儿童卵巢幼年颗粒细胞瘤超声表现及病理对照研究

Ultrasonographic features and pathological comparison of juvenile ovary granulose cell tumors

目的探讨儿童卵巢幼年颗粒细胞瘤(JGCTs)超声表现及病理特征。方法回顾性分析2005年1月至2020年12月经重庆医科大学附属儿童医院手术病理证实为JGCTs的14例患儿的临床资料。依据国际卵巢肿瘤分析组织(IOTA)标准对瘤体超声图像进行模式分型,并与术后组织病理结果进行对照分析。结果14例患儿肿瘤最大径线范围37~286 mm,最大径线平均值(105±56)mm。超声声像图表现为:实性6例(42.9%)、多房囊实性4例(28.6%)、单房囊实性1例(14.3%)、多房囊性2例(14.3%)以及单房囊性1例(7.1%)。病理结果显示,实性包块由大量颗粒细胞弥漫增生形成,其间伴有散在大小不等滤泡、坏死出血及纤维条索组织。多房囊实性、单房囊实性、多房囊性及单房囊性肿瘤内均可见数量不一的大滤泡,滤泡内大多数为颗粒细胞分泌的嗜碱性、嗜酸性液体。临床表现为乳房增大5例(35.7%),阴道出血及分泌物5例(35.7%);超声提示子宫增大10例(71.4%)。所有患儿术前血清雌二醇水平均升高,均值(534.0±839.5)pmol/L。结论JGCTs超声表现多样,实性和多房囊实混合性更常见,其病理特征为大量颗粒细胞弥漫增生伴散在大小不等滤泡,超声表现结合内分泌临床表现及血清雌二醇的升高有助于临床诊断。

Objective To investigate the ultrasonographic and pathological features of juvenile granulosa cell tumors(JGCTs)of the ovary in children.Methods The clinical data and ultrasonographic findings of 14 children with JGCTs diagnosed by surgical pathology at Children's Hospital of Chongqing Medical University from January 2005 to December 2020 were retrospectively analyzed.The ultrasonographic images of the tumors were pattern classified according to the International Ovarian Tumor Analysis Organization(IOTA)standards,and compared with the histopathological results.Results Fourteen patients with JGCTs were included in this study.The maximum tumor diameter range of the 14 patients was 37~286 mm,and the mean standard deviation was(105±56)mm.According to IOTA standards,the ultrasonographic manifestations of tumor were classed into five types,namely,solid(6,42.9%),multilocular cystic solid(4,28.6%),multilocular cystic solid(2,14.3%),single-locular cystic solid(1,7.1%),and single-locular cystic(1,7.1%).The pathological results showed that the solid mass consisted of diffuse proliferation of a large number of granulosa cells with scattered follicles of unequal size,necrosis and bleeding,and fibrous cord tissue.Multilocular cystic solid,single locular cystic solid,multiple locular cystic,and single locular cystic masses had varying numbers of large follicles,most of which had basophilic and/or eosinophilic fluid secreted by granulosa cells.Clinical endocrine manifestations included breast enlargement in five cases(35.7%),and vaginal bleeding and secretion in five cases(35.7%).Ultrasound revealed uterine enlargement in ten cases(71.4%),and vaginal bleeding and secretion in five cases(35.7%).The preoperative serum estradiol level was increased in all the children,with an average of(534.0±839.5)pmol/L.Conclusion The ultrasonic manifestations of JGCTs are diverse,and the mixed type of solid and multilocular cystic solid lesion is more common.The pathological characteristics of JGCTs are diffuse proliferation of large granular cells with scattered follicles of different sizes.The combination of ultrasonographic features,endocrine clinical manifestations,and serum estradiol elevation is helpful for clinical diagnosis.