腹膜假黏液瘤浆膜腔积液细胞学诊断价值  

Diagnostic value of cytopathology in pseudomyxoma peritonei

作　　者：卢一艳[1] 齐长海[1] 李方[1] 侯芳[1] 郝志红[1] 庞少军[2] 翟喜超[2] 陈峰[2] 

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9期689-692,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨腹膜假黏液瘤(PMP)浆膜腔积液的细胞学诊断价值。方法分析39例腹膜假黏液瘤浆膜腔积液的细胞学涂片及细胞包埋蜡块的形态学及免疫组化。结果包埋蜡块的阳性率高于涂片阳性率。细胞学形态可根据组织学形态标准采取2级分类法,低级别细胞呈单排排列,核偏位、位于基底部,异型性不显著,胞质丰富,一侧胞质见黏液;而高级别细胞,核位置高低不一,异型显著,部分细胞排列成不规则镶嵌状细胞团,核大小不一,染色质粗糙,呈重度异型,个别细胞胞质可见黏液分泌,均可见黏液背景。包埋蜡块免疫组化显示肠源性标记CK7(-),CK20、villin、CDX-2和MUC-2(+),与组织学一致。结论浆膜腔积液的细胞学检查对腹膜假黏液瘤术前诊断具有一定价值。除了传统涂片,应尽量制作细胞学蜡块,以明确性质及来源。细胞学形态2级分类法与组织学分级符合率高,能为术中治疗方案的选择提供参考,并为无法手术患者提供诊断。Objective To explore the diagnostic value of serous cavity effusion cytology in pseudomyxoma peritonei.Methods 39 cases of serous cavity effusion were processed through centrifugation,and then the samples were smeared,paraffin-embedded,HE staining and immunohistochemical staining. Results The positive rate of the paraffin-embedded block was higher than that of smeared,and the cytological morphology could be classified by2-level,according to the histological morphological criteria： low-grade cells were arranged in single row,cell nuclei located at the base,withnot marked atypia. In the high-grade cells,nuclei were irregularly arranged with significant atypia. Some of the cells were arranged in irregular mosaic cell clusters,the size of the nucleus was different,the chromatin was rough,atypia and mucus secretion was seen in the cytoplasm in individual cells and in the background.Immunohistochemical results of paraffin-embedded block showed enterogenous sign： CK7, CK20 ＋, Villin ＋,CDX-2 ＋,MUC-2 ＋,consistent with histology. Conclusion Cytologic examination of serous effusion is valuable in preoperative diagnosis of pseudomyxoma peritonei. In addition to traditional smear,paraffin-embedded blocks are necessary to define properties and sources of pseudomyxoma peritonei. The morphological of cytological 2-grade classification is coincident with histological changes. It can provide reference for the choice of intraoperative treatment plan,and provide diagnosis for inoperable patients.

关 键 词：腹膜假黏液瘤 浆膜腔积液 细胞病理学 

分 类 号：R730.43[医药卫生—肿瘤]