卵巢表面恶性胃肠道外间质瘤临床病理探究.doc

卵巢表面恶性胃肠道外间质瘤临床病理探究【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 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，adip