Identification of serous ovarian tumors based on polarization imaging and correlation analysis with clinicopathological features

Ovarian cancer is one of the most aggressive and heterogeneous female tumors in the world,and serous ovarian cancer(SOC)is of particular concern for being the leading cause of ovarian cancer death.Due to its clinical and biological complexities,ovarian cancer is still considered one of the most di±cult tumors to diagnose and manage.In this study,three datasets were assembled,including 30 cases of serous cystadenoma(SCA),30 cases of serous borderline tumor(SBT),and 45 cases of serous adenocarcinoma(SAC).Mueller matrix microscopy is used to obtain the polarimetry basis parameters(PBPs)of each case,combined with a machine learning(ML)model to derive the polarimetry feature parameters(PFPs)for distinguishing serous ovarian tumor(SOT).The correlation between the mean values of PBPs and the clinicopathological features of serous ovarian cancer was analyzed.The accuracies of PFPs obtained from three types of SOT for identifying dichotomous groups(SCA versus SAC,SCA versus SBT,and SBT versus SAC)were 0.91,0.92,and 0.8,respectively.The accuracy of PFP for identifying triadic groups(SCA versus SBT versus SAC)was 0.75.Correlation analysis between PBPs and the clinicopathological features of SOC was performed.There were correlations between some PBPs(δ,β,q_(L),E_(2),rqcross,P_(2),P_(3),P_(4),and P_(5))and clinicopathological features,including the International Federation of Gynecology and Obstetrics(FIGO)stage,pathological grading,preoperative ascites,malignant ascites,and peritoneal implantation.The research showed that PFPs extracted from polarization images have potential applications in quantitatively differentiating the SOTs.These polarimetry basis parameters related to the clinicopathological features of SOC can be used as prognostic factors.

Ovarian-adnexal reporting and data system ultrasound evaluation and pathological characteristics of ovarian collision tumor

BACKGROUND Collision tumor are neoplasms,including two histologically distinct tumors that coexist in the same mass without histological admixture.The incidence of collision tumor is low and is rare clinically.AIM To investigate ultrasound images and application of ovarian-adnexal reporting and data system(O-RADS)to evaluate the risk and pathological characteristics of ovarian collision tumor.METHODS This study retrospectively analyzed 17 cases of ovarian collision tumor diagnosed pathologically from January 2020 to December 2023.All clinical features,ultrasound images and histopathological features were collected and analyzed.The O-RADS score was used for classification.The O-RADS score was determined by two senior doctors in the gynecological ultrasound group.Lesions with O-RADS score of 1-3 were classified as benign tumors,and lesions with O-RADS score of 4 or 5 were classified as malignant tumors.RESULTS There were 17 collision tumors detected in 16 of 6274 patients who underwent gynecological surgery.The average age of 17 women with ovarian collision tumor was 36.7 years(range 20-68 years),in whom,one occurred bilaterally and the rest occurred unilaterally.The average tumor diameter was 10 cm,of which three were 2-5 cm,11 were 5-10 cm,and three were>10 cm.Five(29.4%)tumors with O-RADS score 3 were endometriotic cysts with fibroma/serous cystadenoma,and unilocular or multilocular cysts contained a small number of parenchymal components.Eleven(64.7%)tumors had an O-RADS score of 4,including two in category 4A,six in category 4B,and three in category 4C;all of which were multilocular cystic tumors with solid components or multiple papillary components.One(5.9%)tumor had an O-RADS score of 5.This case was a solid mass,and a small amount of pelvic effusion was detected under ultrasound.The pathology was high-grade serous cystic cancer combined with cystic mature teratoma.There were nine(52.9%)tumors with elevated serum carbohydrate antigen(CA)125 and two(11.8%)with elevated serum CA19-9.Histological and pathological results showed that epithelial-cell-derived tumors combined with other tumors were the most common,which was different from previous results.CONCLUSION The ultrasound images of ovarian collision tumor have certain specificity,but diagnosis by preoperative ultrasound is difficult.The combination of epithelial and mesenchymal cell tumors is one of the most common types of ovarian collision tumor.The O-RADS score of ovarian collision tumor is mostly≥4,which can sensitively detect malignant tumors.

Clinical characteristics and treatment of ovarian serous borderline tumors

Ovarian serous borderline tumors (SBTs) are characterized by good prognosis and occasional late recurrence. The 5-year and 10-year survival rates are all more than 90%. But traditionally patients with SBTs used to be treated with bilateral oophorectomy, hysterectomy and postoperative chemotherapy. A high proportion of SBTs occurred in young patients. The traditional treatment with complete excision of reproductive organs seemed to be too aggressive for young patients. It is imperative that conservative surgical procedures with fertility sparing should be employed to them. In this paper the literatures in regard to the final outcome of the conservative surgical therapy for SBTs were reviewed and the appropriate extent of conservative surgical procedures was discussed in detail.

Prognostic Significance of Hormonal Receptor Status of Malignant Ovarian Tumors

The objective of this study is to investigate hormonal receptor status of MOT （malignant ovarian tumor） and to evaluate its clinical and prognostic significance. Retrospective analysis of the case reports of 284 patients with MOT of different histogenesis, stages I-IV, and immunohistochemical study of paraffin-embedded tissues were performed. Hormonal receptor status of tumors with different morphology genesis was studied and hormonal receptor phenotype of serous OC （ovarian cancer） was determined. The analysis of correlation between the expression of steroid hormone receptors （receptors to estrogens （ER）, progesterone （PR） and testosterone （TR）） in ovarian tumors, histological type of tumors and clinical morphological parameters were performed. Overall and relapse-free survival rates of the patients with serous OC depending on the hormonal receptor phenotype of the tumor were assessed. Presence of positive expression of steroid hormone receptors in serous OC （ER-66.4%, PR^53.4%, TR-53.0%）, mucinous OC （ER-88.0%, PR-84.0%, TR-60.0%） and in sex cord stromal tumors （ER-74.1%, PR and TR-77.8%） is proved by correlation of all steroid receptors expression with morphology type of ovarian tumors （ER - r = 0.4; PR - r = 0.4; TR - r = 0.3; p 〈 0.05）. Direct correlation between hormonal receptor phenotype of serous OC and the age period of the patients was established （r = 0.5; p = 0.002）： postmenopausal women patients reported the most increased frequency of serous OC with positive hormonal receptor tumor phenotypes （52.4%）, in particular during their late post-menopausal period （39.0%）. Significantly low overall survival among the patients with positive hormonal receptor phenotype of serous OC was recorded （29.5±3.4%） in comparison with the same score in the patients with negative phenotype of tumors （44.5±3.7%） （p 〈 0.05）. Multifactor analysis of Cox-regression model has defined that positive hormonal receptor phenotype of serous OC increases the risk of disease relapse （HR 1.4; 95.0% CI 1.1-1.7）, significantly decreases overall survival rates in the patients （HR 1.4; 95.0% CI 1.1-1.8）. Positive hormonal receptor status of MOT is an independent factor of unfavorable clinical progress of tumor process which can be regarded as the criterion for development of the methods of hormonal therapy application in complex treatment of the patients, and demands further large-scale multi-center studies in that direction.

Testosterone-producing ovarian tumors:a clinical study of 25 cases

Objective:To study the clinical characteristics of testosterone-producing ovarian tumors.Methods:Twenty-five patients with testosterone-producing ovarian tumors diagnosed pathologically were treated in Peking Union Medical College Hospital from Jan 1986 to Oct 2006.Clinical documents of the 25cases were analyzed retrospectively.Results:(1)The median age of patients was 27 years.Menstrual irregularity was seen in 96% of patients and virilization was seen in 100%.(2)Endocrinological tests:Total testosterone,LH,FSH,LH/FSH,E2 in serum before and after operation were 16.9±6.8/1.0±1.6 nmol/L(P=0.000),6.6±3.41/11.7±6.8 IU/L(P=0.025),4.9±2.6/9.2±7.8 IU/L(P=0.072),2.1±2.5/1.7±1.0(P=0.579),241±139/164±161 pmol/L(P=0.131),respectively.Initial investigation showed the level of E2 was in early follicle stage in 86% of patients,normal level of ACTH in 92%,increased level of17-αOHP and F in 50% and in 22% of patients,respectively.all patients have normal urinary free cortisol collected over a 24-hour period.Dexamethasone suppression tests and ACTH stimulating tests suggested non-adrenocorticotrophic homone dependency of the hyperandrogenic state.(3)Pathological features:of all tumors,60% were Sertoli-Leydig cell tumors in which 67% of them were poor differentiated,32%were lipid cell tumors in which all of them were well differentiated.All tumors were unilateral.The median size of tumors was 4.8cm.On cut surface most of them were solid and yellow.(4)Treatment and prognosis:twenty-two younger patients were performed conservative staging surgery.Patients with poor-differentiated tumors accepted chemotherapy and GnRH-a.After removal of ovarian tumors,symptoms of virilization were improved and five patients had healthy children.Conclusions:Testosterone-producing ovarian tumors are often seen in reproductive ages.They produce defeminization followed by virilization.The total level of testosterone in serum was increased markedly while decreased rapidly after removal of tumor.Owing to their relatively small size,the detection of such tumors may be difficult.Sertoli-Leydig cell and lipid cell tumors are the common pathological types.Total hysterectomy with bilateral salpingo-oophorectomy is the treatment of choice in postmenopausal women.In yonger women,resection of the tumor or unilateral salpingo-oophorectomy is preferable to preserve fertility.The prognosis of these tumors is satisfactory after treatment,but patients should be followed-up regularly.

Pregnancy and Childbirth After Sertoli-Leydig Cell Tumor Resection:A Case Study and Literature Review

Objectives:To explore the clinical manifestations and pathological features in the biopsy of ovarian Sertoli-Leydig cell tumor,as well as to improve the clinical understanding of the disease.Methods:A case of pregnancy and childbirth after Sertoli-Leydig cell tumor resection was retrospectively analyzed.The patients’clinical data were collected,including the clinical manifestations,postoperative biopsy results,auxiliary examination results,immunohistochemical results,treatment,and prognosis of the patient.Results:(1)SLCT occurred unilaterally;(2)according to the International Federation of Obstetrics and Gynecology(FIGO),the clinical staging was stage IA;according to the pathological classification of malignant tumors,it was gradeⅡ(moderately differentiated);(3)a healthy female live baby was delivered.Conclusion:Such tumors are rare low-grade malignancies and are even rarer in pregnancy.An increase in preoperative testosterone levels with positive ultrasonography results can be used to assist diagnosis;however,postoperative biopsy pathology remains the“gold standard”for the diagnosis of SLCTs.The definite diagnosis of SLCTs is of great significance for surgical planning and prognostic evaluation.

A case of primary ovarian carcinoid and the review of the literature

Objective:To investigate the clinicopathologic features of primary ovarian carcinoid.Methods:A case of primary ovarian carcinoid of the ovary were reported.Clinicopathological analysis was performed.Results:The case was just an island-like carcinoid.The tumor cells were round or polygonal,arranged into island-like or pseudo chrysanthemum clusters,and got bilateral tubal and oophorectomy.No evidence of recurrence was consulted in 28 months of follow-up.Conclusion:Primary ovarian carcinoid is rare in clinic.The diagnosis should be differentiated from granulosa cell tumor and sertolithoid cell tumor,and metastatic carcinoid should be excluded.As a low-grade malignant tumor,most ovarian carcinoids have a real good prognosis.

术前外周血炎症标志物联合HE4在浆液性卵巢癌诊断中的价值

目的探讨术前外周血炎症标志物血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)、单核细胞与淋巴细胞比值(MLR)联合人附睾蛋白4(HE4)对浆液性卵巢癌的诊断价值以及与临床病理特征的相关性。方法回顾性分析郑州大学第三附属医院2021年8月至2023年8月收治的92例浆液性卵巢癌患者为浆液性卵巢癌组,并选取同期收治的88例卵巢良性肿瘤患者为对照组,收集两组患者术前PLR、NLR、MLR和HE4水平的实验室资料以及浆液性卵巢癌组患者术后病理资料。比较两组患者术前PLR、NLR、MLR和HE4的表达差异,应用受试者工作特征(ROC)曲线评估PLR、NLR、MLR联合HE4对浆液性卵巢癌的诊断价值,并分析PLR、NLR、MLR与临床病理特征的关系。结果与对照组相比,PLR、NLR、MLR和HE4水平在浆液性卵巢癌组中较高(P<0.05);PLR、NLR、MLR、HE4以及四者联合检测对浆液性卵巢癌诊断的ROC曲线下面积分别为0.693、0.733、0.759、0.937、0.954,灵敏度分别为72.8%、70.7%、84.8%、79.3%、80.4%,特异度分别为61.2%、69.4%、52.9%、96.5%、95.3%。PLR与FIGO分期有关,NLR与FIGO分期和淋巴结转移有关,MLR与FIGO分期和组织分化有关。结论术前NLR、PLR和MLR与浆液性卵巢癌的病理分期、组织分化和淋巴结转移密切相关,术前外周血炎症标志物与HE4联合检测可以作为浆液性卵巢癌诊断中的重要参考指标,可为临床诊治提供参考信息。

卵巢微乳头亚型浆液性交界性肿瘤临床病理与分子特征分析

目的探讨卵巢微乳头亚型浆液性交界性肿瘤(micropapillary serous borderline tumor,MSBT)的临床病理学特征、免疫表型、分子改变、鉴别诊断、治疗和预后。方法收集14例卵巢MSBT的临床资料,采用免疫组化EnVision法染色分析IMP3的表达,运用qRT-PCR法和Sanger测序法检测BRAF和KRAS的基因突变,分析其临床病理特征并复习相关文献。结果患者年龄27~56岁,平均41.7岁;9例为双侧卵巢肿物;11例术前血清CA125值升高。肿瘤切面呈囊实性,伴囊内乳头状物。14例卵巢MSBT均呈乳头状结构,特征性的细长微乳头直接从囊壁或大的无分支乳头上发散出来,乳头长宽比>5,乳头被覆细胞呈立方至多角形,轻-中度异型性,微乳头区范围均>5 mm。5例伴微浸润;6例伴腹膜非浸润性种植;5例伴腹水均可见异型肿瘤细胞;3例伴淋巴结受累;9例伴砂粒体。免疫表型:ER、PR、CA125、CK7和WT-1均呈阳性,p53野生型,HER2、IMP3均阴性,Ki67增殖指数为5%~30%。分子病理学特征:14例中KRAS基因突变3例(3/14,21.4%),突变位点分别为G12C、G12D和Q70(无义突变);BRAF V600E均未突变;BRAF T559I突变1例(1/14,7.1%)。7例患者行根治性手术,另7例患者行保守性手术,术后均未经特殊治疗。随访时间1~12年,14例患者中5例有复发。结论MSBT形态学特殊,多双侧发病,易伴腹膜种植,易复发,诊断时应与经典型卵巢浆液性交界性肿瘤鉴别。

血清可溶性CD276与晚期高级别浆液性卵巢癌预后及肿瘤免疫浸润相关性分析

目的探讨血清可溶性CD276(sCD276)与晚期高级别浆液性卵巢癌(HGSOC)预后及肿瘤免疫浸润的相关性。方法将2017年3月至2020年3月资阳市第一人民医院就诊的晚期HGSOC患者73例纳入A组,选取同期入院治疗的其他类型卵巢癌患者80例纳入B组,另选择80名健康人群作为健康人群组,检测三组血清sCD276表达水平。并依据血清sCD276表达水平中位数将A组分为高表达组(≥451.26 pg/ml)与低表达组(<451.26 pg/ml)。分析血清sCD276水平变化与晚期HGSOC患者不同临床特征的关系,并采用生存曲线和Cox比例风险回归分析血清sCD276与晚期HGSOC预后的相关性。结果A组和B组血清sCD276表达水平均高于健康人群组(P<0.05),且A组血清sCD276水平高于B组(P<0.05);卵巢癌患者sCD276低表达与高表达的无病生存率比较,差异无统计学意义(P>0.05);在A组中,低表达组的无病生存率及总生存率高于高表达组(P<0.05),无病生存时间≥12月组的血清sCD276表达水平低于无病生存时间<12月组(P<0.05);A组患者中sCD276高表达组与低表达组在有无淋巴结转移、术后残余病灶、CD3^(+)阳性、FoxP3^(+)阳性等方面比较有差异统计学意义(P<0.05);经多因素COX比例风险回归分析得出,有术后残余病灶、CD3^(+)阳性、FoxP3^(+)阳性、血清sCD276≥451.26 pg/ml均是晚期HGSOC患者预后的危险因素(P<0.05);经免疫组化法对肿瘤组织检测得出,A组中有59例患者膜CD276表达为阳性,14例患者膜CD276表达为阴性,膜CD276阳性组的血清sCD276表达及FoxP3^(+)阳性比例均明显高于膜CD276阴性组(P<0.05)。结论血清sCD276在晚期HGSOC呈高表达水平,其水平升高与TILs标志物FoxP3^(+)T细胞数量均是晚期HGSOC患者复发或死亡的危险因素,与患者预后关系密切,血清sCD276为晚期HGSOC新辅助化疗期间的免疫应答监测提供了可能性。

卵巢支持-间质细胞瘤临床病理学及分子遗传学特征分析

目的 探讨卵巢支持-间质细胞瘤(SLCT)的临床病理学特征及分子遗传学特征。方法 回顾郑州大学第一附属医院收治的13例SLCT患者的临床病理资料,Sanger测序检测DICER1热点区域体细胞突变(第24、25外显子相关位点),完善随访资料,分析DICER1突变与SLCT临床病理特征的相关性,并检索相关文献。结果 SLCT中位数年龄24岁,首发临床症状为月经失调、盆腔包块或下腹胀痛;镜下见管状、条索状及肉瘤样等区域,免疫组化表达CR、WT-1、Inhibin-α、SF-1等。预后随访中30.8%(4/13)患者复发,76.9%(10/13)检测到DICER1基因突变,且DICER1基因突变在年龄上差异有统计学意义(P<0.05),在组织学分化程度、肿瘤是否复发上差异无统计学意义(P>0.05),有异源性分化者DICER1突变率可能高。结论 SLCT形态多样,诊断需要结合临床特点、免疫组化及DICER1基因检测。DICER1突变多发生于年轻患者,与组织学分化、肿瘤是否复发的关系需进一步研究。

卵巢浆液性交界性肿瘤57例临床病理分析

目的分析卵巢浆液性交界性肿瘤的临床病理特征,探讨其诊断及鉴别诊断。方法回顾性分析厦门大学附属第一医院病理科诊断卵巢浆液性交界性肿瘤57例进行病理组织学观察,分析其免疫表型,结合临床资料复习相关文献。结果卵巢浆液性交界性肿瘤普通型及微乳头亚型在组织病理形态上有差别,在双侧卵巢发病率,伴有非浸润性种植及伴有微小浸润等方面存在差异。结论区分浆液性交界性肿瘤普通型和微乳头型很重要,微乳头型预后较普通型差。

类似卵巢性索肿瘤的子宫肿瘤的临床病理分析

目的探讨类似卵巢性索肿瘤的子宫肿瘤(UTROSCT)的临床、病理特征以及相关基因组学变化,以期更好地了解其性质,有助于精确的治疗和预测患者的预后。方法通过对10例患者做UTROSCT镜检及免疫组化分析,对患者进行随访,并查阅相关文献。结果患者平均年龄48岁,范围为26~69岁。肿瘤直径0.5~8 cm,切面多为灰白、灰黄色。首发症状常为经期紊乱或异常阴道出血,肿瘤位于黏膜下或者肌间多见。10例患者均预后良好,无病生存,随访时间2~125个月。镜检:肿瘤可多种方式排列,如条索、巢状、小管样、网状或小梁状,间质常可见玻璃样变。细胞呈圆形或卵圆形,核仁较常见,偶见核分裂象。免疫表型:肿瘤多向分化,10例肿瘤性索分化的标记均有不同程度表达,大部分表达平滑肌、上皮标记,ER、PR和CD10也常为阳性。结论UTROSCT是一种多表型且少见的肿瘤,临床特征无特异性,预后一般较好,也可转移复发。目前主要依靠组织病理结合免疫组化,分子病理是明确诊断及判断患者预后的重要手段。治疗方式主要为手术切除。

PLA2G2D在卵巢浆液性腺癌组织中的表达及与患者预后的关系研究

目的分析磷脂酶A2组ⅡD(phospholipase A2 groupⅡD,PLA2G2D)在卵巢浆液性腺癌(ovarian serous cystadenocarcinoma,OSC)患者中表达特征、预后价值及临床意义。方法选取2019年1月至2022年1月在丹阳市人民医院手术治疗的65例OSC患者。通过多种公共数据库和免疫组织化学(immunohistochemistry,IHC)分析PLA2G2D在OSC中表达特征及预后价值。通过TIMER 2.0数据库分析OSC中PLA2G2D表达与肿瘤浸润性免疫细胞间关联。通过Pearson检验分析PLA2G2D共表达基因,并进行功能富集信号通路分析。基于TCGAOSC队列构建预测OSC患者预后列线图。基于Kaplan-Meier构建65例OSC患者生存曲线,使用单因素和多因素Cox回归分析临床变量与预后间的关联。结果PLA2G2D RNAseq和蛋白水平在OSC组织中表达增高且患者总体生存率更高(P<0.05)。OSC中PLA2G2D RNAseq表达与巨噬细胞(r=0.472)、树突状细胞(r=0.331)和NK细胞(r=0.274)呈显著正相关性,与B细胞(r=−0.194)和中性粒细胞(r=−0.125)呈负相关性,差异均有统计学意义(P<0.05)。PLA2G2D富集于炎症反应、白细胞活化和免疫反应正向调节等信号通路。基于TCGA-OSC队列构建的列线图能有效预测OSC患者1年、3年和5年生存率。PLA2G2D高表达组患者5年总生存率(overall survival,OS)和无复发生存率(recurrence-free survival,RFS)高于低表达组(P<0.001)。多因素Cox风险回归结果显示PLA2G2D表达是OSC患者DFS[风险比(hazard ratio,HR)=0.412,95%可信区间(confidence interval,CI)0.253~0.672,P<0.001]和OS(HR=0.354,95%CI 0.173~0.724,P=0.004)的独立影响因素。结论PLA2G2D在OSC中高表达且与更好预后相关,这可能与其调控肿瘤微环境中免疫细胞浸润丰度有关,提示PLA2G2D可能作为OSC患者的潜在预后生物标志物及治疗靶点。

不同临床病理特征卵巢浆液性肿瘤患者E-cadherin、BRCA1及P53的表达变化研究

目的:探究不同卵巢浆液性肿瘤中E-钙黏蛋白(E-cadherin)、乳腺癌易感基因1(BRCA1)、P53的表达变化情况。方法:选取2017年12月—2022年2月赣州市妇幼保健院的50例卵巢浆液性癌患者为A组,同时期的40例卵巢交界性浆液性肿瘤患者为B组,30例卵巢良性浆液性囊腺瘤患者为C组。检测及比较三组的组织E-cadherin、BRCA1、P53表达情况,并比较A组中不同年龄、淋巴结转移情况、FIGO分期及不同病理分级者的检测结果。结果:A组的E-cadherin及BRCA1阳性率显著均低于B组及C组,B组则显著均低于C组(P<0.05);A组P53阳性率显著高于B组及C组,B组则显著高于C组(P<0.05)。A组中低级别浆液性癌者E-cadherin和BRCA1阳性率均高于高级别浆液性癌者,低级别浆液性癌者P53阳性率显著低于高级别浆液性癌者,差异均有统计学意义(P<0.05)。A组中不同年龄及FIGO分期者的组织E-cadherin、BRCA1及P53阳性率比较,差异均无统计学意义(P>0.05)。A组有淋巴结转移者E-cadherin和BRCA1阳性率均低于无淋巴结转移者,有淋巴结转移者P53阳性率高于无淋巴结转移者,差异均有统计学意义(P<0.05)。结论:卵巢浆液性癌患者中E-cadherin及BRCA1呈低表达,而P53呈高表达,且不同临床病理情况者存在差异,因此在卵巢浆液性癌的早期筛查检测中有一定的参考价值。

五例卵巢Brenner瘤诊治分析

目的:总结卵巢Brenner瘤的临床特征、病理特点和治疗情况。方法:回顾性分析2000年1月—2023年12月在兰州大学第一医院手术并经术后石蜡病理确诊为卵巢Brenner瘤的5例患者的病例资料,总结其临床特征、病理特点及治疗经验。结果:5例患者发病年龄为46~72岁,中位年龄70岁;体质量指数(body mass index,BMI)为19.11~28.77 kg/m^(2),中位BMI为25.64 kg/m^(2)。其中2例为卵巢交界性Brenner瘤(borderline Brenner tumor,BdBT),3例为卵巢恶性Brenner瘤(malignant Brenner tumor,MBT)。2例MBT患者出现糖类抗原125(carbohydrate antigen 125,CA125)水平显著升高。5例患者肿物最大直径均大于2 cm,且均为单侧。影像学结果均提示囊实性占位。镜下见,卵巢BdBT由移行细胞上皮巢及纤维间质组成,细胞层次增多,细胞核存在不典型性,但无间质浸润。卵巢MBT细胞明显异型,细胞质嗜酸性或透亮,瘤组织浸润生长。5例患者的细胞角蛋白7(cytokeratin 7,CK7)、GATA3、P63均为阳性;CK20、肾母细胞瘤基因1(Wilms tumor gene 1,WT1)均为阴性。1例BdBT患者的Ki-67增殖指数<5%,其余4例患者的Ki-67增殖指数约为20%~40%。5例患者均行手术治疗,2例患者辅以化疗。除1例卵巢MBT患者失访,其余4例随访时间均存活未复发。结论:术前影像学及CA125检查对卵巢Brenner瘤无明确诊断价值,需依据组织病理学和免疫组织化学检查确诊。MBT与BdBT的鉴别在于细胞的异型程度及有无间质浸润。手术是治疗卵巢Brenner瘤的主要手段。

卵巢恶性PEComa 1例报道并文献复习

目的:探讨卵巢原发恶性血管周上皮样肿瘤(perivascular epithelioid cell tumor,PEComa)的临床病理特征、诊断、鉴别诊断、治疗及预后。方法:对1例卵巢原发恶性PEComa进行常规病理学和免疫组化学标记分析并文献复习。结果:肿瘤由上皮样至梭形细胞组成,弥漫片状生长,部分区域可见瘤细胞围绕在血管周围呈放射状排列,瘤细胞胞质透亮或淡嗜伊红色,可见色素,见坏死及核分裂象。免疫组化:HMB45(+),Melan-A(+),TFE3(+),Ki-67 (指数<10%)。结论:卵巢原发恶性PEComa是一种罕见的表达黑色素标记和平滑肌标记的一组间叶性肿瘤,临床症状不典型,组织学形态及免疫标志物在诊断及鉴别诊断具有重要价值,术后影像学随访非常重要,免疫治疗及放射治疗仍值得探索。

卵巢幼年型粒层细胞瘤超声图像及病理特征分析

目的 分析卵巢幼年型粒层细胞瘤(JGCT)的超声图像及病理特征。方法 选取我院经手术病理证实的JGCT患者4例,总结其超声图像特征及病理表现。结果 4例患者病灶超声均表现为边界清晰、形态规则的囊实性包块,其囊性部分多发分隔,囊壁光滑,未见血流信号,最大径均>6 cm;实性部分呈不均匀高回声,可见较丰富的血流信号及低阻动脉频谱,阻力指数≤0.5。4例患者均伴有不同程度腹腔积液,2例伴有胸腔积液,1例伴有心包腔积液,积液均透声好;3例表现为子宫内膜增厚。病理检查示JGCT由颗粒细胞弥漫增生形成,同时伴新生血管生成,囊性成分与滤泡样结构的模式有关。结论 JGCT超声表现多样,巨大囊实性占位伴多发分隔、多合并浆膜腔积液为其特征性表现。

HE4、CA125及CEA在卵巢癌患者血清中的表达及与病理特征、预后的关系

目的 探讨人附睾蛋白4(HE4)、糖类抗原125(CA125)、癌胚抗原(CEA)在卵巢癌中的表达及与临床病理特征、预后的关系。方法 将58例卵巢癌患者作为观察组,58例同期健康体检者作为对照组。所有研究对象均采血检测HE4、CA125、CEA水平,比较2组血清HE4、CA125、CEA差异,并分析HE4、CA125、CEA与病理特征间的关系。随访3年,比较存活患者与死亡患者血清HE4、CA125、CEA间差异。结果 观察组血清HE4[(178.52±8.39)pmol/L]、CA125[(52.14±5.17)U/ml]、CEA[(18.29±2.14)ng/ml]水平高于对照组,差异有统计学意义(P<0.05);低分化、Ⅲ、Ⅳ期及有淋巴结转移卵巢癌患者血清HE4、CA125、CEA水平高于中高分化、Ⅰ、Ⅱ期及无淋巴结转移患者,差异有统计学意义(P<0.05)。58例患者随访3年,存活41例,存活率为70.69%(41/58);存活组患者血清HE4[(151.69±7.68)pmol/L]、CA125[(41.02±4.39)U/ml]、CEA[(13.25±1.69)ng/ml]水平低于死亡组,差异有统计学意义(P<0.05)。结论 HE4、CA125、CEA在卵巢癌患者血清中呈高表达状态,与组织分化程度、肿瘤分期、淋巴结转移及预后关系密切,能够用于病情及预后评估。

术中冰冻切片病理诊断在卵巢肿瘤中的应用价值

目的探讨术中冰冻切片病理诊断在卵巢肿瘤中的应用。方法选择2021年3月—2022年10月邹平市人民医院收治的70例卵巢肿瘤患者作为研究对象,分别进行术中冰冻切片病理诊断和快速石蜡切片病理诊断,将术中快速石蜡切片病理诊断结果作为“金标准”,分析不同方法的诊断价值。结果术中冰冻切片病理诊断良性肿瘤20例,交界性肿瘤23例,恶性肿瘤21例,误诊6例,总确诊率为91.43%;术中快速石蜡切片病理诊断良性肿瘤22例,交界性肿瘤24例,恶性肿瘤22例,误诊2例,总确诊率为97.14%。组织学检查结果显示,术中冰冻切片与快速石蜡切片病理诊断的总符合率分别为92.86%、98.57%,差异无统计学意义(P>0.05)。结论术中冰冻切片病理诊断对卵巢肿瘤的诊断价值较高,值得推广。