腹水沉渣包埋诊断阑尾低级别黏液性肿瘤1例并文献复习  

A case of low grade mucinous tumor of appendix diagnosed by ascites sediment embedding and literature review

作　　者：丁春晓[1] 张恒[2] 郭丹阳 祝迪[2] 王健[2] DING Chunxiao;ZHANG Heng;GUO Danyang;ZHU Di;WANG Jian(Department of Pathology,Liaoning Province Chinese Medicine Research Institute,Liaoning Shenyang 110034,China;Department of Pathology,the First Affiliated Hospital of China Medical University,Liaoning Shenyang 110001,China)

机构地区：[1]辽宁省中医药研究院病理科,辽宁沈阳110034 [2]中国医科大学附属第一医院病理科,辽宁沈阳110001

出　　处：《现代肿瘤医学》2024年第2期285-288,共4页Journal of Modern Oncology

摘　　要：目的:探讨低级别阑尾黏液性肿瘤腹水脱落细胞的病理形态学特征,结合组织学活检病理特征和临床症状体征,以提高细胞学角度对该病的认识。方法:回顾性分析1例阑尾低级别黏液性肿瘤患者的临床资料、影像学特征、腹水脱落细胞和活检组织学病理形态学特征及预后,并复习国内外相关文献。结果:以腹水为首发症状的阑尾低级别黏液性肿瘤非常罕见,其液基细胞形态主要特点为细胞核通常小而规则,仅有轻度异型性改变,细胞内富含黏液,沉渣包埋制片后可见细胞呈柱状,极向存在,单层或假复层排列,核分裂罕见。本文报道1例以腹水伴盆腔肿物为首发症状就诊,影像学检查与卵巢原发肿瘤鉴别困难,必须结合脱落细胞的病理形态特征进行诊断。结论:阑尾低级别黏液性肿瘤脱落细胞病理形态特点主要为细胞呈柱状,细胞核通常小而规则,异型性小,核分裂罕见,细胞内富含黏液,细胞排列极向存在。腹水伴盆腔肿物极易首诊误诊为原发卵巢肿瘤,同时,通过腹水沉渣细胞学诊断阑尾低级别黏液性肿瘤非常罕见,因此,需结合细胞学形态及临床症状和体征,提高对该病的认识,达到早诊断、早治疗的目的。Objective:To explore the pathological and morphological characteristics of ascitic fluid exfoliated cells in low-grade appendiceal mucinous tumors,combining the pathological features of histological biopsy with clinical symptoms and signs to improve the understanding of the disease from a cytological perspective.Methods:Retrospective analysis of the clinical data,imaging features,ascitic fluid exfoliated cells,biopsy histopathological features,and prognosis of a patient with low-grade mucinous tumor of the appendix,and review relevant literature both domestically and internationally.Results:Low grade mucinous tumors of the appendix with ascites as the initial symptom are very rare.The main characteristic of their liquid based cell morphology is that the nucleus is usually small and regular,with only mild atypical changes.The cells are rich in mucus,and after sediment embedding and sectioning,the cells are columnar,polarized,single-layer or pseudostratified,and nuclear division is rare.This article reports a case of ascites accompanied by pelvic mass as the initial symptom for diagnosis.It is difficult to distinguish between imaging examination and primary ovarian tumor,and diagnosis must be based on the pathological morphological characteristics of exfoliated cells.Conclusion:The pathological characteristics of exfoliated cells in low-grade mucinous tumors of the appendix are mainly columnar in shape,with small and regular nuclei,small atypia,rare nuclear division,abundant mucus in the cells,and polarized cell arrangement.Ascites with pelvic masses are easily misdiagnosed as primary ovarian tumors on initial diagnosis.At the same time,it is very rare to diagnose low-grade mucinous tumors of the appendix through ascites sediment cytology.Therefore,it is necessary to combine cytological morphology,clinical symptoms and signs to improve understanding of the disease and achieve the goal of early diagnosis and treatment.

关 键 词：阑尾黏液性肿瘤 细胞沉渣包埋 腹水 

分 类 号：R735.36[医药卫生—肿瘤]