卵巢类似性索肿瘤的内膜样腺癌临床病理观察  

Ovarian endometrioid adenocarcinoma resembling sex-cord tumors:a clinicopathologic study

作　　者：李青[1] 肖家诚[1] 金晓龙[1] 谈炎[1] 陈元栋[1] 陈同钰[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院病理科

出　　处：《诊断病理学杂志》2008年第4期279-282,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨卵巢类似性索肿瘤的内膜样腺癌的临床病理特点。方法对1例卵巢类似性索肿瘤的内膜样腺癌进行光镜观察、免疫组化标记和文献复习。结果患者女性,71岁。阴道出血2周,B超示右侧附件有直径5 cm肿块。镜检:肿瘤绝大部分(95%)由粒层细胞瘤样的实体细胞巢、小梁和小腺管样组织构成;仅局部区域(5%)出现典型的内膜样癌形态。免疫组化:性索间质样细胞AE1/AE3、CK7、EMA、CEA和ER(+),α-inhibin和calretinin(-),Ki-67(MIB-1)阳性细胞数<1%。结论在形态学上,卵巢类似性索肿瘤的内膜样腺癌与卵巢性索间质来源的颗粒细胞瘤、支持细胞和/或间质细胞肿瘤极易混淆。多取材,镜下仔细寻找内膜样腺癌的组织学依据,免疫组化性索样肿瘤细胞角蛋白、EMA和ER/PR(+),α-inhibin和calretinin(-)可明确诊断。Objective To investigate the clinical and pathological characteristics of ovarian endometrioid adenocarcinoma resembling sex-cord tumors. Methods One case of ovarian endometrioid adenocarcinoma resembling sex-cord tumors was studied with light microscope and immunohistochemical approaches. Results A 71 year-old lady presented virginal bleeding with unknown cause for two weeks and was hopitalized. Uhrasound examination revealed that she had a mass in right side pelvis, measuring 50 cm in diameter. Pathologically, the most part of tumor （95 % ） was consisted of solid cords, trabecular, miniglands, and small tubular structures, which were very similar to the granular cell tumor and Leydig-Sertoli cell tumors on histology. The minority of the tumor （5% of the tumor） showed typical morphology of endometrioid carcinoma. Some of the glands contained PAS positive mucin. Immunohistochemical staining demonstrated the tumor cells were positive for epithelial markers （AE1/AE3, CK7, EMA, CEA）, but negative for markers of sex-cord tumors （calretinin, α-Inhibin）. Only few cells （〈 1%） were positive for Ki-67 （MIB-1）, which indicated very low proliferation activity of tumor cells. Conclusion Ovarian endometrioid adenocarcinoma resembling sex-cord tumors is a rare low-grade subtype of ovary endometrioid carcinoma. It is very important to sample enough tissue and thoroughly observe under microscope in order to seek the clue of differential diagnosis. Immunohistochemcally, using a panel of antibodies, including cytokeratins, inhibin, melan A, calretinin, CD99, EMA, ER and PR and CD10, will facilitate to confirm the diagnosis and make differential diagnosis from real ovary granular cell tumor and Leydig /Sertoli cell tumor. Key diagnosis points for ovary endometrioid adenocarcinoma resembling sex-cord tumor include typical endometrioid carcinoma foci under microscope and sex-cord like areas showing cytokeratins^＋ , EMA^＋ and inhibin^- , cairetinin^- characteristics on immunohistochemistry.

关 键 词：卵巢 性索肿瘤 子宫内膜样癌 病理学 

分 类 号：R737.31[医药卫生—肿瘤]