卵巢粒层细胞瘤的病理特点及其与预后的关系

Pathologic Features and Prognostic Factors of Ovarian Granulose Cell Tumor

目的分析卵巢成人型粒层细胞瘤(AGCT)与幼年型粒层细胞瘤(JGCT)的病理组织学特点、相关临床症状和预后的相关因素。方法收集2002年4月至2011年9月我院收治的40例卵巢粒层细胞瘤病例,总结AGCT及JGCT的病理组织学特征和临床特征,并分析其病理特征与预后的关系。结果本组病例中,AGCT 34例(85%),JGCT 6例(15%)。AGCT平均发病年龄50.1岁,JGCT平均发病年龄35.3岁,差异有统计学意义(P=0.034)。病理组织学特征方面,AGCT多以滤泡状、岛状及梁索状结构为主,Call-Exner小体较多见,肿瘤细胞黄素化及出血坏死等特征则不明显;JGCT细胞多呈弥漫状排列,Call-Exner小体少见,肿瘤细胞黄素化及出血坏死等特征明显。术后复发、肿瘤盆腔内蔓延和肿瘤自发破裂为预后不良指标,预后不良的病例较预后良好病例肿瘤细胞排列结构多样,多为混合型(P=0.045);Call-Exner小体少见(P=0.034);核分裂相多≥3/10个高倍视野(HPF)(P=0.003);PTEN表达率降低(P=0.034),Ki-67表达率升高(P=0.021)。结论肿瘤细胞排列结构、核分裂数、PTEN及Ki-67的表达率对判断卵巢GCT的临床预后具有一定的指导意义。

Objecitve To identify the pathological features, clinical symptoms and the prognostic factors for adult granulose cell tumor （AGCT） and juvenile granulose cell tumor （JGCT）. Methods The pathological features and clinical characters of 40 patients with granulose cell tumors （GCT） between April 2002 and September 2011 were reviewed, and the relevant prognostic factors were analyzed. Results 34 cases （85%） were AGCT, and the average age of onset was 50.1 years old. 6 cases （15%） were JGCT, with an average 35.3 years old age of onset. The difference of average onset age was significant （P = 0. 034）. The histopathological patterns of AGCT were mainly follicular, insular and trabecular, Call-Exner bodies were found frequently, while the luteinization, hemorrhage and necrosis of tumor cells were not common. In contrast, the histopathological pattern of JGCT was mainly diffuse, Call-Exner bodies were rare, while the luteinization, hemorrhage and necrosis of tumor cells were common. The pathological features of the cases with unfavorable prognosis were： ① Mixed mode with tumor cell histopathological pattern （follicular, insular, trabecular and diffuse pattern, the tumor cells were mainly organized in two or more than two kinds of patterns above）. ② Call-Exner bodies were rare;③ mitosis number of tumor cells ≥3/10 HPF ④ low expression of PTEN and high expression of Ki-67. Conclusion The histological patterns, mitosis number, the expression rate of PTEN and Ki-67 were identified to predict the prognosis for GCT of ovary.