腹膜黏液性肿瘤临床病理特征分析及其起源探讨  

Clinicopathologic characteristics and histogenesis of mucinous tumor of peritoneum

作　　者：张和平[1,2] 孙宇[1] 黄小征[1] 贾玲[1] 白艳花[1] 曹登峰[1] 

机构地区：[1]北京大学临床肿瘤学院北京肿瘤医院暨北京市肿瘤防治研究所病理科恶性肿瘤发病机制及转化研究教育部重点实验室,100142 [2]安徽省妇幼保健院病理科

出　　处：《中华病理学杂志》2014年第3期163-168,共6页Chinese Journal of Pathology

基　　金：北京市卫生系统高层次卫生技术人才队伍建设专项经费（2013-3-082）;北京市科技新星计划项目（2009BG-02）

摘　　要：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，并对其起源进行探讨。方法按照WHO2010消化系统肿瘤分类标准对34例曾诊断为“腹膜假黏液瘤”的病例重新分类，分为低级别和高级别两类，分析低级别和高级别黏液性肿瘤的临床病理特征及其与预后的关系。采用免疫组织化学EnVision法检测特异性AT序列结合蛋白2（specialAT—richsequence．bindingprotein2，SATB2）在腹膜黏液性肿瘤中的表达，并对未明确原发病灶的病例进行CK7、CK20及CDX-2染色对其起源加以探讨。结果34例腹膜黏液性肿瘤中，低级别黏液性肿瘤25例（其中2例为无细胞型），高级别黏液性肿瘤9例，两者与患者年龄、性别、是否复发及累及周围器官均无相关性（P〉0．05）。对30例患者的随访发现，低级别和高级别黏液性肿瘤的总体生存比例分别为13／21（61．9％）和3／9，中位生存时间分别为74和24个月，两者统计学具有相关性，高级别黏液性肿瘤的生存率显著低于低级别黏液性肿瘤（P=0．002）。对除去2例为无细胞型病例共32例行免疫组织化学染色，CDX-2、CK20及CK7总的表达比例分别为93．8％（30／32）、96．9％（31／32）和3／16；在已明确来源的16例中，表达CDX．2、CK20、CK7的分别为15、16和1例；在未明确原发病灶的16例中，表达CDX-2、CK20、CK7的分别为15、15和2例；表达CDX-2、CK20、CK7的在已明确来源的和未明确来源的肿瘤之间差异无统计学意义（P〉0．05）。SATB2在肿瘤中总的表达率为56．3％（18／32），在低级别和高级别黏液性肿瘤的表达比例分别为15／23（65．2％）和3／9，二者差异无统计学意义（P=0．102）；SATB2的阳性表达与预后也无明显相关性（P=0．786）。结论腹膜黏液性肿瘤其WHO最新分级与预后相关，其中高级别肿瘤患者生存率显著低于低级别肿瘤患者；大部分腹膜黏液Objective To investigate the clinicopathologic characteristics, prognosis and histologic origin of the mucinous tumor of the peritoneum. Methods According to 2010 WHO classification of turnouts of the digestive system, 34 cases diagnosed as ＂pseudomyxoma peritonei （PMP）＂ were reevaluated and divided into low grade and high grade. Immunohistochemistry was applied to investigate the expression of SATB2 and the histologic origin of the mutinous tumor of the peritoneum, using antibodies against SATB2, CK7, CK20 and CDX-2. The relationship between clinicopathologic characteristics and prognosis of the low grade and high grade tumors were analyzed. Results Twenty five patients had low grade mueinous tumors （ two of them were no cell type） , nine patients had high grade mucinous tumors. There was no significant difference between low grade and high grade mucinous tumors in age, sex, recurrence and organs involvement （ P 〉 0, 05 ）. Thirty patients were followed up, the overall survival rates of patients with low grade and high grade mueinous tumors were 13/21 （61.9%） and 3/9, respectively. The median survival time was 74 and 24 months in low and high grade patients, and the difference was statistically significant （ P = 0. 002）. Immunohistoehemistry showed the 32 cases （excluding 2 cases of no cell type ） expression rates of CDX-2, CK20, and CK7 in totally were 30/32（93.8%）, 31/32 （96.9%）, and 3/16, respectively; the expression rates of CDX-2, CK20, and CK7 in 16 cases with distinct primary site were 15, 16, and 1, respectively; fifteen of 16 cases of tumors of unknown primary site were positive for CDX-2 and CK20, two of the them were positive for CK7. There was no difference in the expression of CDX-2, CK20 and CK7 between tumors with distinct primary site and tumors with unknown primary site （P 〉 0. 05）. The expression rate of SATB2 in the cases was 56. 3% （ 18/32）, excluding 2 cases of no cell type. There was no significant difference between low grade and high grade tu

关 键 词：假粘液瘤 腹膜 腺癌 粘液 预后 形态发生 免疫组织化学 

分 类 号：R735.5[医药卫生—肿瘤]