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目的探讨腹膜假黏液瘤(PMP)浆膜腔积液的细胞学诊断价值。方法分析39例腹膜假黏液瘤浆膜腔积液的细胞学涂片及细胞包埋蜡块的形态学及免疫组化。结果包埋蜡块的阳性率高于涂片阳性率。细胞学形态可根据组织学形态标准采取2级分类法,低级别细胞呈单排排列,核偏位、位于基底部,异型性不显著,胞质丰富,一侧胞质见黏液;而高级别细胞,核位置高低不一,异型显著,部分细胞排列成不规则镶嵌状细胞团,核大小不一,染色质粗糙,呈重度异型,个别细胞胞质可见黏液分泌,均可见黏液背景。包埋蜡块免疫组化显示肠源性标记CK7(-),CK20、villin、CDX-2和MUC-2(+),与组织学一致。结论浆膜腔积液的细胞学检查对腹膜假黏液瘤术前诊断具有一定价值。除了传统涂片,应尽量制作细胞学蜡块,以明确性质及来源。细胞学形态2级分类法与组织学分级符合率高,能为术中治疗方案的选择提供参考,并为无法手术患者提供诊断。
Objective To investigate the cytological diagnostic value of peritoneal pseudomyxoma (PMP) serosal effusion. Methods The morphology and immunohistochemistry of cytological smears and paraffin-embedded sections of 39 cases of peritoneal pseudomyxoma serous effusions were analyzed. Results The positive rate of embedded paraffin blocks was higher than the positive rate of smear. Cytological morphology can be taken according to the histological criteria of two-level classification, low-grade cells were arranged in rows, nuclear deviation, located in the basal part, atypia was not significant, abundant cytoplasm, cytoplasm on one side of the mucus; and high-level Cells, the nuclear position of different levels, significant shaped, part of the cells arranged in irregular mosaic cell clusters, nuclear size, chromatin rough, severe atypia, individual cells can be seen in the cytoplasm mucus secretion, are visible mucus background. Immunohistochemistry showed that intestinal markers CK7 (-), CK20, villin, CDX-2, and MUC-2 (+) were embedded in paraffin blocks and were histologically identical. Conclusions Cytological examination of serous effusions has some value in the preoperative diagnosis of peritoneal pseudomyxoma. In addition to the traditional smears, we should try our best to make cytological wax blocks to clarify the nature and source. Cytology morphology level 2 classification and histological grading coincidence rate, can provide a reference for intraoperative treatment options, and provide diagnosis for patients who can not surgery.