卵巢恶性非性腺母细胞型生殖细胞-性索-间质肿瘤

Malignant germ cell-sex cord stromal tumor of the ovary,non-gonadoblastoma cellular type:A case report and literature review

目的 :探讨卵巢恶性非性腺母细胞型生殖细胞 性索 间质肿瘤的临床病理学特点。方法 :对 1例卵巢恶性非性腺母细胞型生殖细胞 性索 间质肿瘤进行光镜、组织化学和免疫组化染色。结果 :(1 )光镜观察 :瘤细胞呈巢状或蜂窝状分布 ,个别区域有囊性滤泡状结构。瘤细胞主要向生殖细胞、间质细胞和粒层细胞分化 ,并以生殖细胞分化占优势。 (2 )组织化学染色 :向生殖细胞分化的部分细胞PAS染色阳性。 (3)免疫组化染色 :绒毛膜促性腺激素 (hCG)、细胞角蛋白 (CK)合体滋养细胞阳性 ;波形蛋白 (vimentin)间质细胞、粒层细胞阳性 ;孕激素受体 (PR)、神经元特异性烯醇化酶 (NSE)以及c erbB 2、bcl 2部分生殖细胞及间质细胞阳性 ;甲胎蛋白 (AFP)少数生殖细胞阳性 ;白细胞共同抗原 (LCA)、胶质纤维酸性蛋白 (GFAP)、雌激素受体(ER)、转移抑制因子 (nm2 3)、癌胚抗原 (CEA)、平滑肌肌动蛋白 (SMA)均阴性。结论 :非性腺母细胞型生殖细胞 性索 间质肿瘤 ,组织学起源尚未明了 ,组织学形态须与性腺母细胞瘤、两性母细胞瘤、无性细胞瘤、性索 间质肿瘤及非特殊类型类固醇细胞瘤相鉴别。

Objective:To study the clinico pathological features of germ cell sex cord stromal tumor of the ovary,non gonadoblastoma cellular type(GSST,NGCT).Methods:One case of GSST,NGCT was examined by light microscopy,histochemistry and immuno histochemistry.Results:Microscopically,the tumor was mainly composed of germ cells,stromal cells and granule cells,which arranged in nests,bee nests or cords.Histochemically,the part clear cells were positive for PAS.Immunohistochemically,the trophoblastic cells were positive for hCG and CK;partly,the germ cells were positive for PR,c erbB 2,bcl 2 and NSE;a few germ cells were positive for AFP;LCA,GFAP,ER,CEA,SMA and nm23 were negative.Conclusions:Mixed germ cell sex cord stromal tumor is the rare tumor in the ovary,the cells origin remains undetermined.Differential diagnostic considerations of GSST,NGCT should include gonadoblastoma,gynandroblastoma,dysgerminoma,sex cord stromal cell tumor and nonspecial type of the steroid cell tumor.