卵巢成熟性囊性畸胎瘤癌变临床病理及基因检测分析

A clinicopathologic and genetic analysis on transformation of matured cystic ovarian teratoma to cancer

目的探讨卵巢成熟型囊性畸胎瘤恶性病变患者的临床病例特征与基因检测结果。方法回顾性选取2014年至2017年收治的8例卵巢成熟型囊性畸胎瘤恶性病变患者,对患者的临床病理检查结果与血清基因检查结果进行分析。结果 8例患者均为单侧卵巢病变,下腹部疼痛的患者为3例。肿瘤最大径在10 cm以上的患者3例。8例患者中鳞癌3例,腺癌5例。鳞癌影像学检查囊壁存在部分厚度增加,腺癌存在附壁乳头组织,免疫组化检查结果中鳞癌P63与CK5/6为阳性,腺癌Villin、CK20、CDX2为阳性。基因检测发现肠状腺癌恶性病变患者存在KRAS基因突变。结论通过临床检查、超声影像学检查以及血清肿瘤标记因子可以诊断部分卵巢成熟型囊性畸胎瘤恶性病变,KRAS基因突变检查可以辅助诊断是否存在恶性肿瘤病变。

Objective To explore the results of clinicopathologic and genetic analysis in patients with mature ovarian cystic teratoma transformed to malignancy. Methods Eight patients with mature ovarian cystic teratoma transformed to malignant lesion during 2014 to 2017 in this hospital were selected for this study,their results of clinico-pathologic examination and the serum genetic examination of these patients were analyzed. Results 8 patients were suffered with unilateral ovarian lesions,3 of them had lower abdominal pain. The maximum diameter of tumor in3 patients was over 10 centimeters. Among them,3 of 8 patients suffered with squamous cell carcinomas and 5 patients with adenocarcinoma. The results of imaging scanning showed capsule wall existing partial thickness,the adenocarcinoma tissue having coanda nipple,immunohistochemical results showed squamous carcinoma and positive CK5/6,adenocarcinoma villin,CK20 and CDX2 were positive. Genetic testing found the existance of KRAS mutation in enterolithic adenocarcinoma patients with malignant lesions. Conclusion By clinical examination,ultrasonic imaging examination and examination of serum levels of tumor markers can make the diagnosis of malignant lesions in ovarian mature cystic teratoma,and the examination of KRAS mutation can help the diagnosis for existence of malignant lesions.