卵巢交界性黏液瘤和黏液癌近期病理学研究

卵巢交界性黏液瘤(mucinousborderline overian tumor,MBT)的病理诊断和生物学行为始终存在较多争论。目前,对于卵巢交界瘤有的仍按低度恶性肿瘤的治疗原则进行处理,结果多数患者接受过分的治疗。近期研究证实,MBT和它伴同的上皮内癌及微浸润癌在排除了腹膜假黏液瘤和转移癌后,预后良好。500例MBT经随访,死亡率为1%。分析死亡原因认为,肿瘤内存在的破坏性浸润未被发现或者将腹膜假黏液瘤及转移癌误诊为MBT,结果出现了死亡病例。MBT伴上皮内癌的诊断标准为腺上皮细胞增生至3~4层以上,胞核明显异形性,其生存率为100%。MBT伴微浸润的诊断标准是肿瘤间质内出现单个或呈巢状排列的癌细胞浸润,癌灶直径3~5mm,经随访无1例复发和死亡。卵巢黏液癌的浸润特点是“融合性和膨胀性浸润”,若出现间质浸润则要考虑为转移癌。卵巢黏液癌内有80%为转移癌。卵巢原发性和转移性癌的病理诊断除根据上述特征外,免疫组织化学染色有助于鉴别。

Recent research on pathologic diagnosis of mucinous borderline ovarian tumor and mucinous carcinomas

There are many arguments in pathologic diagnosis and biologic behavior of mucinous borderline ovarian tumor (MBT). At present, some MBT are handled according to the therapeutic principle of low potential malignancy tumor and result in excessive therapy. Recent researches prove that MBT, MBT with intraepithelial carcinoma and MBT with microinvasion have well prognosis when pseudomyxoma peritonei(PMP) and ovarian metastatic carcinoma are removed. Among 500 cases of MBT the death rate is 1%. The specialist analyzed the reasons of death. They thought that the undiscovered destructiveness infiltration in tumor or PMP and misdiagnosing metastatic carcinoma to MBT would result in the cases of death. The diagnostic criteria of MBT with intraepithelial carcinoma is that glandular epithelium cellular proliferation layer above 3-4 layer. The heteromorphism of nucleus is obvious. The survival rate is 100%. The diagnostic criteria of MBT with microinvasion is that single or nest shape disposed cancer cell infiltration appear in tumor interstitial substance, and while the diameter of cancer focus is 3-5 mm, no cases recur or die after follow-up. The invasion feature of ovarian mucinous carcinoma was confluent glandular or expansile pattern of invasion. The presence of an infiltrative pattern of stromal invasion should raise concern for metastatic mucinous carcinoma. Eighty percent of ovarian mucinous carcinoma should be thought to metastatic mucinous carcinoma in previous reports. The pathologic diagnosis of ovarian primarily or metastatic mucinous carcinoma should be diagnosed according to the features mentioned above. The immunohistochemistry stain conduces to discrimination.