Schmoeckel Elisa, Kirchner Thomas, Mayr Doris
Institute of Pathology, Faculty of Medicine, LMU Munich, Germany.
Institute of Pathology, Faculty of Medicine, LMU Munich, Germany.
Pathol Res Pract. 2018 Mar;214(3):426-430. doi: 10.1016/j.prp.2017.12.008. Epub 2017 Dec 14.
The differentiation between a primary mucinous ovarian neoplasm and an extra-ovarian metastasis in the ovary is often challenging in the histopathologic practice. Among various ovarian metastases from the gastro-intestinal tract the low-grade appendiceal mucinous neoplasm (LAMN) is an important differential diagnosis to consider particularly in case of pseudomyxoma peritonei. A newly recognized marker in the routine diagnostic of a mucinous neoplasm in the ovary is SATB2 (Special AT-rich sequence-binding protein 2). The expression of SATB2 is, within cells of epithelial lineages, mainly restricted to the lower gastro-intestinal tract, indicating colorectal or appendiceal cancer origin. We report seven cases of LAMN, which clinically became apparent due to ovarian metastases in context of pseudomyxoma peritonei or at least small foci of peritoneal tumor spread. An immunohistochemical marker-panel including SATB2, CDX2, CK20, CK7, PAX8, ER and PR revealed a strong expression of SATB2 in all seven cases. On the contrary SATB2-negativity could be demonstrated in the 40 cases of mucinous borderline tumors and primary mucinous carcinomas of the ovary. The histopathologic tentative diagnosis of an ovarian metastasis of LAMN could be confirmed in the findings of the Appendix in six of seven cases. This report supports SATB2 as an additional diagnostic marker for the diagnosis of an ovarian manifestation of LAMN.
在组织病理学实践中,区分原发性卵巢黏液性肿瘤与卵巢内的卵巢外转移瘤往往具有挑战性。在胃肠道的各种卵巢转移瘤中,低级别阑尾黏液性肿瘤(LAMN)是一个重要的鉴别诊断要点,尤其是在腹膜假黏液瘤的情况下。SATB2(富含特殊AT序列结合蛋白2)是卵巢黏液性肿瘤常规诊断中一种新发现的标志物。SATB2的表达在上皮谱系细胞中主要局限于下胃肠道,提示结直肠癌或阑尾癌起源。我们报告了7例LAMN病例,这些病例临床上因腹膜假黏液瘤背景下的卵巢转移或至少小灶性腹膜肿瘤播散而显现。包括SATB2、CDX2、CK20、CK7、PAX8、雌激素受体(ER)和孕激素受体(PR)在内的免疫组织化学标志物检测显示,所有7例病例中SATB2均呈强表达。相反,在40例卵巢黏液性交界性肿瘤和原发性黏液性癌中可证实SATB2阴性。在7例病例中的6例阑尾检查结果中,LAMN卵巢转移的组织病理学初步诊断得到了证实。本报告支持SATB2作为诊断LAMN卵巢表现的一种辅助诊断标志物。
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