高级别阑尾黏液性肿瘤伴腹膜假黏液瘤9例临床病理分析  

High-grade appendiceal mucinous neoplasm associated with pseudomyxoma peritonei:a clinicopathologic analysis of 9 cases

作　　者：李方[1] 齐长海[1] 卢一艳[1] 侯芳[1] 郝志红[1] 翟喜超[2] 庞少军[2] LI Fang QI Chang-hai LU Yi-yan HOU Fang HAO Zhi-hong ZHAI Xi-chao PANG Shno-jun(Department of Pathology Department of Myxoma, Aerospace Center Hospital, Beijing 100049, China)

机构地区：[1]航天中心医院病理科,北京100049 [2]航天中心医院黏液瘤科,北京100049

出　　处：《诊断病理学杂志》2017年第6期406-410,422,共6页Chinese Journal of Diagnostic Pathology

基　　金：航天中心医院院级课题(YN201505)

摘　　要：目的探讨高级别阑尾黏液性肿瘤(HAMN)及相关性腹膜假黏液瘤(PMP)的临床病理学特征。方法回顾性分析2008-01-2016-06间在航天中心医院接受手术切除的9例HAMN的临床病理资料,对具有代表性的切片进行CK7、CK20、villin、CDX2、MUC-2免疫组化染色。结果男性5例,女性4例,年龄55~66岁,平均年龄61岁。随访6~81个月,4例死亡,4例生存,1例失访。形态学上,HAMN内衬绒毛状/乳头状/波浪状、单层平坦、筛状黏液性上皮,部分区域上皮可脱失,7例局灶见高级别异型增生,2例内衬上皮几乎均呈高级别异型增生,均未见侵袭性浸润。9例均伴有PMP,其中6例为高级别PMP,1例为低级别PMP,2例为无细胞性黏液池。9例免疫组化结果:CK20、villin、CDX2和MUC-2均(+),CK7(-)。结论 HAMN具有独特的形态学特征,并常伴有高级别PMP,生物学行为较LAMN更具侵袭性,在诊断过程中尤其需注意将具有局灶性高级别异型增生的AMN报告为HAMN,以提示临床预后。Objective To investigate the clinicopathologic features of high-grade appendiceal mucinous neoplasm （HAMN） associated with pseudomyxoma peritonei （PMP）. Methods Clinical and pathological data from 9 patients with HAMN undergoing surgical resection in Aerospace Center Hospital during January 2008 and June 2016 were retrospectively analyzed. Representative slides of tumors were submitted for immunohistochemical staining. CK7, CK-20, CDX-2, and MUC-2 were detected by immunohistochemical staining. Results Nine cases were reviewed, including 5 men and 4 women, ranging in age from 55 to 66 years, with an average age of 61 years. The follow-up interval ranged from 6 to 81 months, with 4 patients died and 4 patients survived. Morphologically, HAMN had villiform/papillary/undulating, flattened, cribriform mucinous epithelium, and son^letimes accompanied with epithelial denudation. High-grade cytologic atypia was found in focal region in 7 cases, while involving almost epithelium in 2 cases. No infiltrative invasion was observed in 9 cases of HAMN. All the cases of HAMN were associated with pseudomyxoma peritonei, including 6 cases of high-grade PMP, 1 case of low-grade PMP, and 2 cases of acellular mucin pool. Mucinous epithelium in 9 patients was positive for CK20, Villin, MUC-2 and negative for CK7. Conclusion HAMN has unique morphological features, and fi＇equently accompanied by high-grade PMP. Biological behavior of HAMN is more aggressive than LAMN. Thus, we should pay more attention to AMN with focal feature of high-grade cytologic atypia and report as HAMN in order to predict clinical prognosis.

关 键 词：假黏液瘤 腹膜 阑尾黏液性肿瘤 病理学 

分 类 号：R735.86[医药卫生—肿瘤]