{"id":1212,"date":"2016-12-05T23:24:51","date_gmt":"2016-12-05T22:24:51","guid":{"rendered":"http:\/\/www.newslab.sk\/2016\/12\/05\/mucinozne-karcinomy-ovaria-novinky-v-diagnostike-z-pohladu-patologa\/"},"modified":"2017-10-04T09:26:08","modified_gmt":"2017-10-04T07:26:08","slug":"mucinous-ovarian-carcinoma-news-in-diagnosis-form-the-pathologists-perspective","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/mucinous-ovarian-carcinoma-news-in-diagnosis-form-the-pathologists-perspective\/","title":{"rendered":"Mucinous Ovarian Carcinoma \u2013 News in Diagnosis form the Pathologist\u2019s Perspective"},"content":{"rendered":"
*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf\r\n attachment at the end of the paper.<\/strong><\/span><\/pre>\n
 <\/p>\n
\u00davod<\/strong><\/p>\n
Prim\u00e1rne mucin\u00f3zne karcin\u00f3my ov\u00e1ria s\u00fa pomerne vz\u00e1cne a\u00a0tvoria cca 2-3% v\u0161etk\u00fdch ovari\u00e1lnych karcin\u00f3mov. 10% v\u0161etk\u00fdch mucin\u00f3znych tumorov ov\u00e1ria s\u00fa mal\u00edgne. Histologicky sa jedn\u00e1 zv\u00e4\u010d\u0161a o\u00a0karcin\u00f3my intestin\u00e1lneho typu (1). V\u00a0posledn\u00fdch rokoch do\u0161lo k\u00a0v\u00fdznamn\u00e9mu progresu v\u00a0porozumen\u00ed t\u00fdchto novotvarov. Hoci mucin\u00f3zne tumory ov\u00e1ria s\u00fa zara\u010fovan\u00e9 klasicky do kateg\u00f3rie n\u00e1dorov z\u00a0povrchov\u00e9ho epitelu ov\u00e1ria, tento p\u00f4vod nie je dok\u00e1zate\u013en\u00fd u v\u0161etk\u00fdch pr\u00edpadov. Mo\u017en\u00fd je aj p\u00f4vod zo z\u00e1rodo\u010dn\u00fdch buniek (napr\u00edklad asoci\u00e1cia s terat\u00f3mom), pr\u00edpadne pomerne \u010dast\u00e9 je spojenie s\u00a0Brennerov\u00fdm tumorom (2, 3).<\/p>\n
 <\/p>\n
Klinick\u00fd n\u00e1lez<\/strong><\/p>\n
Ovari\u00e1lne mucin\u00f3zne karcin\u00f3my postihuj\u00fa zv\u00e4\u010d\u0161a \u017eeny po piatej dek\u00e1de \u017eivota, v\u00fdnimo\u010dne sme v\u0161ak zaznamenali v\u00fdskyt aj u\u00a0mlad\u0161\u00edch \u017eien (dokonca aj v\u00a0detskom veku). Rizikov\u00e9 faktory pre t\u00fato skupinu n\u00e1dorov nie s\u00fa jednozna\u010dne definovan\u00e9. Prekurzorom mucin\u00f3zneho karcin\u00f3mu je pravdepodobne mucin\u00f3zny cystaden\u00f3m \/ borderline tumor. Mucin\u00f3zny karcin\u00f3m je v\u00e4\u010d\u0161inou viazan\u00fd na jedno ov\u00e1rium (prezentuj\u00faci sa v\u00a0cca 70-80% pr\u00edpadov v\u00a0prvom \u0161t\u00e1diu ochorenia), zriedka sa \u0161\u00edri mimo ov\u00e1ria do peritone\u00e1lnej dutiny (4).<\/p>\n
 <\/p>\n
Progn\u00f3za<\/strong><\/p>\n
Mucin\u00f3zne karcin\u00f3my v\u00a0\u0161t\u00e1diu I\u00a0maj\u00fa v\u00fdborn\u00fa progn\u00f3zu s\u00a090% 5-ro\u010dn\u00fdm pre\u017e\u00edvan\u00edm. Prim\u00e1rne karcin\u00f3my, ktor\u00e9 sa prezentuj\u00fa v\u00a0pokro\u010dilom \u0161t\u00e1diu s\u00fa zriedkav\u00e9, vo v\u00e4\u010d\u0161ine pr\u00edpadov pokro\u010dil\u00e9ho ochorenia sa v\u00a0skuto\u010dnosti jedn\u00e1 sk\u00f4r o\u00a0metast\u00e1zu mucin\u00f3zneho karcin\u00f3mu do ov\u00e1ria z\u00a0in\u00e9ho origa. Prim\u00e1rne mucin\u00f3zne karcin\u00f3my s\u00a0peritone\u00e1lnym \u0161\u00edren\u00edm v\u0161ak maj\u00fa pravdepodobne hor\u0161iu progn\u00f3zu ako ser\u00f3zne karcin\u00f3my s\u00a0podobn\u00fdm rozsahom ochorenia (5). Histologicky expanz\u00edvny typ inv\u00e1zie sa pova\u017euje za prognosticky lep\u0161\u00ed ako de\u0161trukt\u00edvny (infiltrat\u00edvny) typ inv\u00e1zie. Na rozdiel od in\u00fdch typov ovari\u00e1lnych karcin\u00f3mov (napr. high grade ser\u00f3zneho karcin\u00f3mu), mucin\u00f3zny karcin\u00f3m vykazuje pomerne n\u00edzku citlivos\u0165 na chemoterapiu (1).<\/p>\n
 <\/p>\n
Makroskopick\u00fd patologick\u00fd n\u00e1lez<\/strong><\/p>\n
Makroskopicky prim\u00e1rne mucin\u00f3zne karcin\u00f3my dosahuj\u00fa pomerne ve\u013ek\u00e9 rozmery (medi\u00e1n cca 20 cm), maj\u00fa hladk\u00fd povrch, sol\u00eddne-cystick\u00fd charakter, pri\u010dom cystick\u00e9 priestory s\u00fa vyplnen\u00e9\u00a0hlienist\u00fdm obsahom. M\u00f4\u017eu tie\u017e obsahova\u0165 oblasti nekr\u00f3z a\u00a0krv\u00e1cania. Postihnutie ov\u00e1ria je typicky jednostrann\u00e9 (vo ve\u013ekej v\u00e4\u010d\u0161ine pr\u00edpadov) (1, 2, 3).<\/p>\n
 <\/p>\n
Mikroskopick\u00fd patologick\u00fd n\u00e1lez<\/strong><\/p>\n
Mucin\u00f3zne karcin\u00f3my intestin\u00e1lneho typu s\u00fa spravidla architektonicky dobre diferencovan\u00e9, b\u00fdvaj\u00fa asociovan\u00e9 s\u00a0komponentou mucin\u00f3zneho cystaden\u00f3mu, pr\u00edpadne mucin\u00f3zneho borderline tumoru.<\/p>\n
Rozli\u0161ujeme dve z\u00e1kladn\u00e9 formy inv\u00e1zie v\u00a0mucin\u00f3znom karcin\u00f3me.<\/p>\n
Expanz\u00edvny typ inv\u00e1zie (\u010dastej\u0161\u00ed) pozost\u00e1va z\u00a0v\u00fdrazne agregovan\u00fdch \u017e\u013eazov\u00fdch \u0161trukt\u00far s\u00a0minim\u00e1lnym mno\u017estvom str\u00f3my medzi \u017eliazkami (obr. 1). Tak\u00e9to invaz\u00edvne fokusy by mali dosahova\u0165 minim\u00e1lny rozmer aspo\u0148 5 mm (priemer) alebo plochu aspo\u0148 10 mm2<\/sup> (1, 3).<\/p>\n
\"1\"<\/em><\/strong><\/p>\n
Obr. 1:<\/em><\/strong> Mucin\u00f3zny karcin\u00f3m ov\u00e1ria s\u00a0expanz\u00edvnym typom inv\u00e1zie (farbenie hematoxyl\u00edn-eoz\u00edn, objekt\u00edv 4x).<\/em><\/p>\n
Druh\u00fdm typom inv\u00e1zie je de\u0161trukt\u00edvna inv\u00e1zia (v prim\u00e1rnych novotvaroch menej \u010dast\u00e1), s\u00a0chaotickou infiltr\u00e1ciou ovari\u00e1lnej str\u00f3my n\u00e1dorov\u00fdmi \u017eliazkami (obr. 2), pr\u00edpadne izolovan\u00fdmi bunkami (niekedy charakteru buniek typu pe\u010datn\u00e9ho prste\u0148a). Pomerne \u010dast\u00e1 je dezmoplastick\u00e1 reakcia str\u00f3my (2, 3).<\/p>\n
\"2\"<\/em><\/strong><\/p>\n
Obr 2:<\/em><\/strong> Mucin\u00f3zny karcin\u00f3m ov\u00e1ria s\u00a0de\u0161trukt\u00edvnym (infiltrat\u00edvnym) typom inv\u00e1zie (farbenie hematoxyl\u00edn-eoz\u00edn, objekt\u00edv 4x).<\/em><\/p>\n
Z\u00a0cytologick\u00e9ho h\u013eadiska n\u00e1dorov\u00e9 bunky s\u00fa v\u00e4\u010d\u0161inou cylindrick\u00e9ho tvaru, vykazuj\u00fa variabiln\u00fa intracytoplazmatick\u00fa produkciu muc\u00ednu (zv\u00e4\u010d\u0161a detekovate\u013en\u00e1 u\u017e pri hematoxyl\u00ednom-eoz\u00ednom farben\u00fdch prepar\u00e1toch),\u00a0 s\u00a0variabiln\u00fdm stup\u0148om atypie. S\u00fa\u010das\u0165ou novotvaru m\u00f4\u017eu by\u0165 aj poh\u00e1rikovit\u00e9 bunky, Panethove bunky, \u010di neuroendokrinn\u00e9 bunky (4).<\/p>\n
 <\/p>\n
Imunofenotyp<\/strong><\/p>\n
V\u00e4\u010d\u0161ina mucin\u00f3znych karcin\u00f3mov je cytokerat\u00edn 7 pozit\u00edvnych, s\u00a0variabilnou pozitivitou cytokerat\u00ednu 20 (v\u00e4\u010d\u0161inou fok\u00e1lnou). Mo\u017en\u00e1 je jadrov\u00e1 imunohistochemick\u00e1 expresia CDX2 (marker intestin\u00e1lnej diferenci\u00e1cie). \u010eal\u0161ie markery, ako p16, estrog\u00e9nov\u00fd receptor, progester\u00f3nov\u00fd receptor \u010di WT1- s\u00fa typicky negat\u00edvne (obr. 3-6) (6). Vyu\u017eitie imunohistochemick\u00fdch markerov v\u00a0diferenci\u00e1lnej diagn\u00f3ze mucin\u00f3znych tumorov ov\u00e1ria uv\u00e1dzame v\u00a0tabu\u013eke \u010d. 2.<\/p>\n
\"3\"<\/em><\/strong><\/p>\n
Obr. 3: <\/em><\/strong>Imunohistochemick\u00e1 pozitivita cytokerat\u00ednu 7 v\u00a0mucin\u00f3znom karcin\u00f3me ov\u00e1ria (cytoplazmatick\u00e1 pozitivita vizualizovan\u00e1 vo forme hnedej farby, objekt\u00edv 10x).<\/em><\/p>\n
\"4\"<\/em><\/strong><\/p>\n
Obr. 4:<\/em><\/strong> Fok\u00e1lna imunohistochemick\u00e1 pozitivita cytokerat\u00ednu 20 (cytoplazmatick\u00e1) v\u00a0\u010dasti mucin\u00f3zneho tumoru ov\u00e1ria (objekt\u00edv 4x).<\/em><\/p>\n
\"5\"<\/em><\/strong><\/p>\n
Obr. 5: <\/em><\/strong>Imunohistochemick\u00e1 jadrov\u00e1 pozitivita CDX2 v\u00a0mucin\u00f3znom karcin\u00f3me ov\u00e1ria (jadr\u00e1 hnedej farby, objekt\u00edv 20x).<\/em><\/p>\n
\"6\"<\/em><\/strong><\/p>\n
Obr. 6: <\/em><\/strong>Imunohistochemick\u00e9 vy\u0161etrenie estrog\u00e9nov\u00e9ho receptoru, bez expresie v\u00a0mucin\u00f3znom karcin\u00f3me ov\u00e1ria (objekt\u00edv 10x).<\/em><\/p>\n
 <\/p>\n
Molekul\u00e1rna patol\u00f3gia<\/strong><\/p>\n
Prim\u00e1rne mucin\u00f3zne karcin\u00f3my obsahuj\u00fa pomerne \u010dasto mut\u00e1ciu KRAS\u00a0 (cca 75% pr\u00edpadov). Identick\u00e9 mut\u00e1cie s\u00fa detekovan\u00e9 aj v\u00a0ter\u00e9ne okolit\u00e9ho mucin\u00f3zneho borderline tumoru alebo cystaden\u00f3mu (ak je pr\u00edtomn\u00fd v\u00a0okol\u00ed karcin\u00f3mu), \u010do podporuje n\u00e1zory, ktor\u00e9 tvrdia, \u017ee prekurzormi mucin\u00f3zneho karcin\u00f3mu s\u00fa mucin\u00f3zny cystaden\u00f3m a\u00a0mucin\u00f3zny borderline tumor (3, 7). Taktie\u017e v\u00a0cca 20% pr\u00edpadov sa v\u00a0niektor\u00fdch \u0161t\u00fadi\u00e1ch (taktie\u017e aj na\u0161a osobn\u00e1 sk\u00fasenos\u0165) preuk\u00e1zala amplifik\u00e1cia a\u00a0overexpresia g\u00e9nu HER2 (\u010do m\u00f4\u017ee ma\u0165 v\u00a0bud\u00facnosti terapeutick\u00fd v\u00fdznam, podobne ako v\u00a0pr\u00edpade karcin\u00f3mu prsn\u00edka alebo \u017eal\u00fadka) (1, 8, 9).<\/p>\n
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Diferenci\u00e1lna diagn\u00f3za<\/strong><\/p>\n
Odl\u00ed\u0161enie mucin\u00f3zneho karcin\u00f3mu od in\u00fdch prim\u00e1rnych n\u00e1dorov ov\u00e1ria je vo v\u00e4\u010d\u0161ine pr\u00edpadov jednoduch\u00e9 a\u00a0je mo\u017en\u00e9 na z\u00e1klade pos\u00fadenia rut\u00ednnych hematoxyl\u00edn-eoz\u00ednom farben\u00fdch prepar\u00e1tov. Omnoho z\u00e1va\u017enej\u0161\u00edm probl\u00e9mom v\u00a0diferenci\u00e1lnej diagn\u00f3ze je v\u0161ak odl\u00ed\u0161enie od metastatick\u00e9ho mucin\u00f3zneho karcin\u00f3mu, najm\u00e4 vtedy, ak je n\u00e1dorov\u00e9 postihnutie ov\u00e1ria prv\u00fdm klinick\u00fdm prejavom ochorenia. Naj\u010dastej\u0161\u00edm origom metastatick\u00e9ho mucin\u00f3zneho karcin\u00f3mu do ov\u00e1ria je gastrointestin\u00e1lny trakt (appendix vermiformis, hrub\u00e9 \u010drevo, \u017eal\u00fadok), pankreatikobili\u00e1rny trakt, cervix uteru, menej \u010dasto respira\u010dn\u00fd trakt a\u00a0in\u00e9 lokality. Morfologick\u00e9 charakteristiky, ktor\u00e9 umo\u017e\u0148uj\u00fa odl\u00ed\u0161enie prim\u00e1rneho od sekund\u00e1rneho novotvaru uv\u00e1dzame v\u00a0tabu\u013eke \u010d. 1.<\/p>\n
 <\/p>\n\n\n\n\n\n\n\n\n\n
<\/td>\nPrim\u00e1rny mucin\u00f3zny karcin\u00f3m ov\u00e1ria<\/strong><\/td>\nMetastatick\u00fd mucin\u00f3zny karcin\u00f3m do ov\u00e1ria<\/strong><\/td>\n<\/tr>\n
Lateralita<\/strong><\/td>\nUnilater\u00e1lne (>95%)<\/td>\nBilater\u00e1lne (75%)<\/td>\n<\/tr>\n
Ve\u013ekos\u0165 novotvaru<\/strong><\/td>\nV\u00e4\u010d\u0161inou viac ako 10-13 cm<\/td>\nV\u00e4\u010d\u0161inou menej ako 10 cm<\/td>\n<\/tr>\n
Makroskopick\u00e9 \u010drty<\/strong><\/td>\nMulticystick\u00fd, mo\u017en\u00e9 sol\u00eddne oblasti, povrch hladk\u00fd<\/td>\nNodul\u00e1rny charakter,\u00a0 s\u00a0postihnut\u00edm povrchu, niekedy v\u0161ak mo\u017en\u00fd hladk\u00fd povrch<\/td>\n<\/tr>\n
Lokaliz\u00e1cia tumoru<\/strong><\/td>\nIntracystick\u00e1, v\u00a0str\u00f3me ov\u00e1ria<\/td>\nPovrchov\u00e9 noduly, postihnutie kortik\u00e1lnej str\u00f3my<\/td>\n<\/tr>\n
Mikroskopick\u00e9 rysy<\/strong><\/td>\nPreva\u017ene expanz\u00edvny typ inv\u00e1zie, dobre diferencovan\u00fd mucin\u00f3zny epitel<\/td>\nInfiltrat\u00edvny \/ de\u0161trukt\u00edvny charakter rastu v\u00a0dezmoplastickej str\u00f3me<\/td>\n<\/tr>\n
Extraovari\u00e1lne postihnutie<\/strong><\/td>\nV\u00e4\u010d\u0161inou nepr\u00edtomn\u00e9<\/td>\n\u010castokr\u00e1t pr\u00edtomn\u00e9<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
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Tabu\u013eka \u010d.1:<\/em><\/strong> Mo\u017enosti odl\u00ed\u0161enia prim\u00e1rneho a\u00a0metastatick\u00e9ho mucin\u00f3zneho karcin\u00f3mu v\u00a0ov\u00e1riu. <\/em><\/p>\n
Je v\u0161ak potrebn\u00e9 si uvedomi\u0165, \u017ee morfologick\u00e9 rysy uveden\u00e9 v\u00a0tabu\u013eke \u010d. 1 s\u00edce umo\u017e\u0148uj\u00fa odl\u00ed\u0161enie prim\u00e1rnych od metastatick\u00fdch mucin\u00f3znych karcin\u00f3mov vo ve\u013ekej \u010dasti pr\u00edpadov, mo\u017en\u00e9 s\u00fa v\u0161ak aj v\u00fdnimky, ktor\u00e9 sa neriadia t\u00fdmito pravidlami. Napr\u00edklad s\u00fa zn\u00e1me metast\u00e1zy mucin\u00f3zneho karcin\u00f3mu z\u00a0gastrointestin\u00e1lneho traktu, ktor\u00e9 dok\u00e1\u017eu morfologicky dokonale imitova\u0165 prim\u00e1rny novotvar ov\u00e1ria (s jednostrann\u00fdm postihnut\u00edm, hladk\u00fdm povrchom ov\u00e1ria, dokonca s\u00a0v\u00fdskytom oblast\u00ed, ktor\u00e9 morfologicky napodob\u0148uj\u00fa mucin\u00f3zny borderline tumor, pr\u00edpadne mucin\u00f3zny cystaden\u00f3m ov\u00e1ria). (1, 2, 3, 4)<\/p>\n
Ur\u010dit\u00fa pomoc v\u00a0t\u00fdchto problematick\u00fdch pr\u00edpadoch m\u00f4\u017ee poskytn\u00fa\u0165 imunohistochemick\u00e9 vy\u0161etrenie (tabu\u013eka \u010d. 2), av\u0161ak v\u00a0\u010dasti pr\u00edpadov ani to nemus\u00ed\u00a0 vies\u0165 k\u00a0\u00faspechu (vzh\u013eadom na ne\u0161pecifick\u00fd imunofenotyp mucin\u00f3zneho karcin\u00f3mu ov\u00e1ria) (6). V\u00a0dne\u0161nej dobe neexistuje \u017eiaden jednozna\u010dne spo\u013eahliv\u00fd pozit\u00edvny imunohistochemick\u00fd marker prim\u00e1rneho mucin\u00f3zneho karcin\u00f3mu ov\u00e1ria. \u00a0Imunohistochemick\u00e9 vy\u0161etrenie pri odl\u00ed\u0161en\u00ed prim\u00e1rneho a\u00a0metastastick\u00e9ho mucin\u00f3zneho karcin\u00f3mu uv\u00e1dzame v\u00a0tabu\u013eke \u010d. 2.<\/p>\n\n\n\n\n\n\n\n\n\n
<\/td>\nHrub\u00e9 \u010drevo<\/strong><\/td>\nPankreas<\/strong><\/td>\n\u017dal\u00fadok<\/strong><\/td>\nEndocervix (AdenoCa)<\/strong><\/td>\nP\u013e\u00faca (AdenoCa)<\/strong><\/td>\nPrim\u00e1rny MK ov\u00e1ria<\/strong><\/td>\n<\/tr>\n
CK7<\/strong><\/td>\n–<\/td>\n+<\/td>\nvariabilne<\/td>\n+<\/td>\n+<\/td>\n+<\/td>\n<\/tr>\n
CK20<\/strong><\/td>\n+<\/td>\n-\/+<\/td>\nvariabilne<\/td>\n–<\/td>\n– \/ +<\/td>\n+\/-<\/td>\n<\/tr>\n
CDX2<\/strong><\/td>\n+<\/td>\nvariabilne<\/td>\nvariabilne<\/td>\n-\/+<\/td>\n<\/td>\n+\/-<\/td>\n<\/tr>\n
DPC4 \/ SMAD4<\/strong><\/td>\nStrata expresie v\u00a010%<\/td>\nStrata expresie v\u00a050%<\/td>\n+<\/td>\n+<\/td>\n+<\/td>\n+<\/td>\n<\/tr>\n
TTF1<\/strong><\/td>\n–<\/td>\n–<\/td>\n–<\/td>\n–<\/td>\n+<\/td>\n–<\/td>\n<\/tr>\n
p16<\/strong><\/td>\n–<\/td>\n–<\/td>\n–<\/td>\n+<\/td>\n–<\/td>\n–<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
 <\/p>\n
Tabu\u013eka \u010d.2:<\/em><\/strong> Imunohistochemick\u00e1 diferenci\u00e1lna diagn\u00f3za prim\u00e1rnych a\u00a0sekund\u00e1rnych mucin\u00f3znych karcin\u00f3mov ov\u00e1ria. (MK \u2013 mucin\u00f3zny karcin\u00f3m, AdenoCa \u2013 adenokarcin\u00f3m, CK \u2013 cytokerat\u00edn) <\/em><\/p>\n
\u00a0<\/strong><\/p>\n
Mucin\u00f3zne tumory ov\u00e1ria a\u00a0pseudomyxoma peritonei<\/strong><\/p>\n
V\u00a0posledn\u00fdch rokoch sa preuk\u00e1zalo, \u017ee takmer v\u0161etky pr\u00edpady tzv. pseudomyxoma peritonei (PMP) s\u00fa asociovan\u00e9 s prim\u00e1rnym\u00a0mucin\u00f3znym tumorom apendixu (low grade appendiceal mucinous neoplasm (LAMN)), pri\u010dom postihnutie ov\u00e1ria je sekund\u00e1rne. Pri ovari\u00e1lnych mucin\u00f3znych tumoroch asociovan\u00fdch s PMP sa doporu\u010duje pou\u017e\u00edva\u0165 nasledovn\u00e9 pojmy: diseminovan\u00e1 peritone\u00e1lna adenomucin\u00f3za (DPAM), pr\u00edpadne dekript\u00edvny popis \u201esekund\u00e1rne n\u00e1dorov\u00e9 postihnutie \u0161trukt\u00farami low grade apendik\u00e1lneho mucin\u00f3zneho novotvaru). Pojem PMP je iba klinick\u00fd a\u00a0nie patologick\u00fd. Peritone\u00e1lne mucin\u00f3zne tumory s\u00a0low grade morfol\u00f3giou s\u00fa prognosticky odli\u0161n\u00e9 od mucin\u00f3znych karcin\u00f3mov, ktor\u00e9 maj\u00fa hor\u0161iu progn\u00f3zu. V\u00a0pr\u00edpade postihnutia peritone\u00e1lnej dutiny mucin\u00f3znym karcin\u00f3mom je mo\u017en\u00e9 pou\u017ei\u0165 pojem peritone\u00e1lna mucin\u00f3zna karcinomat\u00f3za (1, 3).<\/p>\n
\u00a0<\/strong><\/p>\n
Peropera\u010dn\u00e1 biopsia pri mucin\u00f3znych karcin\u00f3moch ov\u00e1ria<\/strong><\/p>\n
\u00dalohou peropera\u010dnej biopsie ov\u00e1ria je predbe\u017en\u00e9 stanovenie dignity novotvaru (ben\u00edgny, borderline, mal\u00edgny) a\u00a0histologick\u00e9ho typu novotvaru (ak je to mo\u017en\u00e9) za \u00fa\u010delom pos\u00fadenia rozsahu \u010fal\u0161ieho chirurgick\u00e9ho v\u00fdkonu u\u00a0pacientky. N\u00e1dory ov\u00e1ria (obzvl\u00e1\u0161\u0165 ve\u013ek\u00fdch rozmerov) s\u00fa morfologicky pomerne heterog\u00e9nne, kde je mo\u017en\u00e9 striedanie are\u00e1lov s\u00a0ben\u00edgnou, borderline a\u00a0mal\u00edgnou morfol\u00f3giou. Stanovenie dignity novotvaru preto m\u00f4\u017ee by\u0165 po\u010das peropera\u010dnej biopsie problematick\u00e9, ke\u010f\u017ee vy\u0161etrenie len jednej alebo dvoch exc\u00edzi\u00ed (z \u010dasov\u00e9ho d\u00f4vodu nie je mo\u017en\u00e9 rozsiahlej\u0161ie vy\u0161etrenie) m\u00f4\u017ee vies\u0165 k\u00a0falo\u0161n\u00e9mu podhodnoteniu biologick\u00fdch vlastnost\u00ed l\u00e9zie. Pre jednozna\u010dn\u00e9 pos\u00fadenie dignity je \u010dastokr\u00e1t mo\u017en\u00e1 a\u017e definit\u00edvna biopsia s\u00a0rozsiahlym samplingom (1 a\u017e 2 exc\u00edzie na 1 cm priemeru novotvaru). Jednozna\u010dn\u00e9 peropera\u010dn\u00e9 odl\u00ed\u0161enie prim\u00e1rneho od sekund\u00e1rneho mucin\u00f3zneho novotvaru v\u00e4\u010d\u0161inou nie je mo\u017en\u00e9 (s v\u00fdnimkou pr\u00edpadov, ak je klinicky zn\u00e1me origo novotvaru), av\u0161ak je mo\u017en\u00e9 pou\u017ei\u0165 vy\u0161\u0161ie pop\u00edsan\u00e9 morfologick\u00e9 a\u00a0klinick\u00e9 znaky, ktor\u00e9 m\u00f4\u017eu napom\u00f4c\u0165 v\u00a0diferenci\u00e1lnej diagn\u00f3ze (unilateralita vs. bilateralita, ve\u013ekos\u0165 novotvaru, postihnutie povrchu, expanz\u00edvny vs. infiltrat\u00edvny charakter rastu novotvaru, klinick\u00e9 \u00fadaje o\u00a0karcin\u00f3me z\u00a0inej lokality at\u010f.). \u00a0V\u00a0pr\u00edpade ben\u00edgneho n\u00e1lezu (mucin\u00f3zny cystaden\u00f3m, pr\u00edpadne cystaden\u00f3m s\u00a0fok\u00e1lnou atypiou) nie je potrebn\u00fd \u010fal\u0161\u00ed chirurgick\u00fd v\u00fdkon. V\u00a0pr\u00edpade mucin\u00f3zneho borderline tumoru a\u00a0mucin\u00f3zneho karcin\u00f3mu je spravidla potrebn\u00e9 chirurgick\u00e9 ur\u010denie rozsahu ochorenia (napr. odstr\u00e1nenie kontralater\u00e1lneho ov\u00e1ria, uteru, lymfadenekt\u00f3mia, odobratie vzoriek z\u00a0peritonea, omenta, odstr\u00e1nenie apendixu). Metastatick\u00e9 karcin\u00f3my si u\u017e \u010fal\u0161\u00ed chirurgick\u00fd z\u00e1krok za \u00fa\u010delom ur\u010denia rozsahu ochorenia (v pr\u00edpade dok\u00e1zanej ovari\u00e1lnej metast\u00e1zy a\u00a0zn\u00e1meho origa) nevy\u017eaduj\u00fa (1).<\/p>\n
\u00a0<\/strong><\/p>\n
Z\u00e1ver<\/strong><\/p>\n
Prim\u00e1rne mucin\u00f3zne karcin\u00f3my ov\u00e1ria s\u00fa zriedkav\u00e9. Naopak, \u010dastej\u0161ie s\u00fa metastatick\u00e9 mucin\u00f3zne karcin\u00f3my z\u00a0in\u00e9ho origa (najm\u00e4 gastrointestin\u00e1lny trakt). \u00daskal\u00edm v patologickej\u00a0diagnostike je fakt, \u017ee metastatick\u00e9 mucin\u00f3zne tumory v ov\u00e1riu dok\u00e1\u017eu verne morfologicky imitova\u0165 prim\u00e1rne mucin\u00f3zne ovari\u00e1lne novotvary (vr\u00e1tane mucin\u00f3zneho borderline tumoru, \u010di dokonca cystaden\u00f3mu \/ cystadenofibr\u00f3mu), pri\u010dom \u00a0odl\u00ed\u0161enie prim\u00e1rneho od sekund\u00e1rneho novotvaru m\u00e1 samozrejme ve\u013ek\u00fd praktick\u00fd v\u00fdznam z\u00a0h\u013eadiska terapie a\u00a0progn\u00f3zy. Makroskopick\u00e9 a\u00a0mikroskopick\u00e9 vy\u0161etrenie\u00a0 s\u00a0rozsiahlym samplingom novotvaru s\u00edce m\u00f4\u017ee vo ve\u013ekej \u010dasti pr\u00edpadov umo\u017eni\u0165 odl\u00ed\u0161enie prim\u00e1rneho od sekund\u00e1rneho p\u00f4vodu mucin\u00f3zneho karcin\u00f3mu, av\u0161ak p\u00f4vod novotvaru v \u010dasti pr\u00edpadov m\u00f4\u017ee zosta\u0165 nejasn\u00fd. Imunohistochemick\u00e1 anal\u00fdza je taktie\u017e n\u00e1pomocn\u00e1, v\u00a0s\u00fa\u010dasnosti v\u0161ak neexistuje \u017eiaden \u0161pecifick\u00fd pozit\u00edvny marker, ktor\u00fd by dok\u00e1zal jednozna\u010dne identifikova\u0165 prim\u00e1rny mucin\u00f3zny adenokarcin\u00f3m ov\u00e1ria. Ve\u013emi d\u00f4le\u017eit\u00e1 je pre patol\u00f3ga znalos\u0165 podrobn\u00fdch anamnestick\u00fdch a\u00a0klinick\u00fdch \u00fadajov o\u00a0pacientke, ktor\u00e9 m\u00f4\u017eu zna\u010dne spresni\u0165 a\u00a0ur\u00fdchli\u0165 samotn\u00fd diagnostick\u00fd proces. Pre jednozna\u010dn\u00fa a\u00a0definit\u00edvnu diagn\u00f3zu je preto nevyhnut\u00e1 spolupr\u00e1ca medzi patol\u00f3gom, chirurgom,\u00a0 gynekol\u00f3gom a\u00a0onkol\u00f3gom.<\/p>\n
 <\/p>\n
Literat\u00fara:<\/strong><\/p>\n
    \n
  1. Soslow, RA \u2013 Tornos, C. Diagnostic pathology of ovarian tumors.<\/em> New York: Springer, 2011. ISBN 978-1-4419-9751-7. Chapter 9, Pathology of mucinous tumors, p. 112-118.<\/li>\n
  2. Crum, CP \u2013 Nucci, MR et al. Diagnostic gynecologic and obstetric pathology.<\/em> Second edition. Philadelphia: Saunders, 2011. ISBN 978-1-4377-0764-9. Chapter 27, The pathology of pelvic-ovarian epithelial (epithelial-stromal) tumors, 854-862.<\/li>\n
  3. Kurman, RJ \u2013 Ellenson, LH et al. Blaustein\u00b4s pathology of the female genital tract. <\/em>Sixth edition. New York: Springer, 2011. ISBN 978-1-4419-0488-1. Chapter 14, Surface epithelial tumors of the ovary, p. 735-748.<\/li>\n
  4. Hart, WR. Mucinous tumors of the ovary: a\u00a0review. In International Journal of Gynecological Pathology, <\/em>2005, vol. 24, no. 1, p. 4-25.<\/li>\n
  5. Zaino, RJ \u2013 Brady, MF et al. Advanced stage mucinous adenocarcinoma of the ovary is both rare and highly lethal: a\u00a0gynecologic oncology group study. In Cancer, <\/em>2011, vol. 117, no. 3, p. 554-562.<\/li>\n
  6. Tabrizi, AD \u2013 Kalloger, SE et at. Primary ovarian mucinous carcinomas of intestinal type: significance of pattern of invasion and immunohistochemical expression profile in a\u00a0series of 31 cases. In International Journal of Gynecological Pathology, <\/em>2010, vol. 29, no. 2, p. 99-107.<\/li>\n
  7. Cuatrecacas, M \u2013 Villaneuva, A\u00a0et al. K-ras mutations in mucinous ovarian tumors: a\u00a0clinicopathologic and molecular study of 95 cases. In Cancer, <\/em>1997, vol. 79, no. 8, p. 1581-1586.<\/li>\n
  8. McAlpine, JN \u2013 Wiegand, KC et al. HER2 overexpression and amplification is present in a subset of ovarian mucinous carcinomas and can be targeted with trastuzumab therapy. In BMC Cancer<\/em>, 2009, vol. 9, 433.<\/li>\n
  9. Kurman, RJ \u2013 Carcangiu, ML et al. WHO Classification of Tumours of Female Reproductive Organs. <\/em>Fourth edition. Lyon: IARC, 2014. ISBN 978-92-832-2435-8. Chapter 1, Tumours of the ovary, p. 25-29.<\/li>\n<\/ol>\n
     <\/p>\n
     <\/p>\n
     <\/p>\n","protected":false},"excerpt":{"rendered":"
    *All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper.   \u00davod Prim\u00e1rne mucin\u00f3zne karcin\u00f3my ov\u00e1ria s\u00fa pomerne vz\u00e1cne a\u00a0tvoria cca 2-3% v\u0161etk\u00fdch ovari\u00e1lnych karcin\u00f3mov. 10% v\u0161etk\u00fdch mucin\u00f3znych tumorov ov\u00e1ria s\u00fa mal\u00edgne. Histologicky sa jedn\u00e1 zv\u00e4\u010d\u0161a o\u00a0karcin\u00f3my intestin\u00e1lneho typu (1).<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[293],"tags":[754,753,745],"class_list":["post-1212","post","type-post","status-publish","format-standard","hentry","category-cytology","tag-metastasis","tag-mucinous-carcinoma","tag-ovary","typ_clanku-review-article"],"acf":{"abstrakt":"
    Primary mucinous ovarian carcinoma are relatively rare neoplasms classified under the category of the so-called surface epithelial ovarian tumours. From histological perspective, these are predominantly intestine-type carcinoma.\u00a0From the clinical perspective, this disease mainly affects women after 5th<\/sup> decade of life and mostly presents itself at stage I to II; patients at stage I (the disease linked to ovary) have a very good prognosis (90% 5-year survival). On the other hand, this neoplasm shows a relatively low level of chemo-sensitivity. Most primary mucinous carcinoma are unilateral, sized over 10-13 cm, with ovarian surface mostly smooth, without tumour infiltration. Histologically, we differentiate between two invasions in the field of mucinous carcinoma, expansive and destructive (infiltrative) type.\u00a0Imunohistochemical profile of these carcinoma is relatively variable (cytokeratin 7+, cytokeratin 20+\/-, CDX2+\/-, ER-, PR-, PAX8 -\/+, WT1-, DPC4+) and non-specific. The importance of these neoplasms mainly lies in the necessity of differentiating the primary mucinous ovarian carcinoma from metastasis of mucinous carcinoma with another origin \u00a0\u00a0\u00a0\u00a0\u00a0(a more frequent alternative). The most frequent original site of metastatic tumours is particularly large intestine (including the appendix), stomach, pancreaticobiliary tract or endocervix. To differentiate a primary neoplasm from a secondary one, it is inevitable to evaluate a complex set of clinical data, macroscopic and microscopic finding and a immunohistochemical examination is helpful, too. At present, ovarian affliction by a mucinous tumour associated with the so-called pseudomyxoma peritonei is almost always considered to be secondary (mostly associated with a\u00a0low-grade appendiceal mucinous tumour).<\/p>\n
    Key words:<\/strong> ovary, mucinous carcinoma, metastasis<\/p>\n","casopis":[{"ID":1000,"post_author":"7","post_date":"2015-11-21 14:33:24","post_date_gmt":"2015-11-21 13:33:24","post_content":"
    GENETICS<\/strong><\/h4>\r\n
      \r\n \t
    • The laboratory age<\/li>\r\n \t
    • The Odyssey of DNA reading<\/li>\r\n \t
    • Comparative genomic hybridisation: a methodological introduction<\/li>\r\n \t
    • Next generation sequencing and its application in clinical genetics<\/li>\r\n<\/ul>\r\n
      <\/h4>\r\n
      BIOCHEMISTRY<\/strong><\/h4>\r\n
        \r\n \t
      • Determining of the trace elements in blood serum<\/li>\r\n \t
      • Determining of \u03b1-tocopherol (vitamin E) in serum by way of liquid chromatography with tandem mass spectrometry (LC\/MS\/MS)<\/li>\r\n \t
      • Analysis of urinary calculi and its path to Europe<\/li>\r\n<\/ul>\r\n \r\n
        IMMUNOLOGY <\/strong><\/h4>\r\n
          \r\n \t
        • New autoantibodies in diagnosis of autoimmunity myopathies<\/li>\r\n \t
        • Taking advantage of flow-based cytometry in determining prognostic markers<\/li>\r\n<\/ul>\r\nCD38 and ZAP-70 in patients with B-CLL\r\n\r\n \r\n
          CYTOLOGY AND PATHOLOGY <\/strong><\/h4>\r\n
            \r\n \t
          • Mucinous ovarian carcinoma \u2013 news in diagnosis from the pathologist\u2019s perspective<\/li>\r\n<\/ul>","post_title":"newsLab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-12015","to_ping":"","pinged":"","post_modified":"2017-08-16 21:43:10","post_modified_gmt":"2017-08-16 19:43:10","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab-12015\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"47","upload_clanok":{"ID":1213,"id":1213,"title":"medirex_1_2015-torday","filename":"MEDIREX_1_2015-\u2013-Torday.pdf","filesize":233716,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2016\/12\/MEDIREX_1_2015-\u2013-Torday.pdf","link":"https:\/\/www.newslab.sk\/en\/mucinous-ovarian-carcinoma-news-in-diagnosis-form-the-pathologists-perspective\/medirex_1_2015-torday\/","alt":"","author":"7","description":"","caption":"","name":"medirex_1_2015-torday","status":"inherit","uploaded_to":1212,"date":"2016-12-05 22:13:36","modified":"2016-12-05 22:13:36","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1212","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1212"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1212\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1212"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1212"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1212"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}