伴有甲状腺成分的卵巢恶性肿瘤五例并文献复习

Five cases of ovarian malignant tumor with thyroid component and literature review

目的探讨伴有甲状腺成分的卵巢恶性肿瘤的临床病理特点。方法回顾性分析2006年5月至2018年3月收治的5例伴有甲状腺成分的卵巢恶性肿瘤患者的临床病理资料,包括4例甲状腺肿类癌和1例卵巢转移性甲状腺滤泡癌(嗜酸性细胞变异型),并复习相关文献。结果5例患者年龄25~65岁,因体检发现盆腔包块或腹部不适就诊。肿瘤均单侧发生,多见左侧。肿物直径5~13 cm,以囊实性为主。镜下甲状腺肿类癌可见甲状腺肿和类癌成分,类癌主要以梁状和岛状分布,免疫组织化学突触素(Syn)、嗜铬蛋白(CgA)阳性。卵巢转移性甲状腺癌患者伴有13年甲状腺功能异常病史,肿瘤短时间内生长迅速。镜下可见密集的甲状腺滤泡排列为乳头状或弥漫散在分布,肿瘤细胞具有丰富的嗜酸性胞质,伴有卵泡膜细胞瘤样增生。结论伴有甲状腺成分的卵巢原发恶性肿瘤类型以乳头状癌和甲状腺肿类癌常见,肿瘤恶性程度低,预后良好。甲状腺癌卵巢转移极其罕见,需与卵巢原发甲状腺癌鉴别。

Objective To investigate the clinicopathological features of ovarian malignant tumor with thyroid components.Methods The clinical and pathological data of ovarian malignant tumor with thyroid component were collected from May 2006 to March 2018,including four cases of stroumal carcinoid and one case of metastatic thyroid follicular carcinoma,and the related literature was also reviewed.Results Ages of 5 cases ranged from 25 to 65 years old,and pelvic mass or abdominal discomfort was presented in physical examination. Tumors were unilateral,and mainly on the left side. The diameter of tumors was 5 to 13 cm with cyst or solid mainly. The strumal and carcinoid components were seen in strumal carcinoid. The insular and trabecular carcinoid were the common types of carcinoid. The synaptophysin (Syn) and chromogranin (CgA) were positive by immunohistochemistry. The patient with metastatic thyroid follicular carcinoma of ovary had a history of thyroid nodules for 13 years and the tumor grew rapidly in a short time. Under the microscope,dense thyroid follicles were arranged in papillary or diffuse distribution. Tumor cells were rich in eosinophilic cytoplasm and accompanied by follicular cell tumor-like hyperplasia.Conclusions Papillary tumor and strumal carcinoid are the most common primary malignant tumors of ovary with thyroid component,which both presented low malignancy and good prognosis. Ovarian metastasis from thyroid cancer is extremely rare and needs to be differentiated from primary ovarian thyroid cancer.