Rudzki Zbigniew, Zazula Monika, Białas Magdalena, Klimek Marek, Stachura Jerzy
Department of Pathomorphology, Collegium Medicum, Jagiellonian University, Kraków.
Pol J Pathol. 2002;53(1):29-34.
Association of mucinous adenomas of the appendix and mucinous ovarian tumors is well known. The origin of the ovarian tumor (metastasis from the appendix vs independent primary) is still debated. Serrated adenoma is a rare neoplasm of the distal gastrointestinal tract, and its precancerous role in the colorectum was recently postulated. A 74-year-old patient was subjected to hysterectomy with routine appendectomy due to a 17-cm tumor of her right ovary. Histological examination revealed a high-grade ovarian adenocarcinoma with peritoneal involvement. The appendix, grossly unremarkable, harbored a serrated adenoma with no evidence of invasion or malignant transformation. Immunohistochemical examination revealed CD7+, CK20-phenotype of the ovarian and reverse (CK7-, CK20+) phenotype of the appendiceal tumor. Microsatellite analysis demonstrated microsatellite instability (MSI-high) within the serrated adenoma (4/5 markers with positive amplification) and no MSI (0/6 amplified markers) in the samples from the ovarian carcinoma, its metastases and the uninvolved uterine cervix. There were also differences in LOH pattern between the ovarian adenocarcinoma and the serrated adenoma. The findings suggest two independent primaries with profound differences in tumorigenetic pathways of both lesions. To the best of our knowledge this is the first report of synchronous serrated adenoma of the appendix and ovarian carcinoma.
阑尾黏液性腺瘤与卵巢黏液性肿瘤的关联已为人熟知。卵巢肿瘤的起源（来自阑尾的转移瘤与独立原发肿瘤）仍存在争议。锯齿状腺瘤是远端胃肠道的一种罕见肿瘤，其在结直肠癌中的癌前作用最近得到了推测。一名74岁的患者因右侧卵巢有一个17厘米的肿瘤接受了子宫切除术及常规阑尾切除术。组织学检查显示为高级别卵巢腺癌伴腹膜受累。阑尾外观无明显异常，含有一个锯齿状腺瘤，无浸润或恶性转化证据。免疫组化检查显示卵巢肿瘤为CD7 +、CK20表型，阑尾肿瘤为相反的（CK7 -、CK20 +）表型。微卫星分析显示锯齿状腺瘤内存在微卫星不稳定性（MSI -高，4/5个标记物扩增阳性），而卵巢癌及其转移灶以及未受累的子宫颈样本中无MSI（0/6个扩增标记物）。卵巢腺癌和锯齿状腺瘤之间的杂合性缺失模式也存在差异。这些发现提示这是两个独立的原发肿瘤，二者在肿瘤发生途径上存在显著差异。据我们所知，这是阑尾同步锯齿状腺瘤和卵巢癌的首例报告。
