卵巢Brenner肿瘤的临床病理分析

Clinicopathological analysis of ovarian Brenner tumors

目的:探讨卵巢Brenner肿瘤的临床病理特征、免疫表型、诊断及鉴别诊断。方法:回顾性分析2 1例卵巢Brenner肿瘤的临床资料、组织学形态、免疫表型,并复习相关文献。结果:2 1例卵巢Brenner肿瘤患者均为成年女性,年龄为28~76(平均52)岁,其中13例(61.9%)已绝经,8例(38.1%)未绝经。囊实性肿物1 6例,实性肿物5例。经病理诊断为Brenner瘤的有1 8例(8 5.7%)、交界性Brenner瘤2例(9.5%),恶性Brenner肿瘤1例(4.7%)。常用的肿瘤标志物CA199、CA125在良性及交界性Brenner瘤中显示正常或仅轻度增高,在1例恶性Brenner瘤中显著升高,术前影像学均未提示为卵巢Brenner瘤。镜下见良性Brenner瘤由致密的纤维间质及散在的移行细胞样上皮巢组成;交界性Brenner瘤形态与良性Brenner瘤相似,但上皮细胞层次增多,有不同程度异型性,无明确间质浸润;恶Brenner瘤镜下为良性、交界性Brenner瘤结构伴间质浸润。免疫表型:肿瘤细胞CK7、GATA3、p63及CK5/6均阳性表达,少数病例Uroplakin III表达,WT-1、PAX-8及CK20均阴性,Ki-67在良性Brenner瘤增殖指数低于3%,交界性Brenner瘤中5%~10%,恶性Brenner肿瘤中达50%。结论:卵巢Brenner肿瘤属于少见的卵巢上皮源性肿瘤,术前影像学及肿瘤标志物检查对卵巢Brenner肿瘤无明确诊断价值,确诊需依赖于组织病理学和免疫组织化学染色。良恶性Brenner瘤的鉴别关键是肿瘤细胞异型程度和有无间质浸润。

Objective: To investigate clinicopathological features, immunophenotype, diagnosis and differentialdiagnosis of ovarian Brenner tumors. Methods: Clinical data, histological morphology, and immunophenotype of 21 cases of ovarian Brenner tumors were retrospectively analyzed, and the related literature was reviewed. Results: All 21 cases of ovarian Brenner tumors were adult women, with an average age of 52(28 to 76) years. Among them, 13 cases(61.9%) were postmenopausal and 8 cases(38.1%) were premenopausal. There were 16 cases of cystic and solid masses and 5 cases of solid masses. Eighteen cases(85.7%) of the Brenner tumors were benign, 2(9.5%) were borderline and 1(4.7%) was malignant. Usual tumor markers of ovarian carcinoma, including CA199 and CA125 were normal or only slightly elevated in 21 cases. Imaging before surgery was not specific to ovarian Brenner tumors. Microscopically, benign Brenner tumors were composed of dense fibrous stroma and scattered nests of transitional-type cells. In borderline Brenner tumors, besides the similar morphology to benign Brenner tumors, the epithelial cell layers were increased, with different degrees of atypia and lack of stromal invasion. In one malignant case, besides the morphology of benign and borderline Brenner tumor, atypical of transitional-type cells exhibited stromal invasion. Immunophenotype: CK7, GATA3, p63 and CK5/6 were positive in tumor cells, Uroplakin III was expressed in a few cases, while WT-1, Pax-8 and CK20 were negative. Ki-67 was less than 3% in benign tumors, 5%–10% in borderline tumors and 50% in malignant tumor. Conclusion: Ovarian Brenner tumors are rare epithelial ovarian tumors. Preoperative imaging examinations and usual ovarian tumor markers do not provide definite diagnostic value. Diagnosis and classification of Brenner tumors depend on histopathological evaluation and immunohistochemical staining. The key to differentiate benign and malignant Brenner tumors is the degree of tumor cells atypia and stromal invasion.