卵巢恶性小圆细胞肿瘤的诊断和鉴别诊断

Diagnosis and differential diagnosis of malignant small round cell tumor of the ovary

卵巢的恶性小圆细胞肿瘤相对少见,主要由缺少细胞质的小圆形细胞组成。卵巢恶性小圆细胞肿瘤种类多,形态学上有重叠,病理医师常难以做出明确诊断。卵巢高血钙型小细胞癌是这些肿瘤中认识最清楚的肿瘤,应注意与性索-间质肿瘤、小圆蓝色细胞肿瘤家族中的肿瘤和未分化恶性肿瘤鉴别。肺型小细胞癌也可发生于卵巢,常与典型的表面上皮-间质肿瘤密切相关。可以发生或累及卵巢的小圆细胞肿瘤还有腹腔内促纤维增生性小圆细胞肿瘤、转移性小细胞癌、外周原始神经外胚叶肿瘤、子宫内膜间质肉瘤等。作者就发生于卵巢的恶性小圆细胞肿瘤形态学特征,以及免疫组化和其他辅助手段在此类肿瘤诊断和鉴别诊断中的应用作一综述。

Ovarian neoplasms, composed predominantly or exclusively of small round cells with scant cytoplasm, is relatively rare. However, there is a wide range of differentiation, and pathologists often struggle to make a correct diagnosis because of its overlapping histological features. Perhaps the best known neoplasm of this kind is ovarian small cell carcinoma of the hypercalcemic type, which may be confused with a wide range of neoplasm from sex cord-stromal tumor to neoplasm in the family of small round blue cell tumor to various undifferentiated malignancies. Small cell carcinoma of the pulmonary type may also arise from the ovary, and this may be a component of a typical ovarian surface epithelial-stromal tumor. Other small cell neoplasm that may arise within the ovary or involve the ovary includes intra-abdominal desmoplastic small round cell tumor, metastatic small cell carcinoma, peripheral primitive neuroectodermal tumor, and endometrial stromal sarcoma. In this review, the morphologic features of some of these neoplasms are described, as well the value of immunohistochemistry and other ancillary techniques in establishing a diagnosis.