卵巢硬化性间质瘤临床病理特征、诊断及鉴别诊断分析

The clinical pathological characteristics,diagnosis and differential diagnosis of ovarian sclerosing stromal tumor

目的探讨卵巢硬化性间质瘤(sclerosing stromal tumour,SST)的临床特点、影像学表现、病理组织学特点、免疫表型、诊断及鉴别诊断,以其提高临床医生对该少见病例的认识。方法报道5例STT,并结合相关文献,对其临床病理特征、诊断及鉴别进行分析。结果 5例SST患者中,3例以月经不规律就诊,1例表现为下腹隐痛,1例无症状,健康体检发现卵巢瘤;超声检查显示,卵巢肿物灶边界清,分叶状,4例为囊实性,1例为实性,内部血流呈轮辐状向心分布是其特征性表现;大体见肿瘤包膜完整,呈实性或囊实性,切面灰白灰黄相间;光镜下瘤细胞丰富区与疏松区相间,呈假小叶样结构;免疫组织化学以表达Vimentin、SMA、α-inhibin为特征。结论卵巢SST为少见病例,临床诊断及影像学诊断较困难,以术中冰冻病理及术后常规病理诊断为主,手术切除治疗效果良好,临床医生应提高对SST的认识,以免过度治疗。

Objective To discuss the clinic characteristics , imaging manifestation , histopathological features, immunophenotyping , diagnosis and differential diagnosis of ovary sclerosing stromal tumor , so as to enhance clinicians understanding of the rare disease .Methods Five STT cases are reported in combination with pertinent literatures to analyze the clinic pathological characteristics , diagnosis and differentiation of the disease . Results Of the five STT patients , three went to hospital because of irregular menstruation , one suffered from dull pain in her lower abdomen , and one showed no symptom but an ovary tumor was detected in a physical exam . Ultrasonography revealed that it had a clear -cut boundary and was lobulated -shaped.There are four cyst -solid, and one solid, featured by a spoke -like centripetal distribution of the inner blood .The tumor capsule is generally intact, either solid or cyst -solid, with sections colored gray -sallow.Observed under a light microscope , the oncocyte-concentration region alternates with the puff region , structured like pseudo lobule .The immunohistochemical manifestation is characterized by Vimentin , SMA, and α-inhibin.Conclusions Ovary SST is rare case which difficult in clinic and imaging diagnosis .Intra-operative frozen pathologic check and post operative routine pathological diagnosis are the main measures taken , and surgical excision has good therapeutic effect.Clinicians should deepen their understanding of SST to avoid over -treatment.