Application Of CK7,CK20,PAX8,SATB2 And Serum Tumor Markers In The Identification Of Ovarian And Appendix Mucinous Tumors

Objective:The ovary and appendix are two common sites of mucinous neoplasms(MNs)in the pelvis and abdominal cavity in women.,and sometimes they are morphologically similar,making it difficult to distinguish between them by microscopic histomorphology alone.In this study,immunohistochemistry was used as an adjunct to analyze the expression of immunomarkers CK7,CK20,PAX8 and SATB2 in ovarian mucinous tumors(MOT)and appendiceal mucinous tumors(AMN),and combined with serum tumor markers to provide a reference for the accurate diagnosis of MNs.Methods:A total of 139 cases of postoperative pathological confirmed mucinous tumors that were surgically resected from June 2017 to June 2022 in the First Affiliated Hospital of Nanchang University were selected as the research subjects,which were divided into three groups according to the lesion site: the first group was a single ovarian mucinous tumor with a total of 102 cases,including 35 cases of ovarian mucinous cystadenoma,31 cases of mucinous borderline ovarian tumor,36 cases of ovarian mucinous cancer,and 31 cases of single appendix mucinous tumor in the second group.Among them,23 cases of low-grade appendiceal mucinous neoplasm(LAMN),8 cases of mucinous adenocarcinoma of appendix,and 6 cases of mucinous tumors in the third group were ovarian and appendix tumors.Paraffin-embedded specimens were selected to detect the expression of CK7,CK20,PAX8 and SATB2 in 139 mucinous tumor specimens,and the clinical characteristics of the cases were analyzed,and the role of immunomarkers and serum tumor markers in the identification of mucinous tumor origin was analyzed.Results:1.There was no significant difference in the positive rate of serum tumor markers(CA125,CEA,CA199)between mucinous borderline ovarian tumor and LAMN,and between ovarian mucinous cancer and mucinous adenocarcinoma of appendix.2.The positive expression rate of CK7 and PAX8 in ovarian-derived mucinous tumors was significantly higher than that in appendical-derived tumors,and the differences were statistically significant(P<0.05).When compared separately between benign and malignant tumors,the positive expression rate of CK7 and PAX8 in mucinous borderline ovarian tumor was also higher than that of LAMN(P<0.05),and the positive expression rate of ovarian mucinous cancer was higher than that of mucinous adenocarcinoma of appendix,and the difference was statistically significant(P<0.05).3.The positive expression rate of CK20 and SATB2 in appendical-derived tumors was higher than that in ovarian-derived mucinous tumors,and the difference was statistically difference(P<0.05).When compared separately between benign and malignant tumors,SATB2 was higher than that of mucinous borderline ovarian tumor in LAMN,and higher than ovarian mucinous cancer in mucinous adenocarcinoma of appendix,and the differences were statistically significant(P<0.05).The positive expression rate of CK20 in LAMN was higher than that of mucinous borderline ovarian tumor,and the difference was statistically significant(P<0.05).However,there was no significant difference in positive expression rates between ovarian mucinous cancer and mucinous adenocarcinoma of appendix.4.In the differentiation of ovarian-derived and appendical-derived mucinous tumors,the single marker SATB2 had the highest diagnostic efficiency,CK7/SATB2 has the highest efficacy when combined for differential diagnosis.In the differentiation of mucinous borderline ovarian tumor and LAMN,the diagnostic efficacy of immunomarkers combined with serum tumor markers CA125/CA199 and CA125/CEA was not improved,and the combination of serum tumor markers in malignant tumors could improve the diagnostic performance in the group with low differential diagnostic performance.5.Mucinous tumors existed in both the ovaries and appendix,and the immunohistochemical results were similar to those of appendical-derived mucinous tumors,with no statistical difference,but statistically significant differences with ovarian-derived mucinous tumors.Conclusions:1.Positive expression of CK7 and PAX8 suggested that the mucinous tumor was ovarian origin,and the positive expression of SATB2 and CK20 suggested that mucinous tumor was appendix origin.2.CK7 combined with SATB2 has the best diagnostic performance in differentiating MOT from AMN,and serum tumor markers can be added to groups with low differential diagnostic efficacy of immunomarkers in malignant tumors.3.When mucinous tumors involve both the ovaries and the appendix,the source of the appendix is likely.