成人型睾丸颗粒细胞瘤临床病理观察

Clinicopathological features of adult testicular granulosa cell tumor

目的探讨成人型睾丸颗粒细胞瘤(ATGCT)的临床病理特征、诊断及鉴别诊断。方法分析1例成人型睾丸颗粒细胞瘤的临床资料,观察其组织学形态及免疫组化特征,并结合相关文献进行复习。结果患者男性,63岁,发现左侧睾丸肿块约1周入院。彩超检查示:左侧睾丸体积增大,实质回声不均匀,其内探及一混合性占位性病变;CDFI:其内探及稍丰富血流信号。镜下见肿瘤组织呈推挤性生长,细胞弥漫分布,瘤细胞圆形、椭圆形,部分成梭形,呈肉瘤样结构,少数细胞内似有核沟,核分裂象易见。肿瘤内可见囊腔结构,部分囊腔内容粉染蛋白样物质。免疫组化:肿瘤细胞vimentin、Calretinin、α-inhibin(+),SMA部分(+),Ki-67阳性指数15%,EMA、AE1/AE3、S-100、Cg A、Syn、CD117、PLAP、SALL4及AFP均(-)。结论睾丸AGCT非常罕见,临床和病理医师应想到AGCT发生于睾丸的可能,避免误诊。送检标本取材应充分,需与间质细胞瘤、支持细胞瘤等进行鉴别,其确诊需结合临床、大体所见、组织病理学及免疫组化信息综合分析。推荐辅助基因突变检测,以期提高ATGCT病理诊断的准确性,为临床治疗该病提供可靠依据。

Objective To explore the clinicopathological features,diagnosis and differential diagnosis of adult testicular granulosa cell tumor( ATGCT). Methods The clinical data of one case of adult testicular granulosa cell tumor were analyzed,its histological morphology and immunohistochemical features were observed,and the related literatures were reviewed. Results A 63-year-old male was hospitalized for about one week after finding a mass in the left testis. Color Doppler ultrasonography showed that the volume of the left testis was enlarged,the echo of the parenchyma was uneven,and a mixed space occupying lesion was detected in the left testis,and the blood flow signal was slightly rich in CDFI.Microscopically,the tumor tissue showed squeezing growth,the cells were diffusely distributed,the tumor cells were round and oval,some of them were fusiform,showing a sarcoma-like structure,a few cells seemed to have nuclear sulcus,and mitosis was easy to be seen. The structure of the cystic cavity was noted in the tumor,and some of the cysts contained powder-stained protein-like substances. Immunohistochemistry showed in the tumor cells were positive for vimentin,calretinin,α-inhibin and SMA;negative for EMA,AE1/AE3,S-100,Cg A,Syn,CD117,PLAP,SALL4 and AFP,with Ki-67 index of 15%. Conclusion Testicular AGCT is very rare. Clinicians and pathologists should consider the possibility of AGCT occurring in the testis to avoid misdiagnosis. The specimens must be widely sampled and should be differentiated from stromal cell tumor and Sertoli cell tumor. The diagnosis must be combined with clinical findings,histopathological and immunohistochemical information. Auxiliary gene mutation detection is recommended in order to improve the accuracy of pathological diagnosis of ATGCT and provide reliable basis for clinical treatment of the disease.