卵巢交界性浆黏液性肿瘤临床病理研究

Clinicopathologic features of ovarian seromucinous borderline tumor

目的探讨卵巢交界性浆黏液性肿瘤(SMBT)的临床病理特点。方法回顾性分析9例卵巢SMBT的临床病理资料,选取同期卵巢交界性浆液性肿瘤(SBT) 39例及黏液性肿瘤(MBT) 32例进行对比分析。结果 9例SMBT患者年龄21~69岁(中位年龄30岁),肿瘤大体呈囊性,直径3~13 cm,囊内含褐色或淡黄色脓液样黏液,囊内壁可见乳头状赘生物,直径0. 3~3. 5 cm。9例中,7例单侧,2例双侧,3例囊壁或乳头间质出现钙化(33%),4例病变伴随同侧卵巢子宫内膜异位(44%)。镜下8例SMBT以复杂的、纤维化、水肿性的乳头结构为特征,其中1例局部出现微乳头状结构,1例以微腺体增生为特征,表面衬覆多种细胞类型,包括黏液、浆液、中性细胞(indifferent cell)、透明、鳞状、鞋钉样或嗜酸性细胞。所有肿瘤的间质及腺腔内均见多量中性粒细胞浸润。8例FIGO分期Ⅰ期,1例FIGO分期Ⅱ期(伴同侧输卵管种植),术后随访8~84个月,无复发或进展。SMBT与SBT、MBT比较,三者发病年龄、术前血CA125、血CA199、病变侧别无差异(P值均>0. 05)。三者是否伴有子宫内膜异位症及钙化差异性显著(P<0. 01)。结论卵巢SMBT以乳头状或微腺体增生样结构为特征,形态与SBT有一定重叠。而对于其组织起源、分子特征及预后尚需进一步研究明确。

Objective To study the clinicopathological features of ovarian seromucinous borderline tumor ( SMBT). Methods 81 cases of ovarian borderline tumor were reviewed,the clinicopathological features of 9 cases of SMBT were analyzed and compared with 39 cases of ovarian serous borderline tumor ( SBT) and 32 cases of ovarian mucinous borderline tumor ( MBT). Results The age at diagnosis in the 9 cases of SMBT ranged from 21 to 69 years ( with a median age of 30 years). The tumors were cystic and ranged in size from 3 to 13 cm,and the cyst contained brown or yellow purulent mucin and had papillary neoplasm ranged in size from 3 to 13 cm. In 7 cases,the neoplasm was unilateral and in 2 cases bilateral. Calcification appeared in the cystic wall or papillary stroma in 3 cases of SMBT ( 33%). Endometriosis lesions were present in 4 cases of SMBT. 8 cases of SMBT exhibited characteristic,complex,fibrotic,hydropic papillary architectures,and 1 had micropapillary area,and 1 exhibited microglandular architecture. A characteristic feature was an admixture of cell types,including mucinous cells,serous cells,indifferent cells,squamous cells,clear cells,hobnail cells and eosinophilic cells. An infiltrate of neutrophil polymorphs was a prominent feature in all cases. 8 were diagnosed in stage I,1 in stage II. All were alive with no evidence of disease ( follow-up for 8 to 84 months). There were no significant differences of median age,the value of serum CA125 and CA199,and laterality among the three groups ( P>0. 05),while there were statistical differences of calcification and endometriosis among the three groups ( P = 0. 005 and P = 0. 002). Conclusions The characteristic of SMBT exhibits special papillary or microglandular architectures,overlap with SBT. Further studies are needed in order to evaluate the histogenesis,molecular features and the prognostic impact of SMBT.