卵巢核分裂活跃的富于细胞性纤维瘤临床病理观察

目的探讨卵巢核分裂活跃的富于细胞性纤维瘤(MACF)的临床病理学特征、免疫表型、诊断和鉴别诊断。方法对1例卵巢MACF进行形态学观察、免疫组化标记并复习相关文献。结果肿瘤主要由丰富的梭形纤维母细胞样细胞组成,细胞界限不清;细胞核卵圆形至梭形,轻度异型,核分裂象5～9个/10HPF。免疫组化:肿瘤细胞vimentin、α-inhibin、CD56和ER(+),CD34、CD117、Dog-1、CD99、CKpan、EMA、CD10、bcl-2、calretinin、PR、HMB45、S-100、SMA、desmin、H-caldesmon和WT-1(-),Ki-67增殖指数为10%。结论卵巢MACF是一种少见的卵巢纤维性肿瘤,形态学上非常容易误诊为纤维肉瘤,但其生物学行为良性,具有良好的预后,需要长期随访。

卵泡膜细胞瘤和细胞性纤维瘤的MRI诊断价值

目的:探讨卵巢卵泡膜细胞瘤和细胞性纤维瘤的磁共振成像(magnetic resonance imaging,MRI)诊断价值。方法:回顾性分析16例女性病人经手术病理证实的17个卵巢卵泡膜细胞瘤或细胞性纤维瘤的MRI表现和相关临床、病理表现。结果:大多数病人(76.5%)是绝经后妇女。58.8%的病人表现为血清CA-125升高。MRI可揭示如下特点:(1)肿瘤大部较大,约123.7±46mm,47.0%为囊实性,43.7%为类圆形。(2)T2WI大部分肿块表现为混杂信号占56.3%;T1WI大部分表现为低信号占43.8%;DWI表现为不均匀高信号占31.3%;增强扫描大部分表现为无强化和明显不均匀强化,分别占43.8%和25.0%。肿瘤之外,未发现子宫增大或内膜异常增厚。结论:MRI在卵泡膜细胞瘤或细胞性纤维瘤的诊断和鉴别诊断中有较大价值。

Recurrent postmenopausal bleeding - just endometrial disease or ovarian sex cord-stromal tumor? A case report

BACKGROUND Postmenopausal bleeding(PMB)is a common gynecologic complaint among elderly women,and endometrial hyperplasia is a common cause of this bleeding.Ovarian fibromas are the most common type of ovarian sex cord-stromal tumor(SCST).They arise from non-functioning stroma,rarely show estrogenic activity,and stimulate endometrial hyperplasia,causing abnormal vaginal bleeding.CASE SUMMARY We report herein the case of a 64-year-old Chinese woman who presented with recurrent PMB.A sex hormone test revealed that her estrogen level was significantly higher than normal,and other causes of hyperestrogenism had been excluded.The patient had undergone four curettage and hysteroscopy procedures in the past 7 years due to recurrent PMB and endometrial hyperplasia.The culprit behind the increase in estrogen level—an ovarian cellular fibroma with estrogenic activity—was eventually found during the fifth operation.CONCLUSION Ovarian cellular fibromas occur insidiously,and some may have endocrine functions.Postmenopausal patients with recurrent PMB and endometrial thickening observed on ultrasonography are recommended to undergo sex hormone testing while waiting for results regarding the pathology of the endometrium.If the estrogen level remains elevated,the clinician should consider the possibility of an ovarian SCST and follow-up the patient closely,even if the imaging results do not indicate ovarian tumors.Once the tumor is found,it should be removed as soon as possible no matter the size to avoid endometrial lesions due to long-term estrogen stimulation.More studies are needed to confirm whether preventive total hysterectomy with bilateral salpingo-oophorectomy should be recommended for women with recurrent PMB exhibiting elevated estrogen levels,despite the auxiliary examination results not indicating ovarian mass.The physical and psychological burden caused by repeated curettage could be prevented using this technique.

卵巢富细胞纤维瘤24例临床病理分析

目的:探讨卵巢富细胞纤维瘤的临床与病理学特征。方法:收集2008年2月至2017年3月复旦大学附属妇产科医院诊治的24例卵巢富细胞纤维瘤患者的临床病理资料,观察肿瘤组织学特征、免疫表型,并进行随访。结果:24例患者年龄为17~70岁,平均46.5岁。临床症状包括卵巢肿块、下腹胀痛或合并胸腹水。2例患者术前伴CA125显著升高。卵巢富细胞纤维瘤发生于右侧卵巢、左侧卵巢、双侧卵巢分别为13、10、1例。镜下显示肿瘤细胞丰富、无明显异型性。3例患者的肿瘤细胞核分裂象活跃,核分裂象5~7个/10个高倍视野(high power fields,HPF),3例患者的肿瘤中含少量(少于10%)性索成分,4例见黄素化细胞。随访1~109个月,未见复发。结论:卵巢富细胞纤维瘤是纯间质肿瘤,可有核分裂象增多、伴有少量性索成分及黄素化。部分患者合并胸腹水及CA125升高,易误诊为恶性肿瘤。为避免误诊以影响临床诊断和治疗,认识该病具有重要的意义。

卵巢核分裂象活跃的富于细胞性纤维瘤临床病理分析

目的探讨卵巢核分裂象活跃的富于细胞性纤维瘤（mitoticallyactivecellularfibroma，MACF）的临床病理学特征。方法观察2例MACF的临床资料、组织学形态、免疫表型，并复习相关文献。结果2例MACF患者临床表现良性。瘤细胞梭形，非常丰富，交叉呈束或漩涡状、席纹状排列，轻度异型，核分裂象4—7个／10HPF，无病理性核分裂象。出血水肿边缘瘤细胞异型明显伴有退变。结论MACF是一组卵巢的富于细胞的纤维性肿瘤，核分裂象≥4个／10HPF，缺乏核的显著异型，临床表现良性。文献报道仅少数病例复发，提示MACF具有低度恶性潜能。

脾氨肽在乳腺纤维瘤患者术后的作用

目的研究脾氨肽在乳腺纤维瘤患者术后的作用。方法选取2017年6月至2018年12月我院收治的78例乳腺纤维瘤患者为研究对象,采用简单随机化方式将其分为参照组与研究组,各39例。参照组术后采用常规治疗,研究组在参照组基础上采用脾氨肽治疗。比较两组的治疗效果。结果术后即刻,两组的CD3+、CD3+CD4+、CD4+/CD8+比较,差异无统计学意义(P>0.05);术后3 d,参照组的CD3+、CD3+CD4+、CD4+/CD8+均低于术后即刻及研究组(P<0.05)。术后即刻,两组的EP、NE、COR水平比较,差异无统计学意义(P>0.05);术后3 d,参照组的EP、NE、COR水平均高于术后即刻及研究组(P<0.05)。两组均未发生不良反应。结论脾氨肽应用于乳腺纤维瘤患者术后,可控制细胞免疫功能下降及减少应激反应,且安全可靠,值得临床推广应用。