肠腔内生性卵巢外腹膜浆液性乳头状腺癌1例并文献复习

doi:10.3969/j.issn.1004-583X.2025.03.011

摘要/Abstract

摘要：

目的通过分析1例罕见生长类型的卵巢外腹膜浆液型乳头状癌(extra-ovarian peritoneal serous papillary carcinoma, EPSPC)病例,探讨这一疾病的临床、病理学特征及诊疗思路。方法回顾分析EPSPC患者1例并复习相关文献。结果患者中年女性,因排便习惯改变伴下腹部隐痛不适2个月就诊,肠镜示直肠巨大隆起性肿物,盆腔核磁示直肠囊样占位,剖腹探查见肿瘤累及直肠左前壁深达黏膜层,送检囊壁提示恶性,排除卵巢及子宫来源,遂行腹腔镜下直肠癌根治术,结合病理诊断为EPSPC。结论 EPSPC临床误诊率高,尤其肠腔内生性EPSPC难与肠道原发腺癌鉴别,需依据临床及病理学特点来诊断。与同类型的卵巢癌相比EPSPC预后较差,手术联合化疗为主要治疗手段。

关键词: 腹膜肿瘤, 腹膜浆液性乳头状癌, 鉴别诊断, 病例报道

Abstract:

Objective To examine a rare case of extra-ovarian peritoneal serous papillary carcinoma (EPSPC) with an atypical growth pattern and to evaluate its clinical and pathological features and diagnostic approach. Methods A middle-aged female patient with EPSPC was retrospectively analyzed, and relevant literature was reviewed. Results The patient presented with abdominal pain and altered bowel habits for two months. Colonoscopy and magnetic resonance imaging (MRI) revealed a large rectal mass and a rectal cystic lesion, respectively. Exploratory laparotomy showed tumor involvement of the rectal left anterior wall mucosa, and the cystic wall suggested malignancy. Histopathology excluded ovarian and uterine origins. Laparoscopic radical resection of rectal cancer was performed, and EPSPC was diagnosed. Conclusion EPSPC has a high clinical misdiagnosis rate, especially intraluminal EPSPC, which mimics primary intestinal adenocarcinoma. Diagnosis relies on clinical and pathological features. Compared to ovarian serous carcinoma, EPSPC has a poorer prognosis, with surgery and chemotherapy as the main treatment options.

Key words: peritoneal neoplasms, peritoneal serous papillary carcinoma, differential diagnosis, case report

中图分类号:

R735.5

李忠标, 赵习浩, 杜敏, 王江, 于跃, 张佃良. 肠腔内生性卵巢外腹膜浆液性乳头状腺癌1例并文献复习[J]. 临床荟萃, 2025, 40(3): 257-261.

Li Zhongbiao, Zhao Xihao, Du Min, Wang Jiang, Yu Yue, Zhang Dianliang. Intraluminal primary extra-ovarian peritoneal serous papillary carcinoma: A case report and literature review[J]. Clinical Focus, 2025, 40(3): 257-261.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.03.011

https://lchc.magtechjournal.com/CN/Y2025/V40/I3/257

图/表 3

图1 肿物相关影像学表现 a~b.盆腔增强CT示子宫多发结节(蓝色标记), 子宫后方见厚壁囊状影(红色标记),相邻直肠受压,局部肠壁增厚;c~d.盆腔MR增强示直肠上段见卵圆形T1信号;e.结肠镜示巨大隆起性病变,局部肠腔狭窄约1/2;f.术中见肿瘤(红色标记)大部分位于腹膜反折以下,直肠(绿色标记)、子宫(蓝色标记)之间,双侧卵巢外观正常(黑色标记)。

Fig.1 Tumor-related imaging findings a, b. Pelvic contrast-enhanced CT shows multiple uterine nodules (blue markers) and a thick-walled cystic lesion (red marker) posterior to the uterus compressing the adjacent rectum with localized bowel wall thickening; c, d. Pelvic MR enhancement reveals an ovoid T1 signal in the upper rectum; e.Colonoscopy identifies a large protruding lesion narrowing the lumen by approximately 50%; f.Intraoperative findings reveal the tumor (red marker) primarily below the peritoneal reflection, located between the rectum (green marker) and uterus (blue marker), with bilaterally normal-appearing ovaries (black markers).

图2 肿物相关病理学表现 a.HE染色癌组织主要位于浆膜层,累及肌层和黏膜下层,黄色箭头标记浆膜层,红色箭头标记肌层(×20);b.癌细胞呈微乳头状,见多形性细胞核和核分裂象(×40);c.免疫组化WT-1核阳性;d.P53弥漫性核染色,错义突变80%+;e.免疫组化ER散在核阳性;f.CK-7弥漫性细胞膜和细胞质阳性;g.PAX-8阳性;H.CDX-2阴性(×50)。

Fig.2 Tumor related pathological findings H&E Staining: a. Tumor predominantly located in the serosa, invading the muscular and submucosal layers; yellow arrow: serosa, red arrow: muscular layer (×20); b.tumor cells micropapillary pattern with pleomorphic nuclei and mitoses (×40). Immunohistochemistry staining (×50):c. WT-1 nuclear positivity;d.P53 diffuse nuclear staining with an 80% missense mutation rate;e.ER scattered nuclear positivity; f. CK-7 diffuse membrane and cytoplasmic positivity; g. PAX-8 positive; (H) CDX-2 negative.

图3 免疫组化神经内分泌标记(Syn)阳性(×50)

Fig.3 Immunohistochemistry staining (×50): neuroendocrine marker SYN positive.

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