Overview Article: Ultrastructural Features of the Common Epithelial Tumors of the Ovary: Part II

The ultrastructural features of benign and malignant serous, mucinous, and endometrial variants of ovarian carcinoma are presented. Clear cell tumors and Brenner tumors are also discussed.

Where possible, specific electron microscopic features are stressed.     

Overview Article: Ultrastructural Features of the Common Epithelial Tumors of the Ovary: Part I

The ultrastructural features of benign and malignant serous, mucinous, and endometrial variants of ovarian carcinoma are presented. Clear cell tumors and Brenner tumors are also discussed.

Where possible, specific electron microscopic features are stressed.     

Overview Article: Ultrastructural Features of the Common Epithelial Tumors of the Ovary: Part I

The ultrastructural features of benign and malignant serous, mucinous, and endometrial variants of ovarian carcinoma are presented. Clear cell tumors and Brenner tumors are also discussed.

Where possible, specific electron microscopic features are stressed.     

Multiple genital tract tumors and mucinous adenocarcinoma of colon in a woman with Peutz-Jeghers syndrome: a case report and review of literatures

We report a very rare case of Peutz-Jeghers syndrome (PJS) composed of multiple genital tract tumors and mucinous adenocarcinoma. A 46-year-old woman presented to our hospital with lower abdominal pain resulting from PJS involves sex cord tumor with annular tubules (SCTAT), ovarian mucinous tumor, ovarian serous tumor, mucinous adenocarcinoma of colon. The CEA concentration is high before surgery, and decreases after the surgery and subsequent chemoradiotherapy. This case demonstrates a classic clinical presentation of a patient with PJS. PJS patients have increased risk of malignancy and early detection and regular surveillance of the high-risk patients with PJS is crucial. Surgery may be required for obstructive gastrointestinal lesions as well as those exhibiting malignant degeneration.     

胰腺黏液性囊性肿瘤临床病理分析

目的；探讨胰腺黏液性囊性肿瘤（MCN）的临床病理学特点。方法：6例MCN均行B超或CT检查。除1例外，均作了手术切除治疗。对6例（MCN）作常规HE及免疫组织化学染色观察。结果：6例MCN中，女性4例，男性2例，平均年龄47岁，均位于胰腺体尾部。黏液性囊腺瘤（MCA）3例，囊壁内衬高柱状黏液上皮，上皮周围可见卵巢样间质组织；黏液性囊腺癌（MCC）3例，黏液上皮 有不典型增生，均有囊壁或胰腺组织的浸润，1例上皮周围可见卵巢样间质。CEA和CK 7在上皮中均阳性，c-erbB－2均阴性，间质SMA均阳性。结论：胰腺MCN是好发于中年女性的少见肿瘤，绝大多数发生于胰腺体尾部。MCA内衬高柱状上皮，上皮外来卵巢样间质包绕；MCC上皮细胞有不典型增生， 浸润性生长。MCN手术切除率高。     

Neoplasms in proteus syndrome

We report on 2 children with Proteus syndrome who developed neoplasms. Patient 1 had a probable mesothelioma, although papillary carcinoma of the thyroid could not be completely ruled out. Patient 2 had bilateral ovarian serous cystadenomas with nuclear atypia. Other unusual neoplasms in Proteus syndrome are discussed, together with their etiologic and pathogenetic possibilities. © 1995 Wiley-Liss, Inc.     

Cystic mucinous tumours of the mesentery and retroperitoneum: report of three cases

A mucinous cystadenoma of the mesentery and two borderline mucinous cystadenocarcinomas of the mesentery and retroperitoneum are reported. The patients were females, aged 38, 47 and 58 years. The cysts showed identical features to those commonly seen in the appendix and ovary. One of our cases, with 'borderline' histology, developed metastases to mediastinal lymph nodes, 4 years after diagnosis. We suggest that these tumours develop through mucinous metaplasia in pre-existing mesothelium-lined cysts, the latter being the commonest cysts in this location.     

卵巢交界性粘液性和浆液性瘤

通过78例粘液性和浆液性交界瘤的随访,进一步阐明交界瘤是介于良恶性之间的一类肿瘤。其病理特点为:有一定程度组织结构和细胞形态的异型性,但无明显的间质浸润。其临床分期绝大多数为Ⅰ期。5年存活率分别为84%与78%。加强对交界性瘤这一概念的认识,将有助于临床制定正确的治疗方案。     

Serous microcystic adenoma (glycogen-rich cystadenoma) of the pancreas: study of 11 cases showing clinicopathological and immunohistochemical correlations

Serous microcystic adenoma of the pancreas, also known as microcystic adenoma, glycogen-rich cystadenoma or serous cystadenoma, is an uncommon benign tumor. We have studied 11 cases involving eight women and three men. The average age at diagnosis was 61.7 years. Four tumors were discovered incidentally. Tumors varied from 1.2 to 20 cm in maximum diameter and all were multicystic. Within the pancreas, three were located in the pancreas head, one involved the head and body, one was located in the body, five were in the tail, and one occupied the whole pancreas. Central stellate scar was seen in five (45%) cases. Histologically, all tumors were composed of microglandular cysts lined by clear epithelial cells rich in glycogen, which were separated by fibrocollagenous stroma. The expression of keratin in clear epithelial cells resembled that in ductal and/or centroacinar cells, but not acinar cells. alpha-Smooth muscle actin (SMA)-positive myoepithelial cells and stromal amyloid deposits were not detected. Ultrastructurally, fibrocollagenous stroma was composed of alpha-SMA-positive myofibroblasts and endothelial cells embedded in thick collagen bundles. Regardless of female propensity, estrogen and progesterone receptors were not detected. Therefore, female predominance in this tumor remains to be elucidated.     

胰腺囊性肿瘤92例临床病理分析

目的探讨胰腺囊性肿瘤的临床病理特征及免疫组织化学特点,以期提高对胰腺囊性肿瘤的认识。方法复习复旦大学附属中山医院1999—2005年间手术切除的92例胰腺囊性肿瘤的临床病理资料和影像资料,根据2002年WHO胰腺肿瘤分类标准将其分类。并采用免疫组织化学EnVision法,借助-组抗体进行鉴别诊断。结果在92例囊性肿瘤中,发病年龄16～80岁,男33例,女59例。其中,浆液性肿瘤18例,黏液性肿瘤14例,导管内乳头状黏液性肿瘤36例,实性假乳头状肿瘤18例,导管腺癌囊性变4例,胰腺内分泌肿瘤囊性变2例。免疫组织化学检测无特异性标记物可以完全区分各类型,常有交叉和重叠。浆液性囊腺瘤表达MUC-1,黏液性囊性肿瘤表达MUC-5AC为主,实性假乳头状肿瘤表达d-抗胰蛋白酶、d-抗胰糜蛋白酶、波形蛋白及孕激素受体,导管内乳头状黏液性腺瘤表达MUC-2,囊性恶性肿瘤主要表达MUC-1。结论胰腺各类囊性肿瘤在临床症状、影像学表现、组织形态及免疫表型上均有一定特征,但均无特异性,需结合起来综合判断,才能做出正确诊断,以指导临床治疗和预后判断。     

胰腺胶样癌四例临床病理学分析

目的 探讨胰腺胶样癌的临床病理学特征、诊断、鉴别诊断及分子生物学特点.方法 分析4例胰腺胶样癌的临床特点,对标本进行病理形态学观察、免疫组织化学EnVision法和K-ras基因突变检测.结果 4例胶样癌中3例发生在胰头部,患者均为男性;另1例在胰体尾部,为女性;平均发病年龄为56.5岁.其中2例首发症状为腹痛,1例为尿糖增高,1例为查体发现.3例大体形态为囊实性结节,囊内含黏液,1例大体呈实性.低倍镜下,纤维及胰腺组织中可见边界清楚的黏液结节,大的黏液湖中可见纤细的纤维结缔组织间隔成多个小黏液湖;肿瘤细胞漂浮在黏液湖中,呈小巢或条索状,或腺管状,也可看到印戒细胞漂浮其中.3例癌周可见肠型胰腺导管内乳头状黏液性肿瘤(IPMN),仅例1伴发胰胆管型IPMN.免疫组织化学染色3例MUC2细胞膜阳性,1例MUC1阳性.3例中例1和例3发现K-ras基因突变,突变位点均位于12密码子Gly12Asp(GGT＞GAT)和Gly12Arg( GGT＞ CGT).结论 胰腺胶样癌是少见的胰腺导管腺癌亚型,经常伴发于IPMN和胰腺黏液性囊性肿瘤,应与普通胰腺导管腺癌、印戒细胞癌及假性囊肿等病变相鉴别.免疫组织化学MUC2多阳性表达,MUC1多为阴性,K-ras基因突变率较低.     

Pseudomyxoma peritonei: A cytohistopathologic study of nine cases

Cytologic examination of seven peritoneal fluids from nine patients with pseudomyxoma peritonei revealed papillary clusters and isolated neoplastic cells. In all patients, one or both ovaries were replaced by proliferating (borderline) mucinous epithelial tumors of grade I–II intestinal type while three patients had synchronous appendiceal tumors of similar morphologic appearance. Four of the nine patients demonstrated positive correlation between the presence of neoplastic cells in the ovarian interstitial mucin (pseudomyxoma ovarii), the extraovarian peritoneum, and the free peritoneal fluid. Two patients demonstrated a negative correlation. The submission of an inadequate amount of ovarian or appendiceal tissue for histologic examination may account for the discordance in three patients. It is concluded that pseudomyxoma peritonei is a distinct clinicopathologic entity which can be subdivided into two types, acellular and cellular. This distinction, unlike the specific cytomorphologic features, may have prognostic significance. Diagn Cytopathol 1996;15:144–150. © 1996 Wiley-Liss, Inc.     

Cytopathology of serous neoplasia of the ovary and the peritoneum: Differential diagnosis from mesothelial proliferations

Serous neoplasia of the ovary ranges from benign adenomas through serous borderline tumors to invasive serous adenocarcinoma. This spectrum of neoplasia is at least partially reflected in the cytomorphologic features of these lesions. The objective of this study is to review the cytopathology of serous neoplasia of the ovary. In addition, cytologic features of serous surface papillary carcinoma and its distinction from peritoneal mesothelial proliferations are discussed. Diagn Cytopathol 1996;15:292–295. © 1996 Wiley-Liss, Inc.     

Clinicopathological significance of DEK overexpression in serous ovarian tumors

To investigate the significance of DEK protein expression in ovarian lesions, a total of 113 ovarian serous tumors, including 62 serous cystadenocarcinomas and 19 serous borderline tumors, were studied on immunohistochemistry. For comparison, 32 benign serous tumors, including 12 serous papillary cystadenomas, 10 serous cystadenomas, and 10 serous surface papillomas, were also included. DEK was positive in 93.5% of serous cystadenocarcinomas (58/62), 63.2% of serous borderline tumors (12/19), and weakly positive in 15.6% of benign serous tumors (5/32). The strong positive signal was detected only in serous adenocarcinomas (80.6%, 50/62) and borderline tumors (21.1%, 4/19), but no serous benign tumors were strongly positive (0%, 0/32). Meanwhile, the strong positivity rate of DEK protein was significantly higher in grade 2 and grade 3 than in grade 1 ovarian cancers ( P < 0.05), but there was no significant association between DEK protein expression level and International Federation of Gynecology and Obstetrics (FIGO) stage of serous ovarian adenocarcinoma ( P > 0.05). In summary, DEK plays an important role in the progression of ovarian serous cancers. The detection of DEK protein expression should be useful for the diagnosis and prognosis of ovarian serous cancers, and DEK might be a useful molecular target for ovarian cancer therapy.     

No evidence of endometriosis within serous and mucinous tumors of the ovary

Ovarian endometriosis can transform into malignant tumors. The author retrospectively examined HE slides of 112 serous tumors and 75 mucinous tumors for the existence of ovarian endometriosis. When endometriosis is present within the tumors, the term "endometriosis-derived tumor" was applied. When endometriosis is recognized adjacent to the tumor, the term "endometriosis-associated tumor" was used. Of the 112 serous tumors (46 benign, 18 borderline, and 50 malignant), 4 (3.5%) (2 benign and 2 malignant) were endometriosis-associated tumors. None was endometriosis-derived tumor. Of the 75 mucinous tumors (30 benign, 26 borderline, and 19 malignant), 4 (5%) (1 borderline and 3 benign) were endometriosis-associated tumors. No tumors showed endometriosis-derived tumors. The data suggest that endometriosis does not transform into serous and mucous tumors. The author felt the limitation of retrospective survey, because the limited numbers of slides (5 to 15) were obtained from each tumor. The author also felt that endometriosis can be difficult to discern because of degenerative changes and other similar lesions such as fallopian tube, fimbria, inclusion cysts, rete ovarii, paraovarian cyst, and Müllerian ducts remnants. Prospective study using whole ovarian examination is required.     

卵巢粘液性及浆液性囊腺瘤癌胚抗原的免疫组化研究

以CEA单克隆抗体,双PAP法研究卵巢粘液性和浆液性囊腺瘤组织内CEA的定位。结果表明:良性瘤23例,CEA全部(-)。交界性肿瘤中粘液性22例,CEA(+)者21例;浆液性15例,CEA(+)者7例。恶性肿瘤中粘液性23例,CEA(+)者18例,浆液性37例,CEA(+)者7例。由于粘液性交界性肿瘤有较高的CEA检出率,可作为诊断参考指标。     

Ovarian borderline tumours: a review with comparison of serous and mucinous types

Ovarian borderline tumours are relatively uncommon but not rare neoplasms. A large majority are of serous or mucinous type with other morphological variants being much more uncommon. In this review, the clinicopathological features of ovarian borderline tumours are discussed, concentrating on serous and mucinous neoplasms. Other morphological types are briefly discussed. A comparison is made between serous and mucinous borderline tumours which exhibit marked differences with regards to incidence of bilaterality, surface involvement, extraovarian spread, lymph node involvement, risk of malignant progression and prognosis. It has been suggested that the category of borderline tumour be abandoned for both serous and mucinous neoplasms but this terminology is useful for both types but for different reasons, namely the significant risk of extraovarian disease in serous borderline tumours and the large size and heterogeneity of mucinous borderline tumours which can result in an invasive focus being undetected by the pathologist.     

A study detection of the ROS1 gene fusion by FISH and ROS1 protein expression by IHC methods in patients with ovarian malignant or borderline serous tumors

Objective

ROS1 is an orphan receptor protein tyrosine kinase which is supposed to undergo genetic rearrangement in carcinogenesis. In the current study, we aimed to investigate the frequency and clinicopathologic features associated with ROS1 gene fusion and ROS1 protein expression in patients with ovarian serous carcinoma or serous borderline tumors.

原发性卵巢血管肉瘤伴浆液性囊腺瘤1例及文献复习

目的探讨原发性卵巢血管肉瘤伴浆液性囊腺瘤的临床病理特征及鉴别诊断。方法对病例进行病理组织学和免疫组织化学观察,复习文献。结果该例卵巢血管肉瘤伴浆液性囊腺瘤临床表现为下腹隐痛、腹部肿块。眼观见肿块呈囊性,囊壁增厚,切面见红褐色出血性肿块。镜下以充满红细胞的大小不等的囊腔、相互沟通的不规则管道、大部分由梭形细胞构成的实性区域为特征,伴有浆液性囊腺瘤形成。免疫表型：CD31、CD34、FⅧRAg、PCNA呈广泛性强阳性,SMA在中等大小的血管及部分肿瘤细胞呈强阳性,Ki-67为散在阳性,CK（AE1／AE3）为阴性。结论原发性卵巢血管肉瘤十分罕见,必需注意其鉴别诊断。