卵巢交界性浆黏液性肿瘤的临床病理学特征

Clinicopathological features of ovarian borderline seromucinous tumor

目的探讨卵巢交界性浆黏液性肿瘤的临床病理学特征。方法回顾性分析2015年4月至2018年3月22例卵巢交界性浆黏液性肿瘤患者的临床资料,复阅病理切片,应用EnVision法进行免疫组织化学染色,总结临床病理学特征。结果患者年龄23~66岁,平均39.2岁,中位年龄36岁。22例患者中,体检发现14例,下腹不适或阴道不规则流血7例,伴有痛经史4例,癌抗原125和/或癌胚抗原升高5例。超声检查均提示附件区包块。平均肿瘤直径7.2cm,囊性或囊实性,囊内为黏稠液体或褐色液体,伴内生性或外生性乳头。镜下可见肿瘤组织排列为粗大的乳头结构,表面被覆单层或复层肿瘤性上皮细胞,以浆液性、宫颈管型及内膜样腺上皮多见,间质伴水肿及中性粒细胞浸润。伴有子宫内膜异位症11例,2例分别伴有腹膜或大网膜肿瘤种植。免疫组织化学染色显示,患者不同程度地表达雌激素受体(ER)、孕激素受体(PR)、配对盒基因(PAX)8和细胞角蛋白(CK)7,均不表达CK20和尾型同源盒基因(CDX)2。国际妇产科联盟(FIGO)Ⅰ期20例,随访3~36个月,平均13.6个月,均未见复发和转移。结论卵巢交界性浆黏液性肿瘤多见于年轻患者,多数无特异性临床症状,其发生主要与子宫内膜异位症相关,可伴有典型内膜异位组织学表现,确诊时需与卵巢交界性浆液性及黏液性肿瘤鉴别。多数卵巢交界性浆黏液性肿瘤为FIGOⅠ期,预后良好,可参照交界性内膜样肿瘤的治疗方案。

ObjectiveTo investigate the clinicopathological features of ovarian borderline seromucinous tumor.MethodsThe clinical data of 22 ovarian borderline seromucinous tumor from April 2015 to March 2018 were retrospectively analyzed. The clinicopathological features were summarized by immunohistochemical staining with EnVision method.ResultsThe age of patients was 23 to 66 years, with an average age of 39.2 years and a median age of 36 years. In the 22 patients, 14 patients were found by physical examination, 7 patients had abdominal discomfort or irregular vaginal bleeding, 4 patients had a history of dysmenorrheal, and 5 patients had cancer antigen 125 and/or carcinoembryonic antigen elevation. Ultrasonography revealed mass in the adnexal region. The average diameter of these tumors was 7.2 cm. The tumors were cystic or cystic solid property and contained viscid or hemorrhagic fluid, with endogenous or exogenous papilla. Microscopically, these tumors showed complex papillary architecture and the larger papillae tended to have edematous stroma containing neutrophils. The epithelium lining the papillae was typically stratified and mostly composed of endocervical-type mucinous or serous epithelium, but endometrioid epithelium was not unusual. Eleven patients had endometriosis, and 2 cases occurred peritoneal or omental tumor implantation respectively. Immunohistochemistry showed that the estrogen receptor (ER), progesterone receptor (PR), paired box gene (PAX) 8 and cytokeratin (CK) 7 were positive in different degrees, and the CK20 and tail-type homeobox gene (CDX) 2 were negative in all patients. Twenty patients were International Federation of Gynecology and Obstetrics (FIGO)Ⅰstage without recurrence or metastasis in 3 to 36 months (average 13.6 months)′ follow-up.ConclusionsMost patients with the ovarian borderline seromucinous tumor are young without specific clinical symptoms. Tumor is associated with endometriosis and maybe has characteristic histological changes. Attention should be paid to the differentiation from borderline serous and mucinous tumor before the final diagnosis. Most patients with ovarian borderline seromucinous tumor are FIGO Ⅰ stage and have the good prognosis. The clinical treatment is referred to the treatment of borderline endometrioid tumors.