卵巢表面的恶性胃肠道外间质瘤临床病理研究(1)
【摘 要】目的：报道1例发生于卵巢表面的恶性胃肠道外间质瘤，并分析其临床病理特征、诊断与鉴别诊断等。方法：复习原切片和临床资料，经HE及免疫组织化学染色确诊，并复习文献。结果：女患者，44岁，肿瘤位于左侧卵巢表面，大小1.9×1.3×1.1cm；肿瘤主要由梭形、上皮样细胞组成，胞质丰富，嗜酸性或淡嗜酸性，可见核仁，并见坏死及核分裂像。术中诊断为：卵巢梭形细胞恶性肿瘤(恶性间皮瘤可能)。经复习原切片并作免疫组织化学染色：Vimentin、CD117和CD34均阳性，calretinin、CD31、CK、S-100、NSE、Syn、SMA和desmin均阴性，修正诊断为：卵巢恶性胃肠道外间质瘤。结论：胃肠道外间质瘤具有平滑肌瘤、神经鞘瘤和神经源性分化的特征，发生于女性生殖系统及其附件者罕见，易误诊为其它妇科肿瘤，临床上应与卵巢癌鉴别，其组织形态应与平滑肌瘤、神经鞘瘤、炎性肌纤维母细胞瘤、脂肪肉瘤、恶性间皮瘤、腹内纤维瘤病及孤立性纤维瘤等鉴别。
【关键词】胃肠道外间质瘤 卵巢 免疫组织化学
, http://www.100md.com
Extragastrointestinal m alignant stromal tumor located in ovary surface report of one case and review of literature
Fang Ping，et al
【Abstract】Objective：To report a case of extragastrointestinal stromal tumors(EGIST) arising from ovary，and analyze its clinicopathologic characteristics，diagnosis and differential diagnosis. Methods： The clinical data and the HE slides of this case were reviewed，and re-diagnosed by immunohistochemical stain. And the literatures of EGIST were reviewed. Results： This female patient was 44 year-old and the tumour located in the surface of the left ovary，measuring 1.9×1.3×1.1cm in size. Histologically，the tumor consisted of spindle or epithelioid cells with rich eosinophilic or light-eosinophilic cytoplasm，ucleoli were clear，necrosis and mitosis could be seen. The former diagnosis was spindle cell m alignant tumour of the left ovary (with the possibility of m alignant mesothelioma). Immunohistochemical assay showed the tumor cells were positive for Vimentin，CD117 and CD34，but were negative for calretinin，CD31，CK，S-100，NSE，Syn，SMA and Desmin. The diagnosis was modified as m alignant EGIST of ovary. Conclusion： EGIST may have same morphological cheracterstics of leiomyoma，schwannoma and neurogenic tumour. It rarely occured in ovary，and could be misdiagnosed as other ovary tumors，so it should be differentiated from other tumors of ovary clinically. Histopathologically，differential diagnosis of EGIST of ovary include leiomyoma，neurilemmoma，inflammatory myofibroblastoma，adipose sarcoma，m alignant mesothelioma，fibromatosis and solitary fibrous tumor.
, http://www.100md.com
【Key words】Extragastrointestinal stromal tumors(EGIST) Ovary Immunohistrochemistry
胃肠道间质瘤(Gastrointestinal stromal tumors，GIST)是起源于Cajal细胞的间叶性肿瘤，常发生于胃肠道。发生于胃肠道外者少见，称为胃肠道外间质瘤(extra-gastrointestinal stromal tumors，EGIST)；临床及病理检查容易误诊。笔者报道1例原发于卵巢表面EGIST，描述其HE及免疫组织化学特点，并结合文献讨论其临床病理特征、诊断与鉴别诊断。
1 病例报道
患者，女，44岁，因“腹胀2月，体检发现卵巢肿块2周”于2003年2月10日入院。查体：左附件触及肿块，质硬，固定。B超示左卵巢肿瘤，考虑为“卵巢癌?”；CT示：左卵巢肿块伴盆腔积液。血生化：CA125为495kU/L。临床诊断“盆腔肿瘤，卵巢癌”，行剖腹探查术，术中见肿块位于卵巢表面，直径约2cm，与大网膜粘连，探查盆腹腔及胃肠道无殊。送检冰冻切片标本为一侧附件标本，卵巢表面见灰红色肿块，大小为1.9×1.3×1.1cm，切面灰白，质嫩，浸润深度约0.6cm(镜下测量浸润深度5.5mm)。镜下：肿瘤由梭形细胞和上皮样细胞组成，呈弥漫性或围绕血管排列，细胞核分裂较多，并见坏死。冰冻切片诊断为：(左)卵巢软组织恶性肿瘤(恶性间皮瘤可能)。遂行全子宫切除+双附件切除+大网膜切除+盆腔淋巴结清扫+阑尾切除术。术后15月复发(肝转移)，22月死亡。
, 百拇医药
大体检查：大网膜总体积4×3×1.5cm，可见少量破碎肿瘤组织，子宫大小4×4×3.5cm，宫颈长3.5cm，直径3cm，宫体表面完整、光滑，宫壁切面无殊。左附件、阑尾肉眼检查未发现明显异常。另送腹水500ml。
镜检：肿瘤由梭形细胞和上皮样细胞组成，富于血管并围绕血管排列，肿瘤细胞核分裂像易见，达12/50hpf，并见多灶性地图样坏死(图1)。大网膜见少量肿瘤组织浸润。子宫、对侧附件、盆腔淋巴结、腹水涂片均未见肿瘤。术中诊断为：(左卵巢)梭形细胞恶性肿瘤(恶性间皮瘤可能)。免疫组织化学结果如下：Vimentin、CD117(图2)和CD34均阳性，calretinin、CD31、CK、S-100、NSE、Syn、caldesmon、SMA和Desmin均阴性。诊断为：(左卵巢)恶性胃肠道外间质瘤。肿瘤主要位于卵巢表面，并浸润卵巢皮质深5.5mm。, http://www.100md.com(方 萍 薛德彬)
【关键词】胃肠道外间质瘤 卵巢 免疫组织化学
, http://www.100md.com
Extragastrointestinal m alignant stromal tumor located in ovary surface report of one case and review of literature
Fang Ping，et al
【Abstract】Objective：To report a case of extragastrointestinal stromal tumors(EGIST) arising from ovary，and analyze its clinicopathologic characteristics，diagnosis and differential diagnosis. Methods： The clinical data and the HE slides of this case were reviewed，and re-diagnosed by immunohistochemical stain. And the literatures of EGIST were reviewed. Results： This female patient was 44 year-old and the tumour located in the surface of the left ovary，measuring 1.9×1.3×1.1cm in size. Histologically，the tumor consisted of spindle or epithelioid cells with rich eosinophilic or light-eosinophilic cytoplasm，ucleoli were clear，necrosis and mitosis could be seen. The former diagnosis was spindle cell m alignant tumour of the left ovary (with the possibility of m alignant mesothelioma). Immunohistochemical assay showed the tumor cells were positive for Vimentin，CD117 and CD34，but were negative for calretinin，CD31，CK，S-100，NSE，Syn，SMA and Desmin. The diagnosis was modified as m alignant EGIST of ovary. Conclusion： EGIST may have same morphological cheracterstics of leiomyoma，schwannoma and neurogenic tumour. It rarely occured in ovary，and could be misdiagnosed as other ovary tumors，so it should be differentiated from other tumors of ovary clinically. Histopathologically，differential diagnosis of EGIST of ovary include leiomyoma，neurilemmoma，inflammatory myofibroblastoma，adipose sarcoma，m alignant mesothelioma，fibromatosis and solitary fibrous tumor.
, http://www.100md.com
【Key words】Extragastrointestinal stromal tumors(EGIST) Ovary Immunohistrochemistry
胃肠道间质瘤(Gastrointestinal stromal tumors，GIST)是起源于Cajal细胞的间叶性肿瘤，常发生于胃肠道。发生于胃肠道外者少见，称为胃肠道外间质瘤(extra-gastrointestinal stromal tumors，EGIST)；临床及病理检查容易误诊。笔者报道1例原发于卵巢表面EGIST，描述其HE及免疫组织化学特点，并结合文献讨论其临床病理特征、诊断与鉴别诊断。
1 病例报道
患者，女，44岁，因“腹胀2月，体检发现卵巢肿块2周”于2003年2月10日入院。查体：左附件触及肿块，质硬，固定。B超示左卵巢肿瘤，考虑为“卵巢癌?”；CT示：左卵巢肿块伴盆腔积液。血生化：CA125为495kU/L。临床诊断“盆腔肿瘤，卵巢癌”，行剖腹探查术，术中见肿块位于卵巢表面，直径约2cm，与大网膜粘连，探查盆腹腔及胃肠道无殊。送检冰冻切片标本为一侧附件标本，卵巢表面见灰红色肿块，大小为1.9×1.3×1.1cm，切面灰白，质嫩，浸润深度约0.6cm(镜下测量浸润深度5.5mm)。镜下：肿瘤由梭形细胞和上皮样细胞组成，呈弥漫性或围绕血管排列，细胞核分裂较多，并见坏死。冰冻切片诊断为：(左)卵巢软组织恶性肿瘤(恶性间皮瘤可能)。遂行全子宫切除+双附件切除+大网膜切除+盆腔淋巴结清扫+阑尾切除术。术后15月复发(肝转移)，22月死亡。
, 百拇医药
大体检查：大网膜总体积4×3×1.5cm，可见少量破碎肿瘤组织，子宫大小4×4×3.5cm，宫颈长3.5cm，直径3cm，宫体表面完整、光滑，宫壁切面无殊。左附件、阑尾肉眼检查未发现明显异常。另送腹水500ml。
镜检：肿瘤由梭形细胞和上皮样细胞组成，富于血管并围绕血管排列，肿瘤细胞核分裂像易见，达12/50hpf，并见多灶性地图样坏死(图1)。大网膜见少量肿瘤组织浸润。子宫、对侧附件、盆腔淋巴结、腹水涂片均未见肿瘤。术中诊断为：(左卵巢)梭形细胞恶性肿瘤(恶性间皮瘤可能)。免疫组织化学结果如下：Vimentin、CD117(图2)和CD34均阳性，calretinin、CD31、CK、S-100、NSE、Syn、caldesmon、SMA和Desmin均阴性。诊断为：(左卵巢)恶性胃肠道外间质瘤。肿瘤主要位于卵巢表面，并浸润卵巢皮质深5.5mm。, http://www.100md.com(方 萍 薛德彬)