卵巢黏液性囊腺瘤合并性索-间质肿瘤的临床病理观察

Mucinous cystadenoma coexisting with sex cord-stromal tumor of the ovary

目的探讨卵巢黏液性囊腺瘤合并性索-间质肿瘤(MCSC)的临床病理特点、组织起源及其诊断和鉴别诊断。方法对1例MCSC进行组织形态学、免疫组化观察,并复习相关文献。结果患者发现盆腔肿物1年,无明显不适及内分泌症状。大体上肿瘤为多房囊性,囊内壁可见散在的实性结节,镜检肿瘤由黏液性囊腺瘤和性索间质肿瘤两种成分组成,前者囊壁衬覆良性肠型黏液柱状上皮,性索间质成分瘤细胞呈小管状、条索状、梁状排列,局部有黄素化,两种成分混合存在,未见移行。免疫组化:性索成分瘤细胞呈Melan A弥漫强阳性;αInhibin和CD56局灶阳性;并见CKpan、vimentin、ER及PR的阳性表达;而EMA、CEA、CD99、S-100、CgA、Syn、nestin及SMA均阴性;Ki-67指数小于5%。结论MCSC是罕见的卵巢肿瘤,性索间质成分可能是黏液性囊腺瘤囊壁内间质的一种反应性增生。诊断时需与类癌、伴异源成分的支持-间质细胞瘤、畸胎瘤等鉴别。

Purpose To study the clinicopathologic features,histogenesis,diagnosis and diferential diagnosis of mucinous cystadenoma coexisting with sex cord-stromal tumor of the ovary（MCSC）.Methods A case of MCSC was observed with histological and immunohistochemical staining.The related literatures were reviewed.Results A 25-year-old femal presented with pelvic mass for a year,no hormonal manifestations and other symptoms were obsereved.Grossly,the cut surface of the tumor revealed multiloculated cysts filled with mucinous fluid.There were some scattered,gray-white solid nodules,1 cm to 1.5 cm within the wall.Microscopically,the tumor was composed of both mucinous cystadenoma and sex cord-stromal tumor.The cysts were lined with benign mucinous epithelium of the intestinal type,and sex cord-stromal tumor cells arranged in small tubuled,cords and trabecular pattern and focal lunization could seen.These two disparate components were intimately mixed,there were no evidence of transition between them.Immunohistochemically,the sex cord elements were diffuse positive for MelanA and focally positive for αInhibin and CD56;CKpan、vimentin、ER and PR were also positive.Howere,it stained negatively for EMA、CEA、CD99、S-100、CgA、Syn、nestin、and SMA;Ki-67 index was less than 5%.Conclusion MCSC is a rare ovarian tumor,the sex cord-stromal elements might be a reactive stromal hyperplasia in the wall of the preexisting mucinous neoplasm.It should be differented from carcinoid,sertoli-leydig cell tumor with heterogolous elements,teratoma.