卵巢浆黏液性癌临床病理学分析

Clinicopathologic study of seromucinous carcinoma of ovary

目的：探讨卵巢浆黏液性癌的临床病理学特征、免疫表型及鉴别诊断。方法收集7例卵巢原发浆黏液性癌的临床病理资料，进行病理形态学观察及免疫组织化学检测，并复习文献。结果7例患者年龄27～70岁（平均48岁）。临床表现主要为腹胀。多数患者血清CA125和／或CA19-9明显升高。4例患者伴有腹水，其中2例腹水或腹腔灌洗液中查见腺癌细胞。大体上，肿瘤最大径为6.0～15.0 cm（平均9.3 cm）。9个肿瘤（包括2例双侧，5例单侧）中，6个主要呈囊性，囊内可见乳头状结构，其中2个肿瘤囊内含黏稠液体；另3个主要呈实性。镜下观察：9个肿瘤均由颈管内膜型黏液上皮及其他苗勒上皮细胞组成。肿瘤细胞中-重度异型。所有肿瘤的间质及腺腔内均见多量中性粒细胞浸润，这是卵巢浆黏液性肿瘤的突出特点。组织结构上主要表现为复杂的乳头结构、高度增生的腺体背靠背排列成筛状结构，或以实性生长方式为主。肿瘤细胞主要表达雌激素受体（6例）、孕激素受体（4例）、细胞角蛋白7（7例）、PAX8（4例）。1例行组织化学染色，阿辛蓝染色、过碘酸-雪夫（ PAS）染色及糖原淀粉酶消化法-PAS染色均为阳性。随访3～86个月（平均21个月），1例于术后81个月死于肿瘤，其余6例均无复发。结论卵巢浆黏液性癌具有相对特殊的临床病理学特征，但其形态学及免疫表型与卵巢子宫内膜样癌及低级别浆液性癌均有一定交叉。

Objective To elucidate the clinicopathologic characteristics, immunophenotype and differential diagnosis of ovarian seromucinous carcinoma.Methods The clinical and pathological characteristics of 7 cases of ovarian seromucinous carcinoma were analyzed.Immunohistochemical study of selected markers was performed employing the EnVision method.Literature of ovarian seromucinous carcinoma were also reviewed.Results The age of the 7 ovarian seromucinous carcinoma patients ranged from 27 to 70 years of age （ mean=48 years）.Two patients had bilateral ovarian tumors.The complaint of most patients was abdominal distention.The serum concentration of CA125 and/or CA19-9 was elevated in most patients.Four patients were found to have ascites during surgery, of whom 2 were also found to have malignant cells in their ascites or peritoneal washings.The maximum dimension of these tumors ranged from 6.0 to 15.0 cm （ mean=9.3 cm）.Grossly, 6 of 9 tumors were predominantly cystic with protrusions of papillae from the inside wall of the cysts.Among these 6 tumors, 2 had brown viscous material in the cyst.The other 3 tumors were predominantly solid.Microscopically, all 9 tumors contained endocervical-like mucinous cells and other Mullerian cells.The tumor cells had intermediate or severe atypia.A lot of acute inflammatory cells especially neutrophil polymorphs could be seen in the stroma and lumens of all the 9 tumors, which is an apparent feature for ovarian seromucinous tumors.Architecturally, the tumors mainly exhibited complex papillary architectures, compactly back-to-back glandular lumensforming cribriform,＆amp;nbsp;labyrinthine formations, or solid growth pattern, with immunophenotype of Mullerian tumors.Mucin stain was performed in 1 tumor with AB positive, PAS positive and D-PAS positive, highlighting intracytoplasmicmucin secretions.Follow-up （3-86 months with a mean of 21 month） data revealed that except 1 patient dying of the tumor at 81 months after surgery, the other 6 patients all survived the malignancy. Conclusions Seromucinous carcinoma of the ovary possesses relatively special clinicopathologic features, with some morphological and immunophenotypical overlap with endometrioid carcinoma and low grade serous carcinoma of the ovary.It is necessary to thoroughly investigate the pathogenesis and molecular changes involved in the type of tumor to determine whether it is a convincingly distinctive category of ovarian carcinoma.