具有罕见的肝样组织学特征卵巢非特异性类固醇细胞瘤的病理学特征及诊治分析  

Pathological feature,diagnosis and treatment of non-spelific ovarian steroid cell tumor with rare hepatoid histological features

作　　者：夏仙根[1] 杨帆[1] 崔家旗 XIA Xian-gen;YANG Fan;CUI Jia-qi(Department of Pathology,the Fifth People’s Hospital of Chengdu,Chengdu 611130,China)

机构地区：[1]成都市第五人民医院病理科,成都611130

出　　处：《诊断病理学杂志》2020年第11期812-815,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨具有肝样组织学特征的卵巢非特异性类固醇细胞瘤的病理学特点及诊断治疗。方法对罕见的1例30岁女性具有肝组织样的卵巢非特异性类固醇细胞瘤进行大体、镜下、免疫组织化学染色检查,观察其临床病理特点,对诊断、治疗进行总结。结果该例患者行剖宫产术时发现左侧卵巢增大,体积约4 cm×3 cm×2 cm,质软,界清。瘤细胞排列呈巢状、腺泡状、条索板层状,部分区域围绕血管放射状排列,似肝小叶,肿瘤间质稀少,有丰富的毛细血管网和血窦样结构,似肝血窦。瘤细胞体积较大,边界清楚,圆形或多边形,胞质较丰富,颗粒状,嗜酸性,核圆形或卵圆形,大小较一致,居中或偏位,似肝细胞,少许细胞胞质可见棕黄色细颗粒,似胆汁,核分裂0~1个/10HPF。免疫组织化学染色,肿瘤细胞a-inhibin、calretinin、Melan-A(+),EMA、CK、D2-40、HCG、CD30、AFP、GPC-3、OCT-4、SALL-4(-),Ki-67阳性率<1%。结论具有肝样组织学特征的卵巢非特异性类固醇细胞瘤是一种非常罕见的肿瘤,容易误诊,组织形态学需与肝样卵黄囊瘤、肝样癌、妊娠黄体瘤等鉴别。临床治疗为手术完整切除,临床随诊。Objective To investigate the pathological features,diagnosis and treatment of ovarian non-specific steroid cell tumor with hepatoid histological features. Methods A rare case of a 30-year-old woman with hepatoid nonspecific ovarian steroid cell tumor was examined by gross,microscopy and immunohistochemical staining,aiming to observe its clinicopathological characteristics and to summarize the way of diagnosis and treatment. Results The patient was found an enlarged left ovary which had soft texture and clear boundaries during cesarean section;the volume was 4 cm × 3 cm × 2 cm in size. The tumor cells were nested,acinar,and lamellar. Some areas were arranged radially around the blood vessels,resembling liver lobules. The tumor stroma was scarce,with a rich capillary network and blood sinus-like structures. The tumor cells were large,with clear boundaries,round or polygonal shapes,abundant eosinophilic granular cytoplasm,and round or oval nucleus( consistent in size,centered or deviated),looking like hepatocytes;in a few cells brown-yellow fine particles were noted in the cytoplasm,resembling bile. The mitotic figures were 0-1/10 HPF. Immunohistochemistry showed that tumor cells were positive for inhibin,calretinin and Melan-A,but negative for EMA,CK,D2-40,HCG,CD30,AFP,GPC-3,OCT-4 and SALL-4;Ki-67 index was <1%. Conclusion Ovarian non-specific steroid cell tumor with hepatoid histological characteristics is a very rare tumor,which is easy to be misdiagnosed. Histomorphology should be distinguished from yolk sac tumor,hepatoid carcinoma,and pregnancy luteum tumor. The clinical treatment is complete surgical resection and clinical follow-up.

关 键 词：肝样组织学 卵巢 非特异性类固醇细胞瘤 

分 类 号：R737.31[医药卫生—肿瘤]