腹膜黏液性肿瘤的临床病理分析

Clinicopathologic characteristics of pseudomyxoma peritonei

目的分析腹膜黏液性肿瘤的临床病理特征及其与预后的关系。方法按照2010年WHO消化系统肿瘤分类标准对首都医科大学附属北京世纪坛医院病理科2012至2017年52例曾诊断为＂腹膜黏液性肿瘤＂的病例重新分级。观察其原发部位、神经侵犯、钙盐沉积、印戒细胞等病理特征，分析其与预后的关系。对所有病例进行CK7、CK20和CDX2的免疫组织化学染色，对来源不明的病例加染雌激素受体、孕激素受体和p16。结果52例腹膜黏液性肿瘤中，男性29例，女性23例；平均年龄52.0岁。阑尾原发者32例，其他部位20例。低级别组织学形态23例（其中无细胞型1例），高级别组织学形态29例。伴印戒细胞者15例，伴神经侵犯者12例，伴钙盐沉积者9例。伴神经侵犯者预后明显较差（P＝0.025），有印戒细胞者更易伴神经侵犯（P〈0.01）。性别、年龄、原发部位、肿瘤级别等与预后无明显相关性。 结论腹膜黏液性肿瘤的原发部位中神经侵犯现象不罕见，且意味着预后不良。

Objective To analyze the relationship between clinicopathologic characteristics of pseudomyxoma peritonei （PMP） and its prognosis. Methods Fifty-two cases of PMP collected from 2012 to 2017 at Beijing Shijitan Hospital, Capital Medical University were reviewed using the diagnostic criteria of WHO 2010. The histopathologic features, including original location, neural invasion and calcification were observed; and the relationship with prognosis was analyzed. Immunohistochemical staining for CK7, CK20 and CDX2 was performed on all cases. ER, PR, and p16 were additionally performed on those without clear origin.ResultsPatients′ mean age was 52.0 years, and included 29 males and 23 females. Thirty-two cases were derived from appendix; among them, 23 were low grade and 29 were high grade. Signet ring-cells, neural invasion and calcification were detected in 15, 12 and 9 cases respectively. Neural invasion was associated with adverse prognosis （P=0.025） and signet ring cell morphology （P〈0.01）. Prognosis was not related to gender, age, original location or grade. Conclusion Neural invasion is not uncommon in PMP and predicts a bad prognosis.