卵巢微囊性间质肿瘤临床病理观察

Microcystic stromal tumor of the ovary: a clinicopathological analysis

目的探讨卵巢微囊性间质肿瘤(MCST)的临床病理特征及鉴别诊断。方法对1例卵巢MCST临床病理特征、免疫表型进行回顾性分析,并复习相关文献。结果患者女性,29岁。巨检:左侧卵巢结节状肿物,大小5.5 cm×5 cm×4.5 cm,表面不规则,似有包膜;切开见一囊腔,囊腔直径2.5 cm,内有咖啡色液体,其余切面实性,灰白、灰红色,质中。镜检:肿瘤细胞呈片巢状分布,多数细胞巢内见大小不等的囊腔,圆形或融合成不规则形,囊腔空亮,部分内含稀薄淡粉或淡蓝色分泌物,囊腔周围细胞呈圆形、卵圆形或短梭形,胞质红染,核大小较一致,无明显异型性,染色质细腻,未见核分裂。部分区域细胞成片,无微囊形成。肿瘤细胞巢之间有大片黏液样或玻璃样变区,可见灶性出血。局部肿瘤细胞呈腺泡状排列,胞质透明,核圆形居中,间质有丰富纤细的毛细血管。免疫组化:vimentin、CD10、β-catenin和WT-1(+),desmin、SMA、α-inhibin、CD99、S-100、CKpan、EMA、calretinin、CD56、Cg A和Syn均(-);Ki-67增殖指数3%。结论卵巢微囊性间质肿瘤是一类独特的肿瘤,其组织起源还不清楚,生物学行为倾向良性。

Objective To investigate the clinical and pathological features, diagnosis and differential diagnosis of ovarian microcystic stromal tumor. Methods Retrospective analysis of the clinical data, histopathological morphology and immunophenotype was conducted in one case of ovarian microcystic stromal tumor. Results The patient was female, 29 years of age. General observation showed the left ovarian tumor measured 5.5 × 5 × 4. 5 cm, without flat surface. Cut surface of the tumor revealed a mixed cystic and soid appearance, cystic cavity was 2. 5 cm in diameter and contained brown liquid; solid components were grayish-white and red. Microscopically, many tumor nests contained varied size of cystic spaces with round or irregular shape. The lumens of cyst were clear and partly filled with finely pale dyed secretions. Tumor cells had a faintly eosinophilic cytoplasm, round-to-ovoid and sometimes short-spindled nuclei devoid of mitotic activity with very fine chromatin. In some areas, solid cellular islands predominanted without a minor cystic component, cellular islands were separated by hyalinized stroma. Focally, tumor cells with clear cytoplasm showed an alveolar pattern with capillaries- rich stroma. Immunohistochemically, tumor cells were diffusely and strongly positive for vimentin, CD10, β-catenin, WT- 1 and negative for desmin, SMA, α-inhibin, CD99, S-100, CK（pan）, EMA, calretinin, CD56, CgA, and Syn. Ki-67- labeling index was appromately 3%. Conclusions Microcystic stromal tumor is a distinctive subtype of ovarian tumor, its histogenesis remains unclear and biological behavior is likely benign.