卵巢粘液性肿瘤的神经内分泌分化

Neuroendocrine differentiation in ovarian mucinous tumors

目的探讨卵巢粘液性肿瘤的神经内分泌分化与肿瘤分化程度、组织发生的关系。方法用免疫组织化学和免疫组织化学与组织化学联合染色方法观察７３例卵巢粘液性肿瘤（良性：３２例，交界性：２０例，恶性：２１例）病变组织中的神经内分泌细胞的形态、分布和数量。结果良性、交界性、恶性三种病变组织中ＣｇＡ和５ＨＴ的检出率分别依次为６２５％、７５０％、７６０％和３１３％、４００％、３９０％。但这些神经内分泌细胞（ＮＥＣ）的数量和分布未见明显的规律性。在４例肠型的良性肿瘤组织中见到较多ＣｇＡ阳性细胞，分布在粘液上皮的基底部，阳性率＞３０％，光镜下频繁观察到胞浆中同时含ＣｇＡ和ＰＡＳ两种阳性颗粒的中间型细胞。结论卵巢粘液性肿瘤随分化程度下降，神经内分泌细胞的检出率逐渐增加。４例肠型的良性肿瘤组织中频繁观察到胞浆中同时含ＣｇＡ和ＰＡＳ两种阳性颗粒的中间型细胞，提示这些肿瘤可能起源于具有多方向分化能力的干细胞，它们与卵巢粘液性肿瘤伴神经内分泌分化之间的确切关系，尚待研究。

Objective To investigate the relationship between neuroendocrine differentiation of ovarian mucinous tumors and its genesis. Methods A morphologic study on 73 cases of ovarian mucinous tumors (32 benign, 20 borderline, 21 malignant) using immunohistochemical and immunohistochemical/histochemical double staining techniques. Results The incidences of CgA positive cell in tumors of benign, borderline and malignant were 62.5%, 75%,76% and that of 5 HT positive cells were 31.3%, 40%, 39% respectively. But these NEC were not evently destributed. The interesting point was that in four cases of the benign tumors the number of CgA positive cell was more than 30 per cent localizing between the glandular basement membrane and the mucinous epithelial cells. There were also many intermediate cells containing both CgA and PAS positive granules. Conclusions The positive rate of CgA was increased correspounding to the lowering down of differentiation grades. The four cases of the benign tumors might be originating from a common stem cell, such as so called amphocrine cell. The relationship between these four tumors and neuroendocrine differentiation in ovarian mucinous tumors remain further clarified.