Gui Xianyong, Escobar Jorge, Lee Cheng-Han, Duggan Máire A, Köbel Martin
*Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary; and †Calgary Laboratory Services, Calgary; and ‡Department of Pathology, University of Alberta, Edmonton, Alberta, Canada.
Int J Gynecol Cancer. 2017 Feb;27(2):214-222. doi: 10.1097/IGC.0000000000000871.
Synchronous ovarian/appendiceal mucinous neoplasms sometimes occur in the absence of clinical pseudomyxoma peritonei (PMP), which raises a question about whether the 2 tumors could be independent.
We identified 11 cases of synchronous ovarian/appendiceal mucinous neoplasms without PMP and subclassified them into groups 1 and 2 based on the presence or absence of microscopic peritoneal/ovarian surface mucin deposits. A 7-marker panel (CK7, CK20, CDX2, PAX8, MUC1, MUC2, and MUC5AC) immunohistochemistry was performed on both tumors.
Between the 2 groups, there were no significant differences in age, laterality, size, and histology of ovarian/appendiceal tumors. In group 1, 2 of 4 cases developed PMP later, and both had ovarian surface and contralateral ovarian involvement and appendiceal perforation with microscopic mucin deposits on the peritoneum. No patients in group 2 developed PMP. All group 1 cases showed a high degree of concordance of immunoprofile between the synchronous tumors, with an identical expression of appendiceal pattern in greater than 90% of the markers. In group 2, only 1 of 7 cases showed concordance in all markers.
If peritoneal mucin deposits present, even microscopic and acellular, the synchronous tumors are most likely of a single appendiceal origin. Otherwise, they are more heterogeneous, and some may be truly dual primaries.
同步性卵巢/阑尾黏液性肿瘤有时在无临床腹膜假黏液瘤（PMP）的情况下发生，这引发了关于这两种肿瘤是否可能独立存在的疑问。
我们确定了11例无PMP的同步性卵巢/阑尾黏液性肿瘤病例，并根据有无显微镜下腹膜/卵巢表面黏液沉积将其分为1组和2组。对两种肿瘤均进行了7标志物免疫组化检测（CK7、CK20、CDX2、PAX8、MUC1、MUC2和MUC5AC）。
两组之间，卵巢/阑尾肿瘤的年龄、双侧性、大小和组织学无显著差异。在1组中，4例中有2例后来发生了PMP，两者均有卵巢表面和对侧卵巢受累以及阑尾穿孔，腹膜有显微镜下黏液沉积。2组中无患者发生PMP。1组所有病例的同步性肿瘤之间免疫表型高度一致，超过90%的标志物呈现阑尾型相同表达。在2组中，7例中只有1例所有标志物一致。
如果存在腹膜黏液沉积，即使是显微镜下的和无细胞的，同步性肿瘤很可能起源于单一阑尾。否则，它们更具异质性，有些可能是真正的双原发肿瘤。
