类似卵巢性索肿瘤的子宫肿瘤1例并文献复习

A case of uterine tumor resembling ovarian sex cord tumor and literature review

目的探讨类似卵巢性索肿瘤的子宫肿瘤(UTROSCT)的临床及组织病理学特征、诊断与鉴别诊断。方法分析1例UTROSCT的临床资料,行组织形态学、免疫组化检查并复习相关文献。结果UTROSCT细胞排列呈小梁状、巢状,浸润周围平滑肌组织,部分瘤细胞呈上皮样,胞浆嗜酸,部分瘤细胞胞浆透亮或泡沫状,核圆形、卵圆形及短梭形,染色质细腻,可见核沟,部分核仁显著,未见核分裂象、脉管内瘤栓及坏死。免疫组化显示细胞角蛋白(CK)、钙结合蛋白(CR)、CD99、inhibin-A、类固醇生成因子-1(SF-1)、肾母细胞瘤基因-1(WT-1)、雌激素受体(ER)、孕激素受体(PR)阳性;T细胞1识别黑色素瘤抗原(Melan-A)、S100、结蛋白灶状阳性;癌胚抗原(CEA)、上皮膜抗原(EMA)、多肿瘤抑制因子1(MTS/P16)、黑色素瘤相关抗原(HMB45)、平滑肌肌动蛋白(SMA)、CD10、CD34阴性;Ki67增殖指数约1%阳性。结论UTROSCT是一类罕见的具有卵巢性索间质肿瘤特征的子宫肿瘤,临床症状及影像学检查缺乏特异性,依赖术后病理组织形态学及免疫组化确诊,其生物学行为具有低度恶性潜能,大多数呈良性过程,需要长期随访。

Objective To investigate the clinical and histopathological features,diagnosis and differential diagnosis of uterine tumor resembling ovarian sex cord tumor(UTROSCT).Methods The clinical data of 1 case of UTROSCT were analyzed,the histomorphology and immunohistochemistry were tested,and the related literature were reviewed.Results The UTROSCT cells are arranged in trabecular and nest shape,infiltrating the surrounding smooth muscle tissue.Some tumor cells were epithelioid,eosinophilic in cytoplasm,and some tumor cells were translucent or foamy in cytoplasm,the nuclei were round,oval and short spindle,the chromatin was delicate,the nuclear groove was visible,and some nucleoli were significant.There were no mitotic image,intravascular tumor thrombus and necrosis.Immunohistochemistry showed that cytokeratin(CK),calretinin(CR),CD99,inhibin-A,steroidogenic factor-1(SF-1),wilms tumor gene-1(WT-1),estrogen receptor(ER)and progesterone receptor(PR)were positive;melanoma antigen recognized by T cells 1(Melan-A),S100 and desmin were focally positive;carcinoembryonic antigen(CEA),epithelial membrane antigen(EMA),multiple tumor suppressor 1(MTS/P16),melanoma marker(HMB45),smooth muscle actin(SMA),CD10 and CD34 were negative;Ki67 proliferation index was about 1%positive.Conclusion UTROSCT is a rare type of uterine tumor with the characteristics of ovarian sex cord stromal tumor.The clinical symptoms and imaging examination are lack of specificity,and the diagnosis depends on postoperative histomorphology and immunohistochemistry.Its biological behavior has low malignant potential,most of which are benign processes and need long-term follow-up.