肿瘤性浆膜腔积液522例细胞病理学分析  

Cytopathological analysis of 522 cases of neoplastic serous effusion

作　　者：郭秀丽[1] 王丽霞[1] 杨静[2] 路静[1] Guo Xiuli;Wang Lixia;Yang Jing;Lu Jing(Department of Pathology,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China;Department of Information Management,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院中国医学科学院肿瘤医院山西医院山西医科大学附属肿瘤医院病理科,太原030013 [2]山西省肿瘤医院中国医学科学院肿瘤医院山西医院山西医科大学附属肿瘤医院信息管理科,太原030013

出　　处：《肿瘤研究与临床》2025年第3期218-222,共5页Cancer Research and Clinic

摘　　要：目的探讨肿瘤性浆膜腔积液中肿瘤细胞的形态特点及免疫细胞化学诊断要点。方法回顾性病例系列研究。收集2019年1月至2023年12月于山西省肿瘤医院经免疫细胞化学检查最终诊断为肿瘤性浆膜腔积液的522例样本。分析样本中肿瘤细胞的显微镜下形态特点及免疫细胞化学诊断要点,并总结少见肿瘤与腺癌的鉴别诊断要点。结果522例肿瘤性浆膜腔积液样本中,胸腔积液305例,腹腔积液178例,心包积液39例。免疫细胞化学诊断为腺癌380例[胸腔积液198例(52.1%),腹腔积液155例(40.8%),心包积液27例(7.1%)]、小细胞癌55例[胸腔积液47例(85.5%),腹腔积液1例(1.1%),心包积液7例(12.7%)]、鳞状细胞癌23例[胸腔积液18例(78.3%),腹腔积液4例(17.4%),心包积液1例(4.3%)]、大细胞神经内分泌癌5例(胸腔积液4例,心包积液1例)、淋巴瘤31例[胸腔积液21例(67.7%),腹腔积液7例(22.6%),心包积液3例(9.7%)]、恶性间皮瘤20例[胸腔积液17例(85.0%),腹腔积液3例(15.0%)]、卵巢交界性肿瘤6例(均为腹腔积液)、卵黄囊瘤2例(均为腹腔积液)。鳞状细胞癌、大细胞神经内分泌癌、淋巴瘤、恶性间皮瘤、卵巢交界性肿瘤、卵黄囊瘤的肿瘤细胞显微镜下形态特点与腺癌细胞相似之处较多,易误诊为腺癌,需借助免疫细胞化学检查才能明确诊断。结论肿瘤性浆膜腔积液中腺癌占绝大多数,其他少见肿瘤细胞形态与腺癌有重叠,需仔细观察并结合患者临床资料及免疫细胞化学检查结果做出正确诊断。Objective To explore the morphological characteristics of tumor cells and the key diagnostic points of immunocytochemistry in neoplastic serous effusions.Methods A retrospective case series study was conducted.A total of 522 samples which were ultimately diagnosed as neoplastic serous effusions by immunocytochemistry were collected in Shanxi Province Cancer Hospital from January 2019 to December 2023.The microscopic morphological characteristics of tumor cells in the samples were analyzed,and the diagnostic points of immunocytochemistry and the differential diagnostic points between rare tumors and adenocarcinoma were summarized.Results Among the 522 samples of neoplastic serous effusion,there were 305 cases of pleural effusion,178 cases of abdominal effusion,and 39 cases of pericardial effusion.Immunocytochemical diagnosis revealed 380 cases of adenocarcinoma[198 cases(52.1%)of pleural effusion,155 cases(40.8%)of peritoneal effusion,and 27 cases(7.1%)of pericardial effusion],55 cases of small cell carcinoma[47 cases(85.5%)of pleural effusion,1 case(1.8%)of peritoneal effusion,and 7 cases(12.7%)of pericardial effusion],23 cases of squamous cell carcinoma[18 cases(78.3%)of pleural effusion,4 cases(17.4%)of peritoneal effusion,and 1 case(4.3%)of pericardial effusion],5 cases of large cell neuroendocrine carcinoma(4 cases of pleural effusion and 1 case of pericardial effusion),and 31 cases of lymphoma[21 cases(67.7%)of pleural effusion,7 cases(22.6%)of peritoneal effusion,and 3 cases(9.7%)of pericardial effusion],20 cases of malignant mesothelioma[17 cases(85.0%)of pleural effusion and 3 cases(15.0%)of peritoneal effusion],6 cases of ovarian borderline tumors(all of which were peritoneal effusions),and 2 cases of yolk sac tumors(both of which were peritoneal effusions).Under the microscope,the morphological characteristics of tumor cells in squamous cell carcinoma,large cell neuroendocrine carcinoma,lymphoma,malignant mesothelioma,ovarian borderline tumor,and yolk sac tumor were similar to those of adenocarcinoma ce

关 键 词：肿瘤 胸腔积液 心包积液 腹水液 免疫细胞化学 细胞诊断学 浆膜腔 

分 类 号：R730.2[医药卫生—肿瘤]