卵巢粒层细胞瘤15例临床病理分析

目的探讨卵巢粒层细胞瘤的临床病理特征,诊断及鉴别诊断。方法回顾本院诊治的15例卵巢粒层细胞瘤的临床表现、病理特征及免疫表型特点,并复习相关文献。结果 15例粒层细胞瘤患者中,2例为幼年型粒层细胞瘤,发病年龄6～20岁,平均12岁;13例为成年型粒层细胞瘤,发病年龄26～74岁,平均46.7岁。临床主要表现为不规则阴道流血、腹痛、腹部包块、闭经、腹水。巨检为实性或囊实性肿块。光镜下成年型粒层细胞瘤可见典型的含Call-Exner小体的微滤泡结构及瘤细胞核内的纵行核沟,幼年型粒层细胞瘤缺乏此特征,瘤细胞有一定异型性,可见核分裂像。免疫组化染色显示瘤细胞表达inhibin-α、CD99和Vimentin,部分患者Melan-A、Calretinin和S-100阳性,CKpan、EMA、PLAP、Syn和CgA缺乏阳性表达。结论卵巢粒层细胞瘤临床少见,属于低度恶性肿瘤,预后较好。确诊依赖于临床特点、组织形态学及免疫组化标记。病理诊断时要与卵巢的子宫内膜样癌、小细胞癌、低分化腺癌及无性细胞瘤等肿瘤相鉴别。

Clinicopathological Study of Ovarian Granulosa Cell Tumor with 15 Cases Report

Objective To investigate the clinicopathologic features,diagnosis and differential of ovarian granulosa cell tumor（GCT）.Methods The history records,pathologic features and immunophenotype of 15 cases of GCT were retrospectively evaluated and relevant literature were reviewed.Results In 15 cases of GCT,there were 2 cases of juvenile granulosa cell tumor（JGCT）,the age of patients ranged from 6～20 years old,with an average age of 13 years.There were 13 casesof adult granulosa cell tumor（AGCT）,the age of patients ranged from 26～74 years old,with an average of 46.7 years.The main clinical manifestations included the anomalous vagina bleeds,abdominalmass,abdominal pain,menopause and ascites.Cut surface of the tumor was typically solid with cystsformed.In cases of GCT,the histopathological changes obviously typical included the Call-Exner micro follicles and vertical shape nuclear ditch,those cases of JGCT lacked these characteristics,thetumor cells had certain heterogeneous type,cell nucleus mitosis figures could be found.Immunohistochemical results showed that the tumor cells expressed inhibin-α,CD99,vimentin;While Melan-A,calretinin and S-100 were positive staining in part of the cases.CKpan,EMA,PLAP,Syn and CgA were negative in all the cases.Conclusions Ovarian granulosa cell tumor is a ratherrare,low malignant tumor with good prognosis.Its diagnosis depends on the histologic and immunohis-toche mical detection and its clinical features.Its differential diagnosis includes ovarian endometrioid adenocarcinoma,small cell carcinoma,low split up adenocarcinoma and dysgerminoma.