卵巢中肾样腺癌一例并文献复习

Mesonephric-like Adenocarcinoma of the Ovary:A Case Report and A Review of the Literature

目的探讨卵巢中肾样腺癌的临床病理特点及诊断、鉴别诊断。方法回顾性分析1例卵巢中肾样腺癌的临床资料、病理学特征及免疫组化、分子检测,并复习相关文献。结果患者老年女性,组织学上肿瘤呈乳头状、腺管状及筛孔状、实性网状、囊状,腺管状区部分管腔内可见嗜伊红物质,细胞形态温和,核呈圆形或卵圆形,核染色质粗颗粒或空泡状,核仁不明显,部分见核沟。免疫组化:Vimintin、CK7、CD10、TTF1、PAX8、PAX2全部或部分阳性,GATA3、P16、CR、CEA、Inhibin-α局灶或散在阳性,P53野生型,Ki-67约30%,ER、PR、WT-1、SF-1阴性。RT-RCR检测显示KRAS突变。结论卵巢中肾样腺癌罕见,组织学形态多样,结合免疫组化及分子检测可明确诊断。术后需化疗,其预后尚需积累多中心大样本研究证实。

Objective To investigate the clinicopathologic features,diagnosis and differential diagnosis of the mesonephric-like carcinomas of ovary.Methods The clinical data,pathological features,immunohistochemical and molecular detection of 1 case of mesonephric-like carcinomas of ovary were analyzed retrospectively,and the relevant literature was reviewed.Results The patient was aged women.Histologically,the tumor was papillary,glandular tubular,ethmoidal,solid reticular,and cystic.Eosinophilic substances could be seen in some lumens of the glandular tubular area,the cell morphology was mild,the nuclei were round or oval,the nuclear chromatin was coarse granular or vacuolar,the nucleoli were not obvious,and some tumor cells had typical nuclear grooves.Immunohistochemical phenotype:Vimintin,CK7,CD10,TTF1,PAX8 and PAX2 were all or part positive,GATA3,P16,CR,CEA and Inhibin-αwere focally or scattered positive,the expression of P53 was wild-type,the expression of Ki-67 was about 30%,ER,PR,WT-1 and SF-1 were negative.KRAS mutation was detected by RT-RCR.Conclusion The mesonephric-like carcinomas of ovary is rare,and it has various histological morphology,combined with immunohistochemical and molecular detection can be definite diagnosis.Postoperative chemotherapy is required,and its prognosis needs to be confirmed by multi-center and large sample studies.