女性腹膜原发癌11例临床病理及免疫组化特征

Primary peritoneal carcinomas of females: Clinicopathologic analysis and immunohistochemical study of 11 cases

目的 :探讨女性腹膜原发癌的临床病理学特征。方法 :复习 11例腹膜原发癌病例 ,分析其临床及病理学特征 ,并进行免疫组化染色研究。结果 :病人除 1例外均为绝经后妇女 ,以腹胀为主要临床表现。 10例病人出现腹水且细胞学检查找到癌细胞。组织学检查 :6例为浆液性乳头状腺癌 ,4例为低分化浆液性腺癌部分区域伴有鳞状细胞癌或移行细胞癌成分 ,1例为移行细胞癌。免疫组化染色 :所有病例的肿瘤组织对CK7及EMA均呈明确的阳性表达 ;其中 8例肿瘤对S 10 0蛋白有不同程度的阳性表达 ;部分病例对CEA、Calretinin及Vimentin呈局灶弱阳性表达 ;没有病例显示CK2 0阳性。结论 :女性腹膜原发癌是起源于第二M櫣ｌｌｅｒｉａｎ系统的肿瘤 ,好发于绝经后妇女 ,与卵巢肿瘤相似 ,腹膜原发癌也可显示多种组织类型。免疫组化染色有助于区别胃肠道转移癌及间皮瘤。

Objective: To observe and analyze the clinicopathological features of primary peritoneal carcinoma in women. Methods: Eleven cases of primary peritoneal carcinoma in female patients were reviewed. The clinical and pathological records as well as all the available cytological and histological slides were reviewed. Immunohistochemical studies were performed in formalin fixed paraffin embedded tissue blocks of the peritoneal tumors. Results: The patients were postmenopausal females except one case. All the patients presented with abdominal distension. They were found to have ascites with positive cytology documented in ten cases. Laparotomy revealed multiple neoplastic nodules at the omentum and other peritoneal surfaces. Histologically, six were serous papillary adenocarcinoma, one was transitional cell carcinoma, and four were poorly differentiated serous adenocarcinoma with squamous cell carcinoma and/or transitional cell carcinoma components. Immunoreactivity for CK7 and EMA were demonstrated in all tumor tissues, 73% (8/11) of the tumors were positive for S 100 protein, while a few cases showed weak positivity for CEA, Calretinin and Vimentin. None of the cases were immunoreactive for CK 20. Conclusion: Primary peritoneal carcinomas of females are considered to arise from the secondary Müllerian system. They occur predominantly in postmenopausal women. The carcinomas may also display a wide variety of morphological appearances comparable to their ovarian counterparts. Immunohistochemical studies may be useful in distinguishing these tumors from metastasis from gastrointestinal tract and mesothelioma.