卵巢Sertoli-Leydig细胞瘤20例临床病理分析

Ovarian Sertoli-Leydig cell tumors: a clinicopathological analysis of 20 cases

目的探讨卵巢Sertoli-Leydig细胞瘤(Sertoli-Leydig cell tumors,SLCT)的临床病理特征、诊断及鉴别诊断。方法收集20例卵巢SLCT的临床病理资料,行免疫组化EnVision两步法染色,分析其临床病理特征,并复习相关文献。结果20例卵巢SLCT患者年龄15~80岁,平均41.2岁,均发生于单侧卵巢。临床表现为下腹胀痛或异常子宫出血,部分患者出现月经量减少、经期缩短、闭经、血清睾酮升高等去女性化表现。肿瘤最大径1.8~10.5 cm,呈囊实性。镜下肿瘤由不同比例及不同分化程度的Sertoli细胞及Leydig细胞组成,并不同程度表达α-inhibin、Calretinin、WT-1、CD99、vimentin、Melan A、CD10、CKpan等,EMA、Syn、CgA等均不表达。中分化13例(1例伴网状成分),中~低分化3例,低分化4例,其中有2例伴异源性成分。随访时间1~97个月,1例低分化者失访,另19例患者均无瘤生存。结论SLCT镜下组织学形态复杂多变,诊断需结合免疫表型及独特的临床表现以提高诊断准确性,经规范治疗后患者预后较好。

Purpose To investigate the clinicopathological features,diagnosis and differential diagnosis of ovarian Sertoli-Leydig cell tumors(SLCT).Methods The clinicopathological data of 20 cases of ovarian SLCT were collected,and immunohistochemical EnVision two-step method was used,the clinicopathological features were analyzed and the relevant literatures were reviewed.Results The age of patients with ovarian SLCT ranged from 15 to 80 years,with an average age of 41.2 years old.All of them occurred in unilateral ovary.The clinical symptoms were abdominal distension or abnormal uterine bleeding,and some patients had decreased menstrual volume,shortened menstrual period,amenorrhea,increased serum testosterone and other defeminization manifestations.The maximum diameter of the tumor was 1.8 to 10.5 cm.The tumors were composed of Sertoli cells and Leydig cells with different proportions and different degrees of differentiation.All of the 20 cases expressed different degrees ofα-inhibin,Calretinin,WT-1,CD99,vimentin,Melan A,CD10 and CKpan,while the expression of EMA,Syn and CgA were negative.Of 20 ovarian SLCTs,there were 13 cases with moderate differentiation(1 case with retiform pattern),3 cases with medium-poorly differentiation and 4 cases with poorly differentiation.There were 2 cases with heterologous components.Nineteen patients were followed up for 1-97 months,and all of them were tumor-free survival.One poorly differentiated patient was lost to follow-up.Conclusion The histological morphology of SLCT is complex and changeable.The diagnosis should be combined with immunophenotype and unique clinical manifestations to improve the diagnostic accuracy.The prognosis is better after standardized treatment.