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目的探讨卵巢粒层细胞瘤的临床病理特征,诊断及鉴别诊断。方法回顾本院诊治的15例卵巢粒层细胞瘤的临床表现、病理特征及免疫表型特点,并复习相关文献。结果 15例粒层细胞瘤患者中,2例为幼年型粒层细胞瘤,发病年龄6～20岁,平均12岁;13例为成年型粒层细胞瘤,发病年龄26～74岁,平均46.7岁。临床主要表现为不规则阴道流血、腹痛、腹部包块、闭经、腹水。巨检为实性或囊实性肿块。光镜下成年型粒层细胞瘤可见典型的含Call-Exner小体的微滤泡结构及瘤细胞核内的纵行核沟,幼年型粒层细胞瘤缺乏此特征,瘤细胞有一定异型性,可见核分裂像。免疫组化染色显示瘤细胞表达inhibin-α、CD99和Vimentin,部分患者Melan-A、Calretinin和S-100阳性,CKpan、EMA、PLAP、Syn和CgA缺乏阳性表达。结论卵巢粒层细胞瘤临床少见,属于低度恶性肿瘤,预后较好。确诊依赖于临床特点、组织形态学及免疫组化标记。病理诊断时要与卵巢的子宫内膜样癌、小细胞癌、低分化腺癌及无性细胞瘤等肿瘤相鉴别。
Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of ovarian cystadenocarcinoma. Methods The clinical manifestations, pathological features and immunophenotypic features of 15 patients with ovarian stratum tumor diagnosed and treated in our hospital were reviewed. Relevant literatures were reviewed. Results Among the 15 patients with granular cell tumor, 2 cases were juvenile granulosa cell tumor, the age of onset was 6 to 20 years old, with an average of 12 years. 13 cases were adult type of granulocytoma, with a mean age of 46.7 years year old. The main clinical manifestations of irregular vaginal bleeding, abdominal pain, abdominal mass, amenorrhea, ascites. Big test for solid or cystic solid mass. Light microscope adult granulosa cell tumor can be seen typical Call-Exner body containing the micro-follicular structure and the tumor cell nucleus longitudinal groove ditch, juvenile granular cell tumor lack of this feature, the tumor cells have a certain atypia, Can be seen as nuclear fission. Immunohistochemical staining showed that inhibin-α, CD99 and Vimentin were expressed in tumor cells. Melan-A, Calretinin and S-100 were positive in some tumor cells, and positive expression of CKpan, EMA, PLAP, Syn and CgA were negative in some tumor cells. Conclusion Ovarian mesothelioma is rare in clinical practice and is a low-grade malignant tumor with good prognosis. Diagnosis depends on clinical features, histomorphology and immunohistochemical markers. Pathological diagnosis with ovarian endometrioid carcinoma, small cell carcinoma, poorly differentiated adenocarcinoma and non-cancerous tumor differentiated.