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[Clinicopathologic characteristics and histogenesis of mucinous tumor of peritoneum]
Heping Zhang1, Yu Sun2, Xiaozheng Huang
1Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education); Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Objective:
To investigate the clinicopathologic characteristics, prognosis and histologic origin of the mucinous tumor of the peritoneum.
Methods:
According to 2010 WHO classification of tumours of the digestive system, 34 cases diagnosed as "pseudomyxoma peritonei (PMP) " were reevaluated and divided into low grade and high grade. Immunohistochemistry was applied to investigate the expression of SATB2 and the histologic origin of the mucinous tumor of the peritoneum, using antibodies against SATB2, CK7, CK20 and CDX-2. The relationship between clinicopathologic characteristics and prognosis of the low grade and high grade tumors were analyzed.
Results:
Twenty five patients had low grade mucinous tumors (two of them were no cell type), nine patients had high grade mucinous tumors. There was no significant difference between low grade and high grade mucinous tumors in age, sex, recurrence and organs involvement (P>0.05). Thirty patients were followed up, the overall survival rates of patients with low grade and high grade mucinous tumors were 13/21 (61.9%) and 3/9, respectively. The median survival time was 74 and 24 months in low and high grade patients, and the difference was statistically significant (P=0.002).Immunohistochemistry showed the expression rates of CDX-2, CK20, and CK7 in totally 32 cases (excluding 2 cases of no cell type) were 30/32(93.8%), 31/32 (96.9%), and 3/16, respectively; the expression rates of CDX-2, CK20, and CK7 in 16 cases with distinct primary site were 15, 16, and 1, respectively; fifteen of 16 cases of tumors of unknown primary site were positive for CDX-2 and CK20, two of the them were positive for CK7. There was no difference in the expression of CDX-2, CK20 and CK7 between tumors with distinct primary site and tumors with unknown primary site (P>0.05). The expression rate of SATB2 in the cases was 56.3% (18/32), excluding 2 cases of no cell type. There was no significant difference between low grade and high grade tumors in the expression of SATB2 [15/23(65.2%) vs 3/9, P=0.102], also SATB2 was not related to the prognosis of the tumor (P=0.786).
Conclusion:
The prognosis of the mucinous tumor of the peritoneum was significantly different between low grade and high grade according to WHO 2010 classification, and most mucinous tumor of the peritoneum originated from the appendix.
Insights
Prognosis for peritoneal mucinous tumors significantly differs between low and high grades, with most originating from the appendix. Low-grade tumors show a better survival rate than high-grade ones.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Mucinous tumors of the peritoneum, often diagnosed as pseudomyxoma peritonei (PMP), present a diagnostic challenge.
- Accurate classification and understanding of their origin are crucial for patient prognosis.
Purpose of the Study:
- To investigate the clinicopathologic features, prognosis, and histologic origin of peritoneal mucinous tumors.
- To differentiate between low-grade and high-grade tumors based on the 2010 WHO classification.
Main Methods:
- Re-evaluation of 34 PMP cases according to the 2010 WHO classification into low and high grades.
- Immunohistochemistry for SATB2, CK7, CK20, and CDX-2 to determine histologic origin and expression patterns.
- Analysis of clinicopathologic characteristics and prognosis in relation to tumor grade.
Main Results:
- 25 low-grade and 9 high-grade mucinous tumors were identified. No significant difference in age, sex, recurrence, or organ involvement between grades.
- Overall survival rates were 61.9% for low-grade and 33.3% for high-grade tumors (P=0.002). Median survival was 74 months (low-grade) vs. 24 months (high-grade).
- Immunohistochemistry indicated a likely appendiceal origin for most tumors, with high expression of CDX-2 and CK20. SATB2 expression did not correlate with grade or prognosis.
Conclusions:
- Peritoneal mucinous tumors exhibit significantly different prognoses between low and high grades.
- The appendix is the most common origin for these tumors.
- WHO 2010 classification effectively distinguishes prognostically different grades of peritoneal mucinous tumors.