卵巢黏液性肿瘤中附壁结节3例临床病理分析  

Clinicopathological features of mural nodules in ovarian mucinous tumors: an analysis of three cases

作　　者：涂小予[1] 陈忠伟[1] 盛伟琪[1] 王坚[1] 朱雄增[1] 

机构地区：[1]复旦大学附属肿瘤医院病理科,上海200032

出　　处：《临床与实验病理学杂志》2007年第5期539-544,共6页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的观察卵巢黏液性肿瘤中附壁结节的临床表现、组织病理学和免疫表型特征,强调诊断标准并探讨病因机制。方法分析3例卵巢黏液性肿瘤中附壁结节的临床资料、组织学形态及其免疫学表型,并复习相关文献。结果3例卵巢黏液性肿瘤中附壁结节的病例1为良性的肉瘤样附壁结节,以两种细胞成分为主:其一为纤维组织细胞样单核细胞,呈卵圆形或梭形,部分细胞形态较一致、温和,部分细胞出现高度的核异型性,核分裂多见并可见病理性核分裂象;另一种细胞为散在分布的破骨样巨细胞,常围绕于小的出血腔隙周围。病变中见出血坏死区,并伴明显的炎症反应背景;病例2为恶性的肉瘤性附壁结节,其组织学形态与肉瘤样附壁结节极其相似,但体积大,并出现血管浸润。该2例中的单核细胞表达vimentin,灶性表达AE1/AE3,多核巨细胞表达CD68为主。病例3为恶性的化生性癌性附壁结节,其中的瘤细胞为化生性或低分化癌成分,以表达上皮性标记如AE1/AE3和CK7为主,同时也表达vimentin。结论卵巢黏液性肿瘤中附壁结节为罕见的伴发病变或肿瘤,具有广泛的病理形态图像谱,不同类型的卵巢黏液性肿瘤中附壁结节有完全不同的预后及治疗原则,正确的诊断具有重要的临床意义。Purpose To investigate the clinicopathological and immunohistochemical characteristics of mural nodules in ovarian mucinous tumors, to emphasize the diagnostic criteria and to explore its pathogenesis. Methods The clinical data, histological features and immunohistochemical characteristics were analyzed in three cases of mural nodules in ovarian mucinous tumors, and related literature was reviewed. Results Three cases were reported with different variants of mural nodules in ovarian mucinous tumors, which included one case of sarcoma-like mural nodule, one case of sarcomatous mural nodule and one case of mural nodule of anaplastic carcinoma. In the first ease, the sarcoma-like mural nodule within borderline mucinous cystoadenoma was predominantly composed of a population of spindle-shaped and round mononucleated cells and scattered muhinucleated osteoclast-like giant cells. The mononucleated cells showed from bland looking to marked nuclear pleomorphic features with numerous mitoses including pathologic mitoses, while osteoclast-like giant cells could often be seen adjacent to haemorrhage. Small areas of necrosis and haemorrhage were present with inflammatory back- ground. The second case was a sarcomatous mural nodule whose histologic features were similar to that of the first case except for its larger size and presence of vescular invasion. In the former two cases the mononucleated tumor cells showed positive for vimentin and focally positive for CK, AE1/3, while the muhinucleated osteoclast-like giant cells positive for CD68. The third case was completely different from the former two cases morphologically and immunohistochemically. Poor - differentiated or anaplastic carcinoma was identified inside the mural nodule, and the tumor cells were both strongly positive for epithelial antibodies such as CK, AE1/AE3 and vimentin. Conclusions Mural nodules within the ovarian mucinous tumors are extremely rare and proliferative lesions or neoplasms which have a board morphological spectrum. It is significant to recogn

关 键 词：卵巢肿瘤 附壁结节 病理学 临床 诊断 鉴别 免疫组织化学 

分 类 号：R737.31[医药卫生—肿瘤]