Yan Tristan D, Brun Erwin A, Sugarbaker Paul H
Peritoneal Surface Malignancy Program, Washington Cancer Institute, Washington Hospital Center, Washington, DC, USA.
Ann Surg Oncol. 2008 May;15(5):1440-6. doi: 10.1245/s10434-007-9754-4. Epub 2008 Feb 26.
Adenocarcinoid is a rare appendiceal tumor that shows histologically both epithelial and neuroendocrine components. We observed that some patients have peritoneal dissemination, which shows adenocarcinoma but lacks the neuroendocrine histology. The objective of the present study was to quantitate these discordant histopathological findings and examine its clinical implication.
Twenty-six patients with peritoneal dissemination from primary appendiceal adenocarcinoid tumors underwent cytoreductive surgery and perioperative intraperitoneal chemotherapy. All resected specimens were individually submitted for histopathological examination and immunostaining with three neuroendocrine markers. The anatomic locations for peritoneal implants were prospectively recorded. The loss of the neuroendocrine tumor type in peritoneal implants was referred to as discordant feature of the adenocarcinoid tumor. Clinical and histopathological prognostic factors for survival were analyzed.
In nine of the 26 patients (35%) with a primary adenocarcinoid of the appendix, a loss of the neuroendocrine immunochemical marker was noted in peritoneal implants. Discordant histology between the primary appendiceal adenocarcinoid and the peritoneal implants was statistically significantly associated with an improved survival (p = 0.0262), when patients were treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy.
Discordant histology of the primary appendiceal tumor as compared to the peritoneal lesions occurs frequently in patients with adenocarcinoid. An assessment of neuroendocrine markers in both primary and peritoneal lesions may help in the clinical assessment of this group of patients. Small numbers of patients were available for this study and the conclusions are therefore limited.
腺类癌是一种罕见的阑尾肿瘤，在组织学上表现为上皮和神经内分泌成分。我们观察到一些患者出现腹膜播散，表现为腺癌但缺乏神经内分泌组织学特征。本研究的目的是量化这些不一致的组织病理学发现并探讨其临床意义。
26例原发性阑尾腺类癌腹膜播散患者接受了肿瘤细胞减灭术和围手术期腹腔内化疗。所有切除标本均单独送检进行组织病理学检查和三种神经内分泌标志物的免疫染色。前瞻性记录腹膜种植的解剖位置。腹膜种植中神经内分泌肿瘤类型的缺失被称为腺类癌肿瘤的不一致特征。分析生存的临床和组织病理学预后因素。
在26例原发性阑尾腺类癌患者中的9例（35%），腹膜种植中观察到神经内分泌免疫化学标志物缺失。当患者接受肿瘤细胞减灭术和围手术期腹腔内化疗时，原发性阑尾腺类癌与腹膜种植之间的组织学不一致与生存改善在统计学上显著相关（p = 0.0262）。
在腺类癌患者中，原发性阑尾肿瘤与腹膜病变的组织学不一致经常发生。对原发性和腹膜病变中的神经内分泌标志物进行评估可能有助于对这组患者进行临床评估。本研究纳入的患者数量较少，因此结论有限。
