卵巢交界性与恶性布莱纳瘤4例观察与分析

目的 观察和分析卵巢交界性和恶性布莱纳（Brenner）瘤的临床和 和病理形态学特点，阐明其诊断和鉴别诊断要点。方法 对该瘤交界性和恶性各2例进行临床病理学、组织化学、免疫组织化学和电镜观察。结果 交界性瘤中可见良性瘤形态，上皮巢大小不一，层次增多，但外周和主腔缘细胞可见排列，巢间可排列紧密，但不见融合。细胞多与良性瘤相同，出现部分缩状核，核仁少，常见核沟，核分裂象少，无间质浸润；恶性瘤中可见交界性瘤形态，但不一定有良性瘤区域。以大巢、融合巢为主，尚见方形、菱形畸形巢。大巢旁有子巢或“出芽”。巢内细胞无极性。 罕见核沟，并见短梭性多核巨细胞，分裂象及病理性分裂象多见。有间质浸润，血管内可见瘤栓，可伴有腺癌。可向周围浸润和转移。结论 上眼巢和纤维间质共存是两者共同点，上皮巢和巢中细胞形态的差别是鉴别要点。由于两者治疗、手术和预后不同，准确鉴别十分重要。

Comparative analysis between borderline and malignant Brenner tumors in the ovary

Objective To elucidate the diagnosis and differential diagnosis of ovarian borderline and malignant Brenner tumors. Methods Two cases of borderline Brenner tumor and two malignant one were investigated with clinicopathological analyses, histochemical and immunohistochemical stains. Results Components of benign Brenner tumor were always present in the borderline tumor. The epithelial nests appeared not uniform with increasing layers and close arrangement of the tumor cells without fusion. Cytolologic appearance of the borderline tumor was similar to the benign one, displaying small nucleoli, grooved nuclei and rare mitotic figures, without stromal invasion. Components of the borderline Brenner tumor were also present, but those of the benign tumor were not always seen in malignant one. Most of epithelial nests were large and fused, and some of them appeared square or rhombic. The malignant cells were lost of polarity, displaying short spindle or multinuclear giant cells with prominent and atypical mitotic figures. Nuclear groove was rare. Stromal invasion, tumor emboli in blood vessels and even metastasis could be seen in the malignant tumor. Conclusions Both borderline and malignant Brenner tumors have epithelial nests and fibrous stroma. Appearance of the epithelial nests and tumor cells is the key point for their differential diagnosis that plays an important role in choice of therapy and prognostic evaluation of the patients.