伴KRAS突变的卵巢中肾样腺癌1例

KRAS-mutated mesonephric-like adenocarcinoma of ovary:A case report

中肾样腺癌(mesonephric-like adenocarcinoma,MLA)是一种主要发生于子宫内膜和卵巢并显示中肾样分化的腺癌,具有侵袭性强及倾向转移等特点。因其镜下表现复杂多样,仅通过组织形态学观察难以确诊,需借助免疫组织化学及分子生物学检测辅助诊断。现报告1例原发于卵巢的MLA。患者,女,52岁,因外院行彩色多普勒超声检查提示盆腔肿物,遂于2022年10月于贵州医科大学附属医院妇科就诊。术中送检右侧卵巢,冰冻诊断结果为(右)侧卵巢腺癌,遂行全子宫、左侧附件、大网膜切除及盆腔淋巴结清扫术。病理诊断为(右)侧卵巢MLA伴子宫内膜异位症;子宫多发平滑肌瘤(肌壁间及浆膜下型);子宫腺肌症。送检淋巴结及大网膜组织均未见转移癌。给予紫杉醇联合卡铂化学治疗6个疗程。随访至2023年10月二维超声检查提示复发。

Mesonephric-like adenocarcinoma(MLA)is a kind of adenocarcinoma mainly occurring in the endometrium and ovaries,displaying mesonephric-like differentiation,and characterized by strong invasiveness and a tendency to metastasize.Due to its complex and diverse microscopic manifestations,it is difficult to diagnose based solely on histological observations and requires assistance from immunohistochemistry and molecular biology detection for diagnosis.A case of primary ovarian MLA is reported.The patient,a 52-year old female,presented to the Department of Gynecology of the Affiliated Hospital of Guizhou Medical University in October 2022 due to a pelvic mass detected by the color Doppler ultrasound examination at an external hospital.Intraoperatively,the right ovary was examined,and the frozen section diagnosis was adenocarcinoma of the right ovary.Subsequently,total hysterectomy,left adnexectomy,omentectomy,and pelvic lymph node dissection were performed.The pathological diagnosis revealed MLA of the right ovary with endometriosis;multiple uterine leiomyomas(intramural and subserosal type);and adenomyosis of the uterus.No metastatic carcinoma was found in the examined lymph nodes or omentum.The patient received six cycles of chemotherapy with paclitaxel combined with carboplatin.Follow-up until October 2023 indicated recurrence detected by two-dimensional ultrasound examination.