卵巢来源腹膜假黏液瘤临床病理分析

Clinicopathological analysis of ovarian pseudomyxoma peritonei

目的:探讨卵巢来源腹膜假黏液瘤(pseudomyxoma peritonei,PMP)的临床病理学特征及免疫组织化学表型。方法:回顾性分析2010年1月至2019年1月272例于首都医科大学附属北京世纪坛医院确诊为PMP患者的临床资料,研究PMP肿瘤来源,复阅病理切片并行免疫组织化学标记,标记抗体包括CK7、CK20、CEA、Villin、CDX2、SATB2、CA125、ER、PR、PAX8、MUC1、MUC2等。结果:272例PMP中阑尾来源245例(90.1%)、非阑尾来源27例(9.9%)。卵巢来源PMP仅5例(1.8%),其中4例为黏液性囊腺瘤、1例为交界性黏液性囊腺瘤,均发生在单侧,5例中2例合并成熟性囊性畸胎瘤;腹膜播散肿瘤中2例为无细胞性黏液、2例为低级别腹膜黏液癌、1例为高级别腹膜黏液癌。免疫组织化学法检测显示,5例PMP患者组织中CK20、CEA、Villin、CDX2均阳性,2例黏液性囊腺瘤合并畸胎瘤患者的SATB2部分阳性、2例SATB2阴性、1例SATB2灶状阳性。结论:卵巢来源PMP罕见,需对阑尾全部取材或对可疑组织块行连续切片,以排除阑尾黏液性肿瘤,并结合临床症状体征、影像学表现、手术所见、组织学特征及免疫组织化学法检测进行综合分析。

Objective:To analyze the clinicopathological characteristics of ovarian pseudomyxoma peritonei(PMP).Methods:Clinical and pathological data from a total of 272 PMP patients diagnosed at Beijing Shijitan Hospital from January 2010 to January 2019 were collected from a database and retrospectively analyzed to study the origin of PMP tumors.Pathological slides marked with antigens were further studied using immunohistochemical staining,including CK7,CK20,CEA,Villin,CDX2,SATB2,CA125,ER,PR,MUC1,and MUC2.Results:Among the 272 PMP patients studied,the tumors of 245(90.1%)originated from the appendix,while the remaining 27(9.9%)originated from non-appendix tissues,including 5(1.8%)from the ovaries.Ovarian cases included two ovarian teratomas,two ovarian mucinous cystadenomas,and one borderline ovarian mucinous cystadenoma.Histopathological analysis of peritoneal metastases further revealed two acellular mucins,two low-grade mucinous carcinoma peritonei,and one high-grade mucinous carcinoma peritonei,while immunohistochemistry revealed positive staining for CK20,CEA,Villin,and CDX2;SATB2 was also found to be partially positive in teratomas with mucinous tumors:negative in two cases and partially positive in one case.Conclusions:The occurrence of ovarian PMP is rare.Its precise diagnosis demands for a serial section of the whole appendix or suspected tissue to exclude any appendiceal mucinous neoplasms,as well as the combination of a comprehensive analysis of its clinical signs and symptoms,imaging findings,surgical findings,histopathological characteristics,and immunohistochemistry.