卵巢孤立性粒细胞肉瘤的临床病理观察

Clinical features and pathology of isolated granulocytic sarcoma of the ovary

目的 探讨卵巢孤立性粒细胞肉瘤的临床病理特点、诊断及鉴别诊断要点.方法 结合文献对1例双侧卵巢孤立性粒细胞肉瘤的临床表现、病理特征、免疫表型及治疗预后进行分析.结果 卵巢孤立性粒细胞肉瘤是一种罕见肿瘤,迄今查到14例报道.本例表现为右卵巢被灰绿色肿物取代,大小10.0cm×8.5 cm×6.0 cm;左卵巢大小4.8 cm×3.0 cm×2.2 cm,部分被肿瘤取代.肿瘤细胞呈弥漫性分布或列兵样排列.细胞分化程度不等,以原始未成熟细胞为主,可找到幼稚嗜酸粒细胞.免疫组化：肿瘤细胞髓过氧化物酶（MP0）（＋）、CD117（＋）、CD43（＋）、CD79α（-）、CD3（-）.结论 仅凭常规形态学观察,卵巢孤立性粒细胞肉瘤易误诊为淋巴瘤、颗粒细胞瘤等.细胞分化程度不等,列兵样排列、幼稚嗜酸粒细胞的出现是重要的诊断线索.免疫组化是获得正确诊断的主要依据.即使病变位于局部仍需行抗白血病化疗.

Objective To investigate the clinical and pathological features,diagnosis and differential diagnosis of isolated granulocytic sarcoma of the ovary. Methods The clinical manifestations,pathological features,immunohistochemistry,treatment and prognosis were analyzed in 1 case of isolated granulocytic sarcoma of the bilateral ovary with the review of literatures. Results Granulocytic sarcoma of the ovary was rare. Only 14 cases had been reported so far. This case presented a greenish masse arising from the right ovary measuring 10.0 cm × 8.5 cm × 6.0 cm and 4.8 cm × 3.0 cm × 2.2 cm mass in the left ovary. The neoplastic cells grew in a diffuse pattern or India file, composed of myeloid cells at various stages of maturation, being predominantly primitive myelocytes with a few immature eosinophils. Immunohistochemistry,tumor cells were strongly positive for MPO,CD117,CD43,but negative for CD79α,CD3 Conclusions In routine morpholog,granulocytic sarcoma may be misinterpreted as lymphoma,granular cell tumor,et al. Neoplastic cells at various stages of maturation,India file pattern and immature eosinophils are important diagnostic clues. Immunohistochemical stains are essential in order to obtain correct diagnosis. Despite the localized nature of tumor, intensive antileukemia chemotherapy is necessary.