COTA在卵巢粘液性肿瘤中的分布及其在诊断上的应用

The localization and diagnostic value of colon-ovarian tumor antigen (COTA) were studied by immunohistochemical S-P method. COTA was found in all 18 cases of mucinous ovarian cystadenocarcinoma (100%) and 3 border line cystadenomas (100%). Yet in 18 cases of ovarian benign mucinous cystadenoma, only 3 were positive (16.6%). These results indicate that COTA is a highly sensitive and specific antigen for mucinous ovarian cystadenocarcinoma and has potential for the early detection of malignant changes in mucinous ovarian cystadenoma.     

Cystadénome hépatique: le besoin d’un traitement radical

The hepatic cystadenoma is a rare tumor, often affecting women. It is characterized by its tendency to recur after surgery and the risk of malignant transformation into cystadenocarcinoma. Only histological examination can decide on the benign or malignant lesion. We report the case of a mucinous cystadenoma with mesenchymal stroma, and we discuss the diagnosis and therapeutic aspects of this type of lesion that justify a radical surgical treatment, even in the absence of arguments in favor of malignancy.     

Malignant fibrous histiocytoma coexistent with mucinous cystadenoma of the pancreas.

A patient with malignant fibrous histiocytoma (MFH) coexistent with mucinous cystadenoma of the pancreas is reported. Primary MFH of the pancreas is rare, with only six patients reported in the world medical literature. A patient with MFH coexistent with a pancreatic mucinous epithelial tumor has not been reported previously, although two patients with pseudosarcomatous tumor associated with mucinous cystadenocarcinoma of the pancreas have been reported. Mural nodules of similar histologic appearance have been reported in ovarian mucinous tumors. The authors believe this to be the first report of the occurrence of MFH in mucinous cystadenoma of the pancreas.     

卵巢浆液性／黏液性囊腺癌中SP1、KLF9的表达及与HPV16／18感染的相关性研究

目的 探讨KLF9、SP1及HPV16／18在卵巢浆液性／黏液性囊腺癌中的表达及临床意义,并进一步探讨三者在浆液性／黏液性卵巢癌发生、发展过程中的作用。方法 制作组织芯片并采用免疫组化SP法及分子原位杂交技术检测60例卵巢浆液性／黏液囊腺癌组织及20例卵巢浆液性／黏液性囊腺瘤组织中KLF9、SP1和HPV16／18的表达情况,分析三者与临床病理特征的关系,并检验三者之间的相关性。结果 SP1、KLF9及HPV16／18在卵巢浆液性／黏液性囊腺癌组织中的阳性表达率分别为71.7％（43／60）、63.3％（38／60）、30.0％（18／60）,而三者在卵巢浆液性／黏液性囊腺瘤组织中分别为15.0％（3／20）、10.0％（2／20）、0（0／20）,差异均有统计学意义（P＜0.01）。KLF9表达与各临床病理特征均无关（P＞0.05）;SP1表达与临床分期有关（P＜0.05）;HPV16／18表达与分化程度有关（P＜0.05）。在卵巢浆液性／黏液性囊腺癌组织中KLF9与SP1的表达呈正相关（r=0.443,P=0.000）,HPV16／18与SP1的表达亦呈正相关（r=0.331,P=0.010）,KLF9与HPV16／18的表达无相关性（P=0.133）。结论 KLF9、SP1及 HPV16／18在卵巢浆液性／黏液性囊腺癌组织中高表达,可能与卵巢浆液性／黏液性囊腺癌的生物学行为有关,在浆液性／黏液性卵巢癌的发生、发展中起重要的促进作用。     

Mucinous tumors of the ovary. A clinicopathologic study of 70 cases

Seventy cases of mucinous ovarian tumor were reviewed. All patients were followed for a minimum of 5 years. Clinicopathologically, three groups were defined: (1) mucinous cystadenoma, which demonstrated no nuclear stratification and no stromal invasion (15 cases); (2) mucinous tumor of uncertain malignant potential, which was characterized by nuclear stratification of two to three layers and no stromal invasion (21 cases); and (3) mucinous carcinoma, which showed stromal invasion and/or nuclear stratification in excess of three layers (34 cases; 15 with invasion, 19 without). All patients with mucinous cystadenomas remained tumor-free after initial surgery. Two patients with mucinous tumors of uncertain malignant potential died of tumor at 55 and 72 months, respectively, whereas 18 with mucinous carcinomas died after intervals ranging from 2 to 71 months. All mucinous tumors of uncertain malignant potential were Stage I at presentation. Twenty-one mucinous carcinomas were Stage I (six tumor deaths), one was Stage II (tumor death), ten were Stage III (nine tumor deaths), one was Stage IV (tumor death), and one was of uncertain stage (tumor death). Patients with mucinous carcinomas having stromal invasion demonstrated poorer survival (10 of 15 dead) than those with mucinous carcinomas lacking this finding (8 of 19 dead); however, stromal invasion was related to higher stage (5 with invasion Stage I; 16 without invasion Stage I).     

卵巢浆液性肿瘤PTTG的表达与MMP-2 及VEGF的关系*

目的:研究垂体肿瘤转化基因（PTTG）蛋白、基质金属蛋白酶-2（MMP-2）、血管内皮生长因子（VEGF）在卵巢浆液性肿瘤中的表达及其相关性,探讨PTTG在卵巢浆液性肿瘤恶性转化中的作用及与肿瘤侵袭性的关系。方法:运用免疫组织化学的方法检测30例卵巢浆液性囊腺瘤、21例卵巢交界性浆液性囊腺瘤、30例卵巢浆液性囊腺癌原发灶和网膜转移灶中PTTG、MMP-2及VEGF的表达水平。结果:1）PTTG在卵巢浆液性肿瘤各分组中表达差异有统计学意义（P<0.01）,其中交界性浆液性囊腺瘤组的表达高于浆液性囊腺瘤组（P<0.01）,浆液性囊腺癌原发灶组表达高于交界性组（P<0.01）,浆液性囊腺癌网膜转移灶组表达高于原发灶组（P<0.05）;2）MMP-2 在浆液性囊腺癌原发灶组及交界性浆液性囊腺瘤组中的表达高于浆液性囊腺瘤组（P<0.01）,在浆液性囊腺癌网膜转移灶中的表达高于原发灶组（P<0.05）;3）VEGF在浆液性囊腺癌原发灶组及交界性浆液性囊腺瘤组中的表达高于浆液性囊腺瘤组（P<0.05）,在浆液性囊腺癌网膜转移灶组与原发灶组间表达差异无统计学意义（P>0.05）;4）PTTG、MMP-2和VEGF三者的表达水平呈正相关（P<0.01）。 结论:PTTG表达程度随卵巢浆液性肿瘤恶性程度及侵袭性的增加而升高,PTTG可能参与了卵巢浆液性肿瘤恶性转化过程并且通过上调MMP-2 及VEGF的表达在肿瘤侵袭转移中发挥重要作用。      

粘蛋白MUC1在卵巢浆液性肿瘤中的表达及其临床意义

目的:研究粘蛋白MUC1在卵巢浆液性肿瘤中的表达及其临床意义。方法:应用免疫组织化学SP法检测53例卵巢浆液性囊腺癌、20例交界性卵巢浆液性囊腺瘤、20例卵巢浆液性囊腺瘤、20例正常卵巢组织中MUC1的表达情况。结果:MUC1在卵巢浆液性囊腺癌中的阳性表达率为88.7%,略高于交界性浆液性囊腺瘤中的表达(70%)(P=0.1172),明显高于良性卵巢浆液性囊腺瘤(35%)及正常卵巢组织(30%)中的表达(P<0.05)。MUC1的阳性表达与卵巢浆液性囊腺癌的临床分期有关(P<0.05),与年龄、组织分级和淋巴结转移无关(P>0.05)。结论:粘蛋白MUC1在卵巢浆液性囊腺癌的发生、发展中起重要作用,MUC1可作为判断卵巢浆液性囊腺癌生物学行为和恶性潜能的参考指标。     

肝胆管黏液性囊性肿瘤临床病理分析

 目的　探讨肝胆管黏液性囊性肿瘤的临床病理特点。方法　选取1993年5月至2007年5月间经手术病理证实的肝胆管黏液性囊性肿瘤9例,对其临床表现、影像学及病理特征进行回顾性分析。结果　肝胆管黏液性囊腺瘤6例,呈多房性,囊壁光整,厚薄一致,分隔均匀;囊腺癌3例,单囊性2例,多囊性1例,壁结节2例,乳头状突起及囊壁局部不均匀增厚1例,钙化2例,CT增强扫描动脉期囊壁及壁结节开始强化,门脉期及延迟期强化明显,呈"慢进慢出"特点,腹膜后淋巴结肿大1例。结论　肝胆管黏液性囊性肿瘤临床表现缺乏特异性,CT表现具有一定特征,单囊、囊壁不均匀增厚、壁上结节或乳头状突起及斑块状钙化者考虑为囊腺癌,但确诊需依靠病理。     

Cystic neoplasms of the pancreas; what a clinician should know

Primary cystic neoplasms of the pancreas (serous cystic neoplasms, mucinous serous neoplasms, and intraductal papillary mucinous neoplasms) are lesions of emerging importance. With the wide availability of modern imaging methods, these neoplasms are being recognized with increasing frequency. Due to the improvement of these sophisticated imaging techniques, it is often possible to differentiate preoperatively these primary pancreatic cystic neoplasms not only from other cystic pancreatic disorders (such as pancreatic pseudocysts) but also from one another. This differentiation is very important for the clinician, since these neoplasms have radically different biologic behavior. Serous cystic neoplasms are uniformly benign and usually do not mandate resection unless the lesion is symptomatic. In contrast, mucinous cystic neoplasms and intraductal papillary mucinous neoplasms have a premalignant or overtly malignant tendency, and therefore should be managed aggressively by pancreatic resection. In these mucinous cystic neoplasms, recognition of an underlying malignancy is often not possible without a detailed histopathologic examination of the entire resected specimen. In the absence of invasive disease, prognosis is excellent after appropriate surgery. The presence of invasive malignancy signifies a poor prognosis.     

A rare case of serous cystadenocarcinoma of the pancreas.

Serous cystadenocarcinoma of the pancreas, a rare disease, developed in a 63-year-old Japanese woman. Pathologic examinations of the pancreatic tumor at the subtotal pancreatectomy showed it to be serous cystadenoma with focal atypical lesions. Three years after the operation, however, metastatic liver nodules were found, and the histologic characteristics of these lesions were quite similar to those of the pancreatic neoplasm. Both primary and metastatic tumors were composed of multiple cysts separated by fibrous septa. The epithelium of cysts was cuboidal and had clear cytoplasm, which had positive results for periodic acid-Schiff (PAS) and negative results for PAS with diastase, Alcian blue, and mucicarmine. To the knowledge of the authors, serous cystic neoplasms of the pancreas have been uniformly benign in biologic behavior. Recently, however, serous cystadenocarcinoma of the pancreas has been reported as a new entity. The current case is the second reported case and might support the existence of serous cystadenocarcinoma of the pancreas.     

Fine-needle aspiration cytology of mucinous tumors of the pancreas

BACKGROUND: Tumors of the pancreas associated with extracellular mucin production include mucin-producing ductal adenocarcinoma, mucinous cystic neoplasm (MCN), and intraductal papillary mucinous tumor (IPMT). Fine-needle aspiration (FNA) is used as an adjunct to radiologic analysis for the preoperative categorization of these tumors. The current study was designed to identify distinctive cytomorphologic features that would be useful for the categorization of mucinous tumors of the pancreas. METHODS: The authors evaluated Papanicolaou smears and Diff-Quik-stained smears of specimens obtained by computed tomography-guided and endoscopic ultrasound-guided FNA of the pancreas in 51 cases of mucinous tumors. In the 19 cases in which the patients underwent surgical excision after FNA, the cytologic features were compared with the histopathologic findings. The remaining cases were categorized as one of the three above-mentioned types of mucinous tumors on the basis of cytomorphologic features identified as indicative of subtype among the cases in which a cytologic-histologic correlation was performed. RESULTS: Among the 19 cases with cytologic-histologic correlation, 2 cases of serous cystadenoma and 2 cases of gastrointestinal duplication cyst were misdiagnosed on cytologic analysis as low-grade MCN. Among the remaining 15 cases, cytologic features by histologic diagnosis were as follows: ductal adenocarcinoma (n = 4): moderate to high cellularity, mild to moderate background mucin, three-dimensional clusters, high nuclear cytoplasmic ratios, and mild to moderate nuclear membrane irregularities; low-grade MCN (n = 5): mild to moderate cellularity, abundant background mucin, small clusters, and flat sheets of relatively bland glandular cells; mucinous cystadenocarcinoma (n = 1): similar to ductal adenocarcinoma but more abundant background mucin; and IPMT (n = 5): moderate to high cellularity, abundant background mucin, and prominent papillary arrangement of tall columnar cells with mild to moderate nuclear atypia. The remaining 32 cases were categorized based on cytology alone as adenocarcinoma with mucin production (n = 24) and low-grade MCN (n = 8). CONCLUSIONS: IPMT and low-grade MCN possess distinctive cytologic features that can be used to diagnose them correctly and distinguish them from one another and from other cystic tumors. Duplication cysts closely mimic low-grade MCN, which can lead to false-positive diagnoses. Because of substantial overlap in cytologic features, mucin-producing ductal adenocarcinoma was unable to be distinguished from mucinous cystadenocarcinoma cytologically.     

Oct4、Stat3在卵巢浆液性/黏液性囊腺癌中的表达及临床意义

目的:探讨Oct4、Stat3在卵巢浆液性/黏液性囊腺癌中的表达及其相关性。 方法:应用组织芯片,采用免疫组化SP法检测60例卵巢浆液性/黏液性囊腺癌组织中Oct4、Stat3的表达。结果:Oct4在卵巢浆液性/黏液性囊腺瘤中的阳性表达率为35.0%（7/20）,低于卵巢浆液性/黏液性囊腺癌中的83.3%（50/60）,两者有显著统计学差异（P<0.01）。卵巢浆液性/黏液性囊腺癌中Oct4的阳性表达率与患者年龄、临床分期、组织学分化程度、患者组织学类型均无相关性（P>0.05）。Stat3在卵巢浆液性/黏液性囊腺癌阳性表达率为71.7%（43/60）,明显高于卵巢浆液性/黏液性囊腺瘤中的35.0%（7/20）,两者有显著统计学差异（P<0.01）。Stat3在Ⅰ、Ⅱ期癌中的阳性表达率低于Ⅲ、Ⅳ期癌（P<0.05）,在中、低分化癌中的阳性表达率高于高分化癌（P<0.05）,与患者组织学类型无关。卵巢浆液性/黏液性囊腺癌中Oct4表达与Stat3表达呈正相关（P<0.05）。结论:Oct4、Stat3高表达可能与卵巢浆液性/黏液性囊腺癌的发生、发展密切相关,且相互间可能具有协同作用。     

Ductectatic-type Mucinous Cystadenoma and Cystadenocarcinoma of the Human Pancreas: A Novel Clinicopathological Entity

A new type of mucinous cystic pancreatic neoplasm is described. The lesions, which have been recognized only recently with the progress of diagnostic techniques and have not previously been described in the literature, are characterized by multilocular cysts with papillary proliferation of the lining epithelium. They occur exclusively in the head and body, predominantly in males, and coexistence of well-differentiated adenocarcinoma as well as adenoma components is frequently encountered. These lesions are quite different from hitherto described mucinous cystic neoplasms of pancreas, not only in terms of gross features but also with regard to intrapancreatic location, and sex and age distributions. We propose to classify these lesions as a new pancreatic tumor entity: the ductectatic-type mucinous cystadenoma/cystadenocarcinoma.     

Case of a 23-year-old woman with serous surface papilloma of borderline malignancy of the left ovary and mucinous cystadenoma of the right ovary

A rare case is reported of a 23-year-old woman with serous surface papilloma of borderline malignancy (SSPBM) of the left ovary associated with a foci of peritoneal “implant,” as well as the coexistence of mucinous cystadenoma of the right ovary. The histologic diagnosis of these tumors was classified according to the criteria of the World Health Organization. To confirm the histologic diagnosis, special staining was performed both with AIcian blue, periodic acid-Schiff (PAS), and PAS with diastase digestion, and with immunohistochemical staining for vimentin, cytokeratin, epithelial membrane antigen (EMA), neuron-specific enolase, and carbohydrate antigen 19-9 (CA 19-9). After hematoxylin and eosin staining of the tissue samples, the right ovarian tumor was diagnosed as benign mucinous cystadenoma, and the left ovarian tumor was identified as serous surface papilloma with no apparent stromal invasion, but showing proliferating activity and nuclear abnormality (SSPBM). The histologic features of the peritoneal lesion resembled those of the SSPBM of the left ovary, and showed no invasion of underlying normal tissue. Moreover, both the SSPBM and the peritoneal lesion showed similar patterns on special staining. The summary diagnosis was SSPBM of the left ovary associated with a foci of peritoneal noninvasive “implant” and coexistent mucinous cystadenoma of the right ovary. Regardless of whether or not the peritoneal loci represented an autochthonous multicentric tumor of the peritoneum or a secondary implant from the left SSPBM, the less aggressive histologic character of her tumors has allowed this patient to survive for 8 years after fertility-retaining surgery with no sign of recurrence.     

胰腺囊性肿瘤15例的外科治疗

回顾分析了 1987年 1月 12日～ 2 0 0 4年 1月 17日外科治疗 15例胰腺囊性肿瘤患者的临床资料。其中术前诊断率 60 0 % ( 9/15 ) ,手术切除率 73 3 % ( 11/15 ) ,术后 7个月～ 16年随访率 80 0 % ( 12 /15 ) ,无复发者 83 3 % ( 10 /12 ) ,2例黏液性囊腺癌术后 6及 8年仍健在。分析结果提示 ,根据临床表现、影像学检查 (B超、CT)、实验室检查、囊内液肿瘤标记物、酶及细胞学检查综合分析 ,可提高诊断率 ;本病手术切除率及治愈率较高 ,应采取积极的外科治疗措施。     

卵巢黏液性肿瘤中claudin-3、claudin-4的表达及其意义

目的 探讨claudin-3、-4在卵巢黏液性囊腺癌的发生、发展过程中的作用.方法 应用免疫组织化学、原位杂交方法检测卵巢上皮、黏液性囊腺瘤、交界性黏液性囊腺瘤、黏液性囊腺癌的石蜡包埋组织中claudin-3、-4和claudin-4 mRNA的表达情况.结果 claudin-3、-4、claudin-4 mRNA在卵巢上皮及卵巢黏液性囊腺瘤中表达最弱;交界性黏液囊腺瘤中表达明显增强,却明显弱于黏液性囊腺癌(P<0.05);在低分化卵巢癌中的表达强于高分化癌及中分化癌(P<0.05),中分化癌与高分化癌中的表达无统计学意义(P>0.05).结论 claudin-3、-4表达增强,与黏液性囊腺癌的发生、发展密切相关,与其分化程度有关,可能会成为诊断卵巢黏液性囊腺癌的特异性标记物.     

Appendiceal Mucocele. A retrospective Analysis of 19 Cases

Background

Appendiceal mucocele is an infrequent well-recognized entity that can present in a variety of clinical syndromes or can be asymptomatic and discovered incidentally.

Patients and Methods

Nineteen patients with a diagnosis of primary appendiceal mucocele treated in our institution between January 1, 1987 and December 31, 2006 were included in this retrospective analysis.

Results

The histological examination of the specimens revealed simple and hyperplastic appendiceal mucocele in nine cases (47%), mucinous appendiceal cystadenoma in eight cases (42%), and mucinous appendiceal cystadenocarcinoma in two cases (11%). Thirteen patients (68%) underwent appendectomy, five patients (26%) right colectomy, and two patients (6%) underwent right colectomy for invasive appendiceal cystadenocarcinoma and at the same time right nephrectomy and sigmoidectomy, respectively, for concomitant malignancy.

Conclusion

Mucocele of the appendix may be related to a benign or malignant appendiceal process, leading to individualized diagnosis and treatment.     

Intrahepatic mucinous biliary cystadenoma

Mucinous biliary cystadenoma (MBC) is a very rare cystic tumour of the liver usually occurring in middle-aged women. This condition is difficult to diagnose before surgery; differential diagnosis with hydatid disease of the liver has to be done and is difficult to distinguish from mucinous biliary cystadenocarcinoma. We report two diagnosed and treated cases of intrahepatic MBC.     

肝胆管囊腺瘤及肝胆管囊腺癌诊疗分析(附10例)

目的:探讨肝胆管囊腺瘤及肝胆管囊腺癌的临床特征、诊断及治疗方法.方法:回顾性分析中国医科大学附属第一医院2009年1月至2016年3月收治的7例肝胆管囊腺瘤及3例肝胆管囊腺癌病例.结果:其中男性3例(肝胆管囊腺瘤2例,肝胆管囊腺癌1例),女性7例(肝胆管囊腺癌2例,肝胆管囊腺瘤5例).肝胆管囊腺瘤患者共7例,其中男性2例,女性5例,平均年龄42.7岁;无明显特异性症状,患者往往于体检中偶然发现,或因瘤体本身较大引发压迫症状、触及腹部包块而入院检查发现病灶.7例患者均行CA19-9检查,3人指标升高,4人在正常范围.AFP未见明显异常.术中所见均为囊性病变,囊内壁多光滑,肿物大小不均,并伴有分隔.肝胆管囊腺癌患者共3例,其中男性1例,女性2例,平均年龄53.7岁;病人多以腹胀为主诉来诊,无其他明显症状;行CA19-9检查均未见异常;AFP未见明显异常.术中所见均为囊性病变,癌肿体积大,囊壁内有多发菜花样赘生物.所有患者均手术切除,其中8例已随访,均无复发及转移.结论:肝胆管囊腺瘤及囊腺癌为肝脏罕见囊性肿瘤,缺乏特异性自觉症状,早期诊断困难,临床误诊率高,增强CT检查有助于明确诊断,最终确诊仍有赖于病理诊断.手术切除可获得较好的治疗效果.     

Intraductal papillary mucinous tumors of the pancreas: biology, diagnosis, and treatment

Pancreatic intraductal papillary mucinous neoplasms (IPMNs) rank among the most common cystic tumors of the pancreas. For a long time they were misdiagnosed as mucinous cystadenocarcinoma, ductal adenocarcinoma in situ, or chronic pancreatitis. Only in recent years have IPMNs been fully recognized as clinical and pathological entities, although their origin and molecular pathogenesis remain poorly understood. IPMNs are precursors of invasive carcinomas. When resected in a preinvasive state patient prognosis is excellent, and even when they are already invasive, patient prognosis is more favorable than with ductal adenocarcinomas. Subdivision into macroscopic and microscopic subtypes facilitates further patient risk stratification and directly impacts treatment. There are main duct and branch duct IPMNs, with the main duct type including the intestinal, pancreatobiliary, and oncocytic types and the branch duct type solely harboring the gastric type. Whereas main duct IPMNs have a high risk for malignant progression, demanding their resection, branch duct IPMNs have a much lower risk for harboring malignancy. Patients with small branch duct/gastric-type IPMNs (<2 cm) without symptoms or mural nodules can be managed by periodic surveillance.