卵巢Sertoli-Leydig细胞瘤伴异源成分伴随精神症状2例临床病理分析

<正>卵巢Sertoli-Leydig细胞瘤(sertoli leydig cell tumor, SLCT)是一种来源于卵巢性索-间质的肿瘤,临床上罕见,占所有卵巢原发性肿瘤的0.1%～0.5%,占卵巢性索间质肿瘤的1%,其中20% SLCT 含有异源性成分。因其形态多样,容易误诊。本文报道2例 SLCT 伴异源成分,并复习相关文献,分析其临床病理特征及其临床治疗、预后、遗传学等方面的特点。1 材料与方法1.1 一般资料例1,女     

卵巢泡膜细胞瘤患者经阴道超声表现

目的 分析卵巢泡膜细胞瘤患者经阴道超声表现,探讨经阴道超声检查对卵巢泡膜细胞瘤的诊断价值。方法 回顾性分析2006—2011年在我院行经阴道超声检查并经手术病理证实的16例卵巢泡膜细胞瘤患者的超声声像图特征。结果 16例卵巢泡膜细胞瘤患者均为单发,其中经阴道超声检查提示卵巢泡膜细胞瘤11例,诊断准确率为68.6%(11/16),另有3例超声检查提示为卵巢实性包块,1例超声诊断为卵巢囊肿,1例未发现卵巢异常。卵巢泡膜细胞瘤的特征性超声表现为卵巢或附件区的实性包块,直径常超过5cm,伴有明显的后回声衰减,实质内部血流稀少,CDFI表现为高阻力型频谱。结论 卵巢泡膜细胞瘤随体积增长,其内部的纤维成分也逐渐增加,经阴道超声检查常表现为特征性的后回声衰减,对不伴有后回声衰减的泡膜细胞瘤超声诊断较为困难。     

卵巢Sertoli-Leydig细胞瘤的影像表现(附3例报道及文献复习)

目的探讨卵巢Sertoli-Leydig细胞瘤的影像表现及临床特征,以提高对该肿瘤的认识及诊断水平。材料与方法搜集经病理证实的3例卵巢SertoliLeydig细胞瘤的CT、MRI影像资料,观察病变的影像学特征,并分析病变的影像学特征与预后的关系。结果 3例患者(17岁,71岁,58岁)共发现3个肿瘤,其中2例位于左侧卵巢,1例位于右侧卵巢,病变于CT、MRI均表现为边界清楚的实性或囊实性肿块,实性部分于T2WI呈等或稍高信号,囊性部分多位于实性部分内部,呈T2WI高信号,DWI病变呈高信号。增强扫描,病变实性部分呈明显强化。3例患者中有2例雄激素水平升高,临床呈男性化表现。结论卵巢Sertoli-Leydig细胞瘤有一定的影像学特征,若发现卵巢实性或以实性成分为主的囊实性肿瘤,且实性成分于T2WI呈等或稍高信号时,结合患者临床病史,应考虑到该肿瘤的诊断。     

妊娠合并卵巢支持-间质细胞瘤伴异源成分MRI表现1例报道及文献复习

卵巢支持-间质细胞瘤(Sertoli-Leydig cell tumor,SLCT)是一种好发于年轻女性的罕见肿瘤,合并妊娠者更为罕见,该肿瘤影像学表现多样。本文通过分析1例妊娠合并卵巢SLCT患者的临床资料、MRI特征、术中所见、术后病理检查和免疫组化,并结合文献复习,旨在提高对该病的认识。     

卵巢Sertoli-Leydig细胞瘤7例临床病理研究

目的 观察卵巢Sertoli-Leydig细胞瘤的临床病理及免疫表型特点,探讨其诊断、鉴别诊断及预后.方法 对7例卵巢Sertoli-Leydig细胞瘤进行光镜及免疫组化检测,并结合临床及病理特点进行分析.结果 7例Sertoli-Leydig细胞瘤的平均年龄为31.00±13.52岁,均发生于一侧卵巢,平均直径9.93±6.58 cm.镜下Sertoli细胞排列呈管状或条索状,细胞核圆形或卵圆形,部分为短杆状,胞质淡染或透明;性腺间质细胞排列密集,核浆比例较大,核染色深,细胞界限不清;两种细胞逐渐过渡移行.Leydig细胞单个或成簇出现于间质内,核小,具有丰富的嗜酸性胞质.随访10～96个月,所有患者无瘤存活.结论 本病罕见,病理诊断尤其在术中冷冻诊断有一定的难度.卵巢支持间质细胞肿瘤较少有术前明确诊断,部分患者年龄轻,有保留生育功能要求,术中冷冻明确诊断具有较重要意义.     

卵巢非特异性类固醇细胞瘤临床病理观察

目的探讨卵巢非特异性类固醇细胞瘤的临床病理特点。方法对1例卵巢非特异性类固醇细胞瘤进行HE染色、光镜观察、免疫组化及特殊染色,并结合临床资料进行文献复习。结果肿瘤组织学形态显示,瘤细胞呈圆形或多边形,细胞胞质较宽,嗜酸性颗粒状或透明空泡状,肿瘤内薄壁窦状血管较为丰富。免疫组化:瘤细胞特征性α-inhibin、calretinin、CK-pan和CD99(+)。特殊染色显示苏丹Ⅲ(+),PAS(-)。结论卵巢非特异性类固醇细胞瘤是一种极少见的肿瘤,组织病理学特点结合免疫组化标记有助于该瘤的确诊。     

卵巢高分化型Sertoli-Leydig细胞瘤1例报道

卵巢Sertoli-Leydig细胞瘤(sertoli-Leydig cell tumors,SLCT),也称男性母细胞瘤,是一种罕见的性索-间质来源的肿瘤,占全部卵巢肿瘤的0.1％[1].20％的SLCT含有异源成分[2].本文报道1例高分化型SLCT并复习文献. 1 临床资料 患者女性,58岁.绝经后阴道不规则出血6年,每年4～5次,每次持续半个月至3个月,无腹痛,出血量少、色暗红.患者平素月经欠规则,1次/1～2个月,量中,无痛经.B超示子宫增大,内膜增厚1.9 cm;右侧卵巢增大3.5 cm ×2.5 cm×1.8 cm.妇科检查:宫体前位,增大,如孕40多天.实验室检查:AFP、CEA、CA125和CA199均正常.行全子宫+双附件切除术.     

后颅凹血管网状细胞瘤的CT诊断及其特点

本文分析１２例血管网状细胞瘤的ＣＴ表现。低密度的囊肿伴附壁肿瘤结节突入囊内和肿瘤显著均一性增强是血管网状细胞瘤的ＣＴ特征性表现。只要认识肿瘤的特点，诊断一般不难。由于后颅凹伪影较多，以及ＣＴ的容积效应，有时可使囊肿内肿瘤小结节漏检，误诊为囊性胶质瘤。作者建议在病变区作ＣＴ薄层和冠状位扫描，可提高肿瘤结节的检出和减少后颅凹伪影。     

卵巢支持-间质细胞瘤临床病理特点分析

<正>卵巢支持-间质细胞瘤(Sertoli-Leydig cell tumors,SLCTs)是一种极为罕见的卵巢肿瘤,占所有卵巢肿瘤的0.2%[1]。文献有关该瘤的报道多为小组病例和个案报道,我们报道2例SLCTs,并结合文献对其临床病理特点进行讨论,以提高对这一病变的认识。1资料与方法1.1资料收集温州医科大学附属第三医院和沭阳人民医院2010年1月至2015年12月共收治     

妊娠黄体瘤10例临床病理研究

目的:探讨卵巢妊娠黄体瘤(pregnancy luteoma,PL)的临床病理学特点、免疫表型、组织学发生、诊断及鉴别诊断。方法:对10例妊娠黄体瘤的临床特点、组织形态学和免疫组织化学及网状纤维染色的结果进行分析,并复习相关文献。结果:10例PL均为初产妇,无妊娠史;肿瘤3~10 cm,棕黄色或红褐色,质地嫩。镜下可见瘤细胞胞质嗜酸性,弥漫性增生。免疫组织化学结果示:α-inhibin,AE1/AE3,CD99及波形蛋白阳性,上皮膜抗原,S-100,HMB45及MelanA阴性。网状纤维染色结果示嗜银网状纤维呈黑色包绕在瘤细胞巢周围。结论:PL是一种罕见瘤样病变,多在妊娠末期出现,大体观、免疫组织化学染色及网状纤维染色结果有助于本病的诊断,需与类固醇细胞瘤、妊娠黄体、转移性恶性黑色素瘤等鉴别。     

13例卵巢Sertoli⁃Leydig细胞瘤的临床病理分析

目的探讨卵巢Sertoli?Leydig细胞瘤(SLCTs)的临床表现、病理学特征,并研究其诊断和鉴别诊断要点及临床意义。方法回顾性研究2006?02—2020?0613例卵巢SLCTs病例,分析其临床特点,进行病理形态观察、免疫组化标记及基因突变检测,并复习相关文献。结果13例患者年龄28~83岁,平均年龄(50.6±16.1)岁,12例阴道异常出血、1例闭经,3例血清AFP升高,均发生于单侧卵巢,肿瘤最大径2~17 cm,平均最大径(8.61±4.66)cm。肿瘤切面实性或囊实性,质中,鱼肉样,色淡黄、灰粉,偶见出血及坏死。镜下肿瘤组织由不同比例的Sertoli细胞和Leydig细胞组成,中分化者10例,低分化者3例,均未见异源性成分及网状结构。免疫组化显示CK、Vimentin、CD99、SF?1、Calretinin、α?Inhibin、WT?1、CD56、PR、MSH2、MSH6、MLH1、PMS2、MelanA、AR呈不同程度阳性,CgA、Syn、AFP、ER、SMA阴性,Ki?67增殖指数5~40%。网状纤维染色显示Sertoli细胞巢周围阳性。1例标本检测出DICER1基因点突变(c.5113 G>A))。11例患者实施全子宫+双附件切除术,FIGO分期均为Ⅰa期,2例患者实施单侧附件切除术,10例术后实施辅助化疗,随访患者2~78个月,均无瘤存活。结论SLCTs是较罕见的卵巢性索?间质来源的肿瘤,预后大都良好,免疫组化染色在诊断及鉴别诊断中具有重要意义。     

Imaging of gynecological disease (2): clinical and ultrasound characteristics of Sertoli cell tumors, Sertoli-Leydig cell tumors and Leydig cell tumors.

OBJECTIVE: To describe the clinical history and ultrasound findings in women with ovarian Sertoli cell, Sertoli-Leydig cell and Leydig cell tumors. METHODS: Women with a histological diagnosis of Sertoli cell tumor, Sertoli-Leydig cell tumor or Leydig cell tumor who had undergone preoperative ultrasound examination were identified from the databases of each of three participating ultrasound centers. The tumors were characterized on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions published by the International Ovarian Tumor Analysis (IOTA) group. In addition, all images were reviewed and described using pattern recognition. RESULTS: Of 22 patients identified, 15 had Sertoli-Leydig cell tumors, two had Sertoli cell tumors and five had Leydig cell tumors. Four patients were postmenopausal, one 48-year-old woman had undergone hysterectomy, 16 were of fertile age and one was a 4-year-old girl. Most patients (82%, 18/22) had endocrine symptoms, the most common being bleeding disturbance (64%, 14/22) and hirsutism (32%, 7/22). Twenty-two (96%) of 23 tumors (one woman had bilateral tumors) contained a solid component; 16 (70%) were purely solid. Pattern recognition showed that the Leydig cell tumors were small solid tumors (four of five had a largest diameter of 1-3 cm) and the two Sertoli cell tumors were somewhat larger solid tumors (4 cm and 7 cm); the Sertoli-Leydig cell tumors were either small (3-4 cm) or medium-sized (6-7 cm) solid tumors, or multilocular solid tumors of any size (3-18 cm) with purely solid areas mixed with areas of innumerable closely packed small cyst locules. CONCLUSIONS: On the basis of endocrine symptoms, the woman's age and ultrasound findings, it should be possible to suggest a correct preoperative diagnosis of Sertoli cell, Sertoli-Leydig cell or Leydig cell tumors in many cases.     

类似卵巢性索肿瘤的子宫肿瘤五例临床病理分析

目的 探讨类似卵巢性索肿瘤的子宫肿瘤(UTROSCT)的临床病理特点.方法 回顾性分析5例UTROSCT的临床特征,总结其组织学形态及免疫组化表达特点,并进行随访.结果 患者年龄40～60岁(平均49.2岁,中位52岁).3例以阴道出血就诊,1例因子宫肌瘤切除发现,1例因体检发现黏膜下肌瘤就诊.3例肿瘤组织位于内膜部位...     

类似于卵巢性索肿瘤的子宫肿瘤的病理特征及免疫学表型分析

目的 探讨罕见的类似于卵巢性索肿瘤的子宫肿瘤（UTROSCF）的临床病理学特征、免疫表型和组织发生学。方法 分析1例UTROSCF的临床表现，对标本进行病理学和免疫组化（SP法）染色观察。结果 肿瘤组织的性索成分包括上皮样细胞和大量的泡沫样细胞，未见子宫内膜间质。免疫组化染色显示肿瘤细胞表达性索（calretinin、Melan A、CD99和inhibin）、平滑肌和上皮标记，还表达vimentin、ER、PR、bcl-2，而CK7、CD10和CD117（-）。结论 形态学和免疫学表型支持UTROSCF是子宫少见的含真正性索成分的多表型性肿瘤，具有不确定的潜在的复发可能性。     

女性Wolffian附件瘤临床病理观察

目的 探讨女性Wolffian附件肿瘤的临床病理特点、免疫表型及鉴别要点.方法 报告2例Wolffian附件瘤的临床病理资料,通过常规病理检查及免疫组化染色观察其形态学特征,并结合有关文献进行讨论.结果 2例肿瘤均为单侧,位于阔韧带,年龄分别为68岁和45岁.镜下肿瘤细胞呈弥漫实性或筛网状分布,弥漫实性区可见成片稍肥胖的梭形或卵圆形细胞及紧密排列的管状结构,管腔内衬立方或柱状上皮,后者似支持细胞样细胞;瘤细胞无明显异型,也无核分裂;管周有PSA(+)的基膜样物质.免疫组化:瘤细胞CKpan、vimentin、WT1和S-100(+),CK5/6、CK7、CD10、CD99、α-Inhibin、MC、calretinin、ER、PR、EMA和SMA均(-).结论 如果Wolffian附件瘤是一少见的妇科肿瘤,发生于Wolffian管沿线部位,易与卵巢的支持细胞瘤、腺瘤样瘤等肿瘤混淆,管样结构和筛网状结构是其特征性改变.该瘤是低度恶性肿瘤,需长期随访观察.     

子宫性索样肿瘤5例临床病理分析

目的探讨子宫性索样肿瘤的临床病理学特征、免疫表型和组织发生学。方法分析5例子宫性索样肿瘤的临床表现,对标本进行组织学和免疫组化染色观察。结果子宫性索样肿瘤形态学表现多样化。肿瘤细胞除表达性索标记（calretinin、inhibin、CD99）,还不同程度表达CK、EMA、DES、CD10、VIM等标记。结论子宫性索样肿瘤是子宫少见的含有真正性索成分的多表型性肿瘤,具有不确定的潜在的复发可能性。     

卵巢二元碰撞瘤的影像学表现及病理特征分析

目的:探讨卵巢二元碰撞瘤的病理特点与相关影像学特征,提高对此类肿瘤的认识。方法:回顾性分析经手术病理证实且影像和临床资料完整的13例卵巢二元碰撞瘤。所有患者均有CT和(或)MR检查,观察病灶的影像学表现并与临床及病理结果进行对照。结果:13例卵巢碰撞瘤(14个病灶)均存在两种独立组织成分,其中9个病灶来源于上皮性肿瘤与性索-间质肿瘤,5个病灶来源于上皮性肿瘤与生殖细胞肿瘤;病灶均表现为类圆形囊实性肿块,其中上皮性肿瘤体积较大或巨大,生殖细胞肿瘤或性索-间质肿瘤相对较小;碰撞样肿瘤中生殖细胞肿瘤全部位于上皮性肿瘤的囊变区内,性索-间质肿瘤病灶全部贴附于其囊壁上,但两种肿瘤组织间分界明确。结论:卵巢二元碰撞瘤的病理类型多样,影像上具有一定特征性,认识肿瘤的构成和影像特征有助于提高影像科医师对本病的认识。     

Sertoli�CLeydig Cell Tumor of the Testis in a Sprague-Dawley Rat

A rare intratubular gonadal stromal tumor was present in the testis of a 7-wk-old male Sprague-Dawley rat. The tumor comprised an intratubular mixture of 2 types of tumor cells with intercellular junctions: the predominant tumor cells were consistent with a Sertoli cell origin, and cells comprising the minor population were situated on basolateral side of the tubuli, consistent with a Leydig cell origin. The neoplastic Sertoli cells had large pleomorphic nuclei and clear cytoplasm with many tubulovesicular cristae and free ribosomes, whereas the neoplastic Leydig cells showed relatively small pleomorphic nuclei, dark cytoplasm with rich smooth endoplasmic reticulum, numerous mitochondria, and lipid droplets. Occasionally, a few transitional type neoplastic cells were observed. The presence of a thick or multilayered basement membrane was confirmed except in tumor-infiltrative lesions. The present case was considered to be a testicular mixed tubular Sertoli–Leydig cell tumor in a Sprague-Dawley rat.The most frequently encountered neoplasm of the rat testis is the Leydig cell tumor, the incidence of which varies greatly among strains. The rate increases with age but varies from 1% to 2% in Long-Evans rats, 1% to 5% in Sprague-Dawley rats, 4% to 7% in Wistar rats, 78% in Wistar substrain U rats, to nearly 100% in Fischer 344 rats.^4,10,12 Leydig cell tumors in rats usually are composed of round cells with dark cytoplasm, and the exact etiology of this tumor is not known.¹² In contrast, Sertoli cell tumors are rare in rats,¹⁰ and only 2 cases in rats have been described in detail to date.^1,3 Sertoli cell tumors are composed of interdigitated rows of tubules lined with elongated palisading cells situated on a thin fibrovascular stromal basement membrane.¹ Mixed gonadal stromal tumors, Sertoli–Leydig cell tumors, are also quite rare in rats.¹⁰ The present report describes a spontaneous testicular mixed Sertoli–Leydig cell tumor in a Sprague-Dawley rat.     

Juvenile granulosa cell tumor

We present three-dimensional computed tomographic findings of a juvenile granulosa cell tumor of the ovary at FIGO stage IA in a 17-year-old woman. Juvenile granulosa cell tumor is one of the rare sex cord stromal tumors of the ovary. Most tumors at FIGO stage IA have a favorable prognosis, whereas those at higher stages have a less favorable outcome.     

Retiform hemangioendothelioma: a rare lesion of the vulva

Retiform hemangioendothelioma (RH) is a rare borderline-malignant vascular tumor with specific histological characteristics, usually occurring in the limbs and trunk. We report the case of a 63-year-old woman who presented with a painless, oval nodule that had been growing slowly on her left vulva for 3 years. Magnetic resonance imaging of the pelvic cavity revealed a 4.4- × 2.7- × 1.8-cm cystic lesion in the subcutaneous fat of the left vulva. Resection beyond the macroscopic border was performed. Pathology revealed vascular structures with elongated and narrow arborizing vascular channels that were arranged in a retiform pattern resembling rete testis tissue. Immunohistochemical endothelial staining was positive for CD31, CD34, and Friend leukemia integration-1 (FLI-1). The above features confirmed a diagnosis of RH. There was no local recurrence or metastasis during the 26-month follow-up. RH of the vulva is rare, and its diagnosis is supported by specific histological characteristics and immunohistochemical staining for CD31, CD34, and FLI-1. Wide surgical resection with tumor-free margins is important for a favorable prognosis.