卵巢巨大完全性囊性粒层细胞瘤的临床病理分析

目的:探讨卵巢囊性粒层细胞瘤的病理类型、临床特征、激素水平及鉴别诊断。方法:回顾分析吉林医药学院附属医院收治的3例卵巢囊性粒层细胞瘤患者的临床病理资料,并结合相关文献进行复习。结果:3例肿瘤均为单侧性,肿瘤大小分别为19.0cm×14.0cm×9.0cm、20.0cm×16.0cm×10.0cm和10.0cm×6.0cm×5.0cm。1例患者性激素六项检查,血清睾酮0.74ng/ml(正常值0.43～0.68ng/ml),表现为男性激素水平增高。结论:卵巢巨大完全性囊性粒层细胞瘤非常罕见,易误诊为良性浆液性囊肿。囊壁内衬细胞中找到单层或复层排列的粒层细胞、纵行的核沟、Call-exner小体、微囊结构及患者男性激素水平增高有助于确诊,免疫组化可作为辅助诊断。     

卵巢甲状腺肿临床病理学分析

目的：探讨卵巢甲状腺肿的临床及病理组织学特征。方法：观察总结21例卵巢甲状腺肿的临床及病理学特征，并对手术切除标本进行免疫组织化学染色，同时复习相关文献。结果：卵巢甲状腺肿平均发病年龄为45．1岁（25-67岁），以盆腔肿物或卵巢囊性肿物为主要临床表现，组织学表现类似于颈部甲状腺组织本身的病变。其中单纯性甲状腺肿4例，混合性甲状腺肿16例，恶性甲状腺肿1例（部分恶变为甲状腺型乳头状癌）。术后无复发转移。文献显示，乳头状癌极少出现转移，绝大多数复发转移是滤泡性癌或滤泡-乳头混合性癌。结论：卵巢甲状腺肿是少见的卵巢单胚层畸胎瘤，恶变率低，预后好。部分病例需注意与卵巢类癌、透明细胞癌、粒层细胞瘤等鉴别。     

卵巢伴少量性索成分的间质肿瘤临床病理学观察

目的：探讨卵巢伴少量性索成分的间质肿瘤（stromal tumor with minor sex cord elements）的临床病理特征、免疫表型、诊断、鉴别诊断及治疗与预后。方法：对4例卵巢伴少量性索成分的间质肿瘤的临床表现、病理学形态、免疫组织化学（免疫组化）等进行观察,并对检索到的相关文献中报道的9例患者的临床和病理资料进行复习总结。结果：卵巢伴少量性索成分的间质肿瘤好发于中老年女性,患者常以腹部不适和阴道出血等症状就诊,多发生于卵巢,常为单侧。肿瘤最大直径多数大于4 cm,镜下均为典型的纤维瘤或卵泡膜瘤背景中混有少量的性索成分（小于10%）,其中性索成分部分为颗粒细胞形态,部分为类似于Sertoli细胞的管状结构。免疫组化染色显示肿瘤中的性索成分α-inhibin、CD99、Calretinin均为阳性。4例患者随访至今,均呈无瘤存活状态,文献报道中的9例患者随访至相关文献发表时亦呈无瘤存活状态。结论：卵巢伴少量性索成分的间质肿瘤的诊断依赖于特征性的组织学表现及免疫组化染色特点,临床表现类似于纤维卵泡膜瘤,部分病例出现雌激素升高症状,罕见病例出现雄激素升高症状,治疗方法为手术切除,预后较好。     

卵巢伴少量性索成分的间质肿瘤临床病理学观察

目的:探讨卵巢伴少量性索成分的间质肿瘤(stromal tumor with minor sex cord elements)的临床病理特征、免疫表型、诊断、鉴别诊断及治疗与预后。方法:对4例卵巢伴少量性索成分的间质肿瘤的临床表现、病理学形态、免疫组织化学(免疫组化)等进行观察,并对检索到的相关文献中报道的9例患者的临床和病理资料进行复习总结。结果:卵巢伴少量性索成分的间质肿瘤好发于中老年女性,患者常以腹部不适和阴道出血等症状就诊,多发生于卵巢,常为单侧。肿瘤最大直径多数大于4 cm,镜下均为典型的纤维瘤或卵泡膜瘤背景中混有少量的性索成分(小于10%),其中性索成分部分为颗粒细胞形态,部分为类似于Sertoli细胞的管状结构。免疫组化染色显示肿瘤中的性索成分α-inhibin、CD99、Calretinin均为阳性。4例患者随访至今,均呈无瘤存活状态,文献报道中的9例患者随访至相关文献发表时亦呈无瘤存活状态。结论:卵巢伴少量性索成分的间质肿瘤的诊断依赖于特征性的组织学表现及免疫组化染色特点,临床表现类似于纤维卵泡膜瘤,部分病例出现雌激素升高症状,罕见病例出现雄激素升高症状,治疗方法为手术切除,预后较好。     

妊娠合并卵巢幼年型颗粒细胞瘤一例报告及文献复习

目的:分析妊娠合并卵巢幼年型颗粒细胞瘤(juvenile granulosa cell tumor,JGCT)的临床特点、诊断要点、治疗及预后,提高鉴别诊断水平。方法:回顾性分析1例妊娠合并JGCT病例资料,复习相关文献。结果:患者27岁,因停经39~(+3)周,间断右下腹疼痛3 d入院。彩色超声提示右下腹部一8.5 cm×6.1 cm囊实混合回声。查糖类癌抗原125(CA125)32.3 U/m L,CA19-9为19.1 U/m L,诊断为先兆临产,盆腔包块(性质待排),行剖宫产术+剖腹探查术,探查见右侧卵巢一囊性肿物,已破溃,行右侧卵巢肿物切除术,术后病理诊断为卵巢JGCT。行二次手术,给予右侧卵巢输卵管切除术+左侧卵巢活检术+盆腔淋巴结取样术+部分大网膜切除术+阑尾切除术+盆腔粘连松解术。术后予顺铂+长春新碱+博莱霉素(PVB方案)化疗3个疗程,随访8个月,肿瘤无复发。结论:JGCT是一种罕见的恶性肿瘤,发生于妊娠期者更为罕见,确诊需依赖病理及免疫组化检查。     

卵巢单纯性和混合性卵泡膜细胞瘤46例临床分析

目的:探讨卵巢卵泡膜细胞瘤的临床特征、影像学诊断、治疗和预后。方法:对46例经手术病理证实的卵巢卵泡膜细胞瘤患者的临床资料进行回顾性分析。结果:46例患者中单纯性卵泡膜细胞瘤24例,混合性卵泡膜细胞瘤22例,包括卵泡膜纤维瘤16例,粒层卵泡膜细胞瘤6例(2例为复发),肿瘤最大径3~20 cm。44例首发者发病年龄20~91岁,中位年龄56岁。最常见的症状为绝经后阴道流血(11例)和月经紊乱(5例)。46例中18例合并腹水,血清CA125升高29例。影像学检查术前仅有6例MRI诊断卵泡膜细胞瘤。术前14例因包块较大,呈囊实性,CA125升高和(或)伴有腹水而考虑卵巢恶性肿瘤。46例中15例合并雌激素刺激相关疾病,包括子宫内膜癌3例。46例均完整切除包块,28例同时行子宫切除术。随访1~6年,42例无复发,3例失访,1例粒层卵泡膜细胞瘤复发患者术后1年半再次复发。结论:卵泡膜细胞瘤常出现绝经后阴道流血或月经紊乱,部分可合并少量腹水及CA125轻度升高,MRI检查对于术前诊断有重要价值。绝大多数卵泡膜细胞瘤完整切除后不易复发,但应警惕合并子宫内膜癌和粒层卵泡膜细胞瘤。     

巨大卵巢子宫内膜异位囊肿伴蒂扭转的病例分析

1　病历简介患者 2 4岁 ,住院号 2 8396 4。无性生活史 ,因下腹痛12h入院。月经规律 ,近 5年有痛经史 ,痛经不剧 (偶用止痛片 ) ,无进行性加剧 ,时有便秘。妇科检查 (肛查 )示子宫正常大小 ,无压痛 ;子宫右前方扪及一儿头大小包块 ,质地囊性感 ,边界清 ,无明显压痛。B超检查提示右附件区见一2 0cm× 15cm× 16cm的囊肿 ,囊内壁毛糙 ,见囊内分隔 ,内液稠厚 ,局部囊壁见散在强光点 ;囊肿周围可及少许血流信号 ,周边可见少量液性暗区 ,拟诊右卵巢囊肿 (卵巢子宫内膜异位囊肿首先考虑 ,扭转可能 )。血CA12 56 3 4kU/L。因诊断卵巢囊肿蒂扭转即…     

妊娠合并卵巢幼年型颗粒细胞瘤一例报告及文献复习

目的：分析妊娠合并卵巢幼年型颗粒细胞瘤（juvenile granulosa cell tumor,JGCT）的临床特点、诊断要点、治疗及预后,提高鉴别诊断水平。方法：回顾性分析 1 例妊娠合并JGCT病例资料,复习相关文献。结果：患者27岁,因停经39+3周,间断右下腹疼痛3 d入院。彩色超声提示右下腹部一8.5 cm×6.1 cm囊实混合回声。查糖类癌抗原125（CA125） 32.3 U/mL, CA19-9为19.1 U/mL,诊断为先兆临产,盆腔包块（性质待排）,行剖宫产术+剖腹探查术,探查见右侧卵巢一囊性肿物,已破溃,行右侧卵巢肿物切除术,术后病理诊断为卵巢JGCT。行二次手术,给予右侧卵巢输卵管切除术+左侧卵巢活检术+盆腔淋巴结取样术+部分大网膜切除术+阑尾切除术+盆腔粘连松解术。术后予顺铂+长春新碱+博莱霉素（PVB方案）化疗3个疗程,随访8个月,肿瘤无复发。结论：JGCT是一种罕见的恶性肿瘤,发生于妊娠期者更为罕见,确诊需依赖病理及免疫组化检查。     

原发性卵巢恶性淋巴瘤四例临床分析

恶性淋巴瘤晚期可侵犯卵巢，但原发性卵巢恶性淋巴瘤很少见，临床上常误诊为卵巢其他恶性肿瘤，延缓诊治。我院1990年1月～1998年11月共收治4例，现结合有关文献，对其临床表现、诊断及治疗分析、报道如下。 一、临床资料 1. 一般情况：4例患者年龄29～66岁，中位年龄43.8岁。发病时间1～12个月。临床症状均有不同程度的腹痛或腹胀，有阴道流血、右下肢水肿、低热各1例。妇科检查均发现盆腔包块。外周血及骨髓中均未发现异常细胞（表1）。 2. 肿瘤情况：肿瘤发生在左侧卵巢3例，双侧1例。肿瘤最大12.0 cm×12.0 cm×10.0 cm，最小5.4 cm×2.9 cm×2.5 cm。2例实性，2例半囊实性。4例均经病理检查确诊为非何杰金淋巴瘤，其中弥漫性小裂细胞型2例，弥漫性小无裂细胞型1例，弥漫性无裂细胞型1例。免疫组织化学（免疫组化）检查均为B淋巴细胞来源。侵犯阴道1例，侵犯直肠1例，侵犯输卵管及大网膜2例（表1）。     

卵巢成年型粒层细胞瘤的临床病理特点分析

目的 探讨卵巢成年型粒层细胞瘤的临床病理特点。方法 收集无锡市妇幼保健院的19例卵巢成年型粒层细胞瘤的病例资料,分析卵巢成年型粒层细胞瘤的临床病理特点。结果 肿瘤发病年龄29～77岁,直径2～17 cm;主诉阴道出血或月经紊乱10例,腹胀1例,9例无明显临床症状;FIGO分期均为Ⅰ期,形态结构多样;EMA、CgA、Syn均为阴性,Calretinin阳性率为94.7%,a-抑制素阳性率为89.5%;子宫内膜病变率为54.5%,均无复发转移。结论 卵巢成年型粒层细胞瘤较为罕见,易伴发子宫内膜病变,组织形态多样,需与多种疾病鉴别诊断。     

Ruptured granulosa cell tumor of the left ovary and mature cystic teratoma of the right ovary: a case report of unusual acute abdominal syndrome

Although granulosa cell tumor combined with a dermoid cyst in the same ovary is rarely seen, adult granulosa cell tumor of the ovary with contralateral teratoma has not been reported to date. In this report we present the first case in the English language literature of a ruptured granulosa cell tumor of the left ovary and mature cystic teratoma of the right ovary presenting as acute abdominal syndrome. The patient underwent total abdominal hysterectomy, bilateral-ophorectomy, and multiple pelvic lymph node sampling and infracolic omentectomy. She received combined chemotherapy consisting of bleomycin, etoposide. and cisplatin for six cycles. Subsequent follow-up and workups have revealed no evidence of disease. At 19 months after initial diagnosis, she is disease-free.     

Juvenile granulosa cell tumor associated with pregnancy: Report of a case and review of the literature

BACKGROUND: Juvenile granulosa cell tumors account for about 5% of all granulosa cell tumors and are diagnosed in nearly 80% of cases during the first two decades of life. Only 10% of granulosa cell tumors present during pregnancy. The incidence of ovarian malignancies during pregnancy varies from 0.05 to 0.07 per 1000 pregnancies. CASE: A 31-year-old pregnant woman was admitted to our university hospital due to an adnexal mass, 9.5 cm in diameter, which was detected at 34 weeks of gestation. At 37 + 5 weeks of gestation, a cesarean section with right salpingo-oophorectomy and removal of the tumor was performed. Histopathological findings, including immunohistochemical study, led to the diagnosis of juvenile granulosa cell tumor (JGCT). CONCLUSION: The histological features and the differential diagnosis of the JGCT are discussed. The optimal management of such adnexal masses during pregnancy is also discussed. A JGCT that is confined to the ovary appears to have an excellent prognosis and can be treated by unilateral salpingo-oophorectomy.     

Granulosa cell tumor arising in the wall of müllerian cyst of the broad ligament: report of a case and immunohistochemical study

Case A unique case of granulosa cell tumor arising in a müllerian cyst of the broad ligament in a 57-year-old woman is presented. The surgically resected unilocular cyst, measuring 9.5 × 9.5 × 6.5 cm³, situated within the right broad ligament. The inner surface of the cyst was lined by a single layer of ciliated columnar cells. Solid cell sheath of the spindled cells were demonstrated in this cystic wall. Immunohistochemically, these spindled cells were diffusely positive for cytokeratin 7, AE1/AE3, vimentin, smooth muscle actin, calretinin and weakly positive for inhibin, but negative for cytokeratin 20, epithelial membrane antigen and CD10. Conclusion Immunohistochemical findings suggested solid cell sheath surrounding the cyst was granulosa cell tumor. Granulosa cell tumor coexisted with müllerian cyst in the current case was recognized a unique histological feature.     

Immunohistochemical differentiation between ovarian granulosa cell tumors and ovarian carcinomas

Summary Differential diagnosis is a major problem in histopathology of ovarian tumors. Difficulties may arise if the tumor is a poorly differentiated carcinoma or a granulosa cell tumor of the sarcomatoid type. It was the aim of the present study to evaluate the usefulness of immunohistochemistry in differentiating between granulosa cell tumors of the ovary and ovarian carcinomas. We investigated 56 ovarian malignancies (13 granulosa cell tumors, 17 serous, 14 mucinous and 12 poorly differentiated carcinomas) and performed immunohistochemical detection of Vimentin, Keratin, CA125, CA19-9, CEA, S100 and Ber-EP4. Expression of Vimentin was highest and expression of Keratin was lowest in granulosa cell tumors in contrast to carcinomas. CA125 and CA19-9 were not expressed in granulosa cell tumors, whereas the detection rate in carcinomas (except for CA125 in mucinous carcinomas) was high. CEA, S100 and Ber-EP4 do not seem to be useful markers in differential diagnosis. A marker profile of Vimentin, Keratin, CA125 and CA19-9 allows a quite strict differentiation between poorly differentiated ovarian carcinomas and granulosa cell tumors of the ovary.     

Glucose metabolism and angiogenesis in granulosa cell tumors of the ovary: activation of Akt, expression of M2PK, TKTL1 and VEGF

OBJECTIVES: Very little is known about the biology of granulosa cell tumors of the ovary. A hallmark of granulosa cell tumors of the ovary is extensive growth, distant metastases however, are rarely found. We hypothesise that granulosa cell tumors of the ovary on the one hand need to stimulate vascularisation; on the other hand glucose metabolism has to be altered to ensure the supply of nutrients and metabolites. Increased glycolysis, the main source of energy supply, is considered to be important during malignant transformation. Thus, we focussed on a selection of key factors in angiogenesis and tumor glycolysis to study metabolic characteristics of granulosa cell tumors of the ovary. STUDY DESIGN: We analysed 32 tumor specimens for immunohistochemical expression of vascular endothelial growth factor, phosphorylated Akt, M2 pyruvate kinase isoenzyme, and transketolase-like enzyme 1. As controls, we stained 10 samples of normal ovaries. RESULTS: We found expression of vascular endothelial growth factor in 94%, transketolase-like enzyme 1 in 81%, and phosphorylated Akt as well as M2 pyruvate kinase isoenzyme in 53% of the specimens. There were no significant differences between the expression levels in primary and those in recurrent tumors. Temporal analysis of marker expression in primary tumors and recurrences in the same patients revealed no increase or decrease of marker expression overtime. In contrast to granulosa cell tumors, normal ovaries showed no expression of the markers analysed in granulosa cells. CONCLUSION: Our results show that granulosa cell tumors of the ovary express vascular endothelial growth factor as an important stimulator of tumor angiogenesis as well as several molecular markers for glycolysis. The dependence of granulosa cell tumors of the ovary on the glycolytic pathway may provide a biochemical basis for therapeutic strategies involving glycolytic inhibitors.     

Recurrent gynandroblastoma of ovary-A case report: a molecular and immunohistochemical analysis.

Gynandroblastoma is a rare ovarian tumor that is composed of both Sertoli cells and granulosa cells. Only 23 cases have been reported in the literature, and recurrence has never been described. We report the first case of a recurrent gynandroblastoma along with its molecular analysis and immunohistochemical studies. A 49-year-old Gravida 0 woman with a 10-year prior diagnosis of ovarian-mixed stromal tissue tumor (well-differentiated Sertoli cell and granulosa cell tumor) and staging laparotomy, presented now with a retroperitoneal mass and an elevated inhibin level. CT scan was suspicious for recurrence. The patient had no prior adjuvant therapy. The histomorphological features of the recurrent tumor had both Sertoli cell and granulosa cell tumor. The molecular analysis of both primary and recurrent tumor showed minor genetic instability in the 17q12.2 gene locus with no dedifferentiation or progression, which is consistent with a low-grade tumor.The immunohistochemical staining profile showed positivity for CD99, inhibin, calretinin, and vimentin; focal positivity for cytokeratin AE1/AE3 and negative for EMA and melan-A. All the previously mentioned immunostainings support the diagnosis. We report the first case of a recurrent gynandroblastoma 10 years after initial presentation along with its molecular analysis and immunohistochemical studies.     

Androgenic function of a granulosa cell tumor.

Virilizing granulosa cell tumors are uncommon and have not been well studied hormonally. A hirsute woman with a cystic granulosa cell tumor of the ovary is presented. Plasma hormone levles obtained before and after surgery indicate testosterone production by the tumor with LH and FSH suppression. Plasma testosterone (T) and T-index returned to normal after tumor removal, and ovulation resumed.     

Meigs’ syndrome and adult-type granulosa cell tumor

ObjectiveAdult-type granulosa cell tumors (GCT) are sex cord-stromal tumors and often accompanied with abdominal distention and hyperestrogenism-related symptoms. Adult-type GCT-presenting ascites and pleural effusion is extremely rare.Case reportA 56-year-old perimenopausal woman presented with abdominal distention and abnormal vaginal spotting. Ultrasound and abdominal computed tomography showed a complex cystic mass in the left ovary accompanied with bilateral pleural effusion and ascites. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, left pelvic lymph node dissection, omentectomy and appendectomy. Final histopathological diagnosis was adult-type GCT. The patient had postoperative hormone and anti-angiogenesis agent therapy with free of disease.ConclusionOvarian cystic complex mass accompanied with ascites and pleural effusion often results from malignant ovarian tumors or benign ovarian fibroma. Based on the aforementioned report, the rare types of ovarian tumors, such as adult-type granulosa cell tumor of the ovary should be taken into consideration.     

早期成人型卵巢颗粒细胞瘤复发相关因素分析北大核心CSCD

目的探讨国际妇产科联盟(FIGO)(2014版)Ⅰ期成人型卵巢颗粒细胞瘤复发的相关高危因素。方法回顾性分析首都医科大学附属北京朝阳医院及中国医学科学院北京协和医院1995年1月至2010年1月收治的FIGOⅠ期成人型卵巢颗粒细胞瘤。分析患者临床及病理相关因素与肿瘤复发的关系。结果研究共纳入18例FIGOⅠ期成人型卵巢颗粒细胞瘤患者,患者中位年龄为43岁(31~69岁)。初始治疗中7例行单纯肿瘤剥除/单侧附件切除术,8例行子宫双附件切除术,3例行卵巢肿瘤全面分期术。患者术后5年和10年总生存率分别为94.4%和83.3%。共6例患者复发,中位复发时间为76个月。肿瘤直径>10cm、术中瘤体破裂是患者近期复发(<5年)的高危因素。低分化、术中瘤体破裂、高核分裂象(≥4/10HPF)是患者远期复发(≥5年)的高危因素。结论早期成人型卵巢颗粒细胞瘤整体预后好,高核分裂象、术中瘤体破裂可能是早期卵巢颗粒细胞瘤复发的潜在高危因素。     

Granulosa cell tumor of the ovary: extensive late recurrence after initial occult microscopic disease

BACKGROUND: Late recurrence can be extensive with initial, clinically undetectable, microscopic granulosa cell tumor of the ovary.CASE: We describe an 83-year-old patient who presented with extensive recurrent granulosa cell tumor of the ovary 6 years after undergoing abdominal hysterectomy and bilateral salpingo-oophorectomy for atypical endometrial hyperplasia with an incidental microscopic finding of ovarian granulosa cell tumor.CONCLUSION: Patients must be monitored closely after a diagnosis of ovarian granulosa cell tumor, even if the tumor is occult.