卵巢幼年型粒层细胞瘤的临床病理分析  

Clinicopathologic study of juvenile granulosa cell tumor of ovary

作　　者：张彦宁[1] 黄受方[1] 

机构地区：[1]首都医科大学附属北京友谊医院病理科,100050

出　　处：《中华病理学杂志》2010年第10期661-665,共5页Chinese Journal of Pathology

摘　　要：目的 分析卵巢幼年型粒层细胞瘤的临床病理特点,探讨其诊断标准、特殊形态及预后因素等.方法 对7例幼年型粒层细胞瘤的临床资料行回顾性分析总结、组织切片进行形态观察,对其中6例行免疫组织化学EliVision法染色.6例进行了随访.结果 7例幼年型粒层细胞瘤的平均年龄为24岁（6～53岁）.5例有性激素紊乱的临床表现,2例以腹胀及腹痛为主要症状.除1例（例2）行全子宫和双附件切除,其余6例均为一侧附件切除.5例Ⅰ A期,2例Ⅰ C期.6例随访病例中除1例（例1）术后1年余死于肿瘤转移,其余5例健在,随访时间平均4.3年（1～10年）.肿瘤最大径7～20 cm（平均13.4 cm）,4例囊实性,2例单房囊性,1例实性.镜下全部为弥漫生长和不典型滤泡样结构,未见Call-Exner小体.肿瘤细胞核小、较圆、深染,极少见核沟,3例重度异形,1例中度,3例轻度.1例（例2）小灶有成年型粒层细胞瘤特征.5例核分裂象＞5/10 HPF,2例核分裂象不易见.6例CK（AE1/AE3）阴性、波形蛋白强阳性;1例α-抑制素阳性;4例CD99阳性、Calretinin阴性.结论 幼年型粒层细胞瘤以不典型滤泡样结构而非Call-Exner小体为结构特点,以核小、圆形、深染而无核沟为主要细胞学特点,以大多数CK阴性和波形蛋白阳性为特殊免疫表型,兼以有少量成年型粒层细胞肿瘤结构及单房囊性肿瘤为其特殊形态.肿瘤破裂可能是影响预后的一个重要因素,核异形、核分裂象多见及肿瘤体积大并不能提示肿瘤具有恶性潜能.Objective To study the clinicopathologic features, diagnostic criteria and prognostic parameters of juvenile granulosa cell tumor of ovary. Methods The clinical and pathologic findings of 7 cases of juvenile granulosa cell tumor were retrospectively reviewed. Immunohistochemical study was carried out in 6 of these cases. The follow-up data were also analyzed. Results The mean age of the patients was 24 years （ range = 6 to 53 years）. Four patients presented with hormonal disturbance, while 3 patients presented with abdominal pain or swelling. Six patients underwent unilateral salpingo-oophorectomy. Six cases were in stage Ⅰ A and the remaining case in stage Ⅰ C. Follow-up information was available in 6 patients and the duration of follow up ranged from 1 to 10 years （mean =4.3 years）. Five patients remained healthy, with no evidence of tumor recurrence. One patient died of tumor metastasis one year after the diagnosis. Gross examination showed that the tumor masses ranged from 7 to 20 cm in the greatest dimension （average = 13.4 cm）. Four of the 7 tumors were mixed solid-cystic in appearance and 2 cases were unilocular cystic in nature. Microscopic examination showed diffuse atypical follicular structures formed by granulosa cells. The granulosa cells contained round hyperchromatic nuclei, without nuclear grooves or Call- Exner body formation （6/7）. In one of the cases studied, minor foci resembling adult granulosa cell tumor were also demonstrated. The degree of cellular atypia varied （3 cases with severe atypia, 1 case with moderate atypia and 3 cases with mild atypia）. The mitotic count ranged from 1 to more than 5 per 10 high power fields. Immunohistochemical study showed diffuse positivity for vimentin （6/6）. The staining for cytokeratin （ AE1/AE3） and calretinin was negative. Four cases expressed CD99 and 1 case was positive for inhibin. Conclusions Juvenile granulosa cell tumor is characterized by the presence of diffuse atypical follicular structures formed by small round c

关 键 词：卵巢肿瘤 粒层细胞瘤 诊断 鉴别 免疫表型 预后 

分 类 号：R686[医药卫生—骨科学]