊腺瘤发生的一个危险因素，提示该肿瘤是IBD的一种肿瘤性并发症。IBD不易导致阑尾类癌的发生。
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