卵巢浆黏液性肿瘤的临床病理学分析

Clinicopathological study on seromucinous tumor of ovary

目的探讨卵巢浆黏液性肿瘤的临床病理学特点和病理学分类。方法采用回顾性研究,收集2015年10月至2019年2月首都医科大学附属北京友谊医院收治的27例卵巢浆黏液性肿瘤患者,分析其临床病史、病理分型及镜下特点,并复习相关文献。结果27例患者中,16例为良性,10例为交界性,1例为恶性。良性者年龄为19~78岁,中位年龄42岁,半数(8/16)为体检时发现,其余表现为腹痛、压迫症状等,镜下显示囊肿被覆混合细胞型单层上皮,其中3例伴局灶上皮增生。交界性者年龄为24~58岁,中位年龄37岁,半数(5/10)为体检时发现,其余表现为痛经、腹痛等,镜下表现为复杂分支的乳头结构,逐级分支形成更小的乳头,最后形成脱落的上皮细胞簇,由混合型上皮组成,其中1例伴有微小浸润。恶性者年龄为26岁,因阴道不规则出血1个月查B超显示盆腔巨大囊实性占位,镜下以膨胀性侵袭为主,伴小灶毁损性间质浸润,由混合型上皮组成,较为突出的是广泛的脉管内癌栓。结论卵巢浆黏液性肿瘤较少见,是2014版世界卫生组织女性生殖器官肿瘤学分类新增加的一类卵巢上皮性肿瘤,分为良性、交界性与恶性,其形态学、免疫表型及分子生物学改变有一定的特殊性,但与卵巢浆液性肿瘤、子宫内膜样肿瘤有一定的重叠。

Objective To explore the clinicopathological features and subtypes of ovarian seromucinous tumors.Methods Clinical and pathological data of 27 patients were retrospectively collected by this hospital during October 2015 to February 2019,these cases were all diagnosed as ovarian seromucinous tumor.Their clinical history,pathological subtypes and microscopical features were studied,then reviewed related medical literatures.Results In 27 cases,16 were benign,10 cases were at borderline,1 case was malignant.16 benign patients were at age range from 19 to 78 years old with median age range of 42 years old,8/16 cases had no symptom,but they were diagnosed by medical examinations,other complaints including lower abdominal pain,symptoms of compression,etc.Microscopically,the epithelia of cysts were arranged in single layer,with mixed type cells,3/16 with focal epithelial proliferation.10 borderline patients were aged from^24 to 58 years old,the median age was 37 years old,5/10 had no symptom,but they were discovered by medical examinations,other complaints include dysmenorrhea,lower abdominal pain,etc.Microscopically,the tumors showed papillary architecture with branches in a hierarchical manner with progressively smaller papillae,terminating in small detached epithelial tufts,with mixture type cells,and 1/10 has microinvasion.The malignant one was 26 years old,with the complaint of irregular vaginal bleeding for one month,then she had an ultrasonography,showed there was a giant cystic solid tumor in pelvic cavity.Microscopically,the tumor shows expansive growth pattern and focal destructive infiltrative pattern,with mixture type cells,one significant feature of this case is extensive vascular invasion.Conclusion Ovarian seromucinous tumor is not so common,it's a new category that introduced by WHO World Health Organization(WHO)Classification of Tumors of the Female Reproductive Organs(2014).It consists of three subtypes,benign,borderline and malignant.It possesses relatively special histological,immunohistochemical,and molecular features,but they are somewhere overlapped with serous tumors and endometrioid tumors.