卵巢交界性浆黏液性肿瘤临床病理特征分析

Clinicopathological characteristics of ovarian seromucinous borderline tumor

目的探讨卵巢交界性浆黏液性肿瘤的临床病理学特征、免疫组织化学表型及鉴别诊断要点。方法收集2013年1月至2017年5月山西省人民医院诊治的15例卵巢交界性浆黏液性肿瘤患者的临床病理资料，对手术标本进行HE及免疫组织化学染色后行病理学观察，同时进行随访，并复习相关文献。结果 15例卵巢交界性浆黏液性肿瘤患者年龄26-56岁，平均37岁；其中8例仅发生于右侧，5例仅发生于左侧，2例为双侧发生。临床表现主要为腹胀，3例伴有腹腔积液。肿瘤最大径4-13 cm（平均9．3 cm）。15例均主要呈囊性表现，囊内见多少不等的乳头状突起，2例少部分区域呈实性表现；9例肿瘤由颈管内膜型黏液性上皮组成，4例由颈管内膜型黏液性上皮及浆液性上皮组成，所有肿瘤间质及腺腔内均见较多中性粒细胞，组织结构上主要表现为复杂的多级分支乳头，细胞轻度异型；2例伴有子宫内膜异位症。肿瘤细胞主要表达雌激素受体（ER）、孕激素受体（PR）、配对盒子基因蛋白8（PAX-8）、细胞角蛋白7（CK7），这些标志物均为苗勒管源性肿瘤的免疫表型。随访3。24个月，平均16．7个月，2例发生对侧卵巢的交界性浆黏液性肿瘤，1例发生腹膜种植，其余12例均无肿瘤复发，无瘤生存。结论卵巢交界性浆黏液性肿瘤具有与交界性黏液性肿瘤不同的临床病理学特征、形态学及免疫组织化学表型，且预后更好。联合使用免疫组织化学标记ER、PR、PAX．8、CK7、CK20、波形蛋白、尾型同源框转录因子2和肾母细胞瘤基因可对该肿瘤作出准确诊断。

Objective To explore the clinicopathological characteristics, immunohistochemical phenotype and differential diagnosis of ovarian seromucinous borderline tumor. Methods Fifteen cases of ovarian seromueinous borderline tumor in Shanxi Provincial People＂ s Hospital from January 2013 to May 2017 were collected. The surgical specimens were observed after HE and immunohistochemical staining, the patients were followed-up, and the relevant literature was reviewed. Results The age of 15 cases of ovarian seromucinous borderline tumor ranged from 26 to 56 years （mean 37 years）. Eight cases occurred in the right, 5 cases occurred in the left, only 2 cases were bilateral tumors. The complaint of most patients was abdominal distention, 3 cases was aseites. The maximum diameter of these tumors ranged from 4 to 13 cm （mean 9.3 em）. Grossly, 15 cases mainly showed cystic performance, varying amounts of papillae inside wall of the cysts. Small region of 2 cases were solid. Microscopically, 9 tumors were composed of endocervical-like mucinous epithelium, 4 tumors were endocervical-like mucinous epithelium and serous epithelium. 2 cases were accompanied with endometriosis. Tumor cells mainly expressed estrogen receptor （ER）, progesterone receptor （PR）, paired box gene protein 8 （PAX-8）, cytokeratin 7 （CK7）, these markers were immunophenotypes of Mullerian tumors. Followed up for 3 to 24 months （mean 16.7 months）, 2 cases showed bilateral tumors, 1 case was peritoneal implantation. No tumor recurrence was found in the remaining 12 eases. Conclusions Different from mucinous borderline tumor, ovarian seromucinous borderline tumor possesses relative special clinicopathological features, morphological and immunohistochemical phenotypes, with better prognosis. Combination of immunohistochemical markers ER, PR, PAX-8, CKT, CK20, Vimentin, CDX-2 and WT-1 can make an accurate diagnosis of this tumor.