Abstract：
Ovarian tumors include neoplasms derived from somatic cells and germ cells, including teratoma. Sometimes, tumors of the somatic cell type may develop from teratoma, causing diagnostic perturbation. We experienced a case of a tumor composed of several types of tissue in the ovary with a teratoma. When findings of teratoma and somatic tumor coexist in an ovary, it is difficult to differentiate whether a somatic tumor was mixed with a teratoma or a teratoma unitarily caused transformation to a somatic cell tumor. A 72-year-old Japanese woman (gravida, 3; para, 1) presented to our hospital with severe constipation and frequent urination, and a large intrapelvic tumor was detected by computed tomography (CT). Soon after admission, ultrasonography (US) and magnetic resonance imaging (MRI) revealed a large multilocular cystic tumor on her left ovary. Based on the clinical diagnosis of ovarian cancer, she underwent a left ovariectomy, appendectomy, and partial omentectomy. We observed an ovarian tumor consisting of teratoma, primitive neuroectodermal tumor (PNET), adenocarcinoma, various types of sarcomas, and clear cell carcinoma on the H and E-stained sections. The component of clear cell carcinoma showed a nuclear positive reaction against PAX8 and napsin A, as well as a loss of ARID1A, suggesting typical endometriosis-derived clear cell carcinoma. On the other hand, the expression of ARID1A was maintained in teratoma, PNET, non-specific adenocarcinoma, and various types of sarcomas, suggesting that these tumors had an origin different from that of clear cell carcinoma. These findings indicated that the ovarian tumor of this patient contained a clear cell carcinoma derived from a somatic cell and a teratoma that transformed to a wide variety of somatic cell types of tumors, which coexisted on one ovary. The appropriate use of immunohistochemistry was diagnostically effective in this case.
摘要：
卵巢肿瘤包括来源于体细胞和生殖细胞的肿瘤，包括畸胎瘤.有时候,体细胞类型的肿瘤可能是从畸胎瘤发展而来的，造成诊断扰动。我们经历了一例由卵巢中几种类型的组织组成的肿瘤，并伴有畸胎瘤。当畸胎瘤和体细胞肿瘤的发现在卵巢中共存时，很难区分体细胞肿瘤是否与畸胎瘤混合或畸胎瘤共同导致向体细胞肿瘤的转化。一名72岁的日本妇女(gravida,第3段，1）出现严重便秘和尿频到我院，通过计算机断层扫描（CT）检测到巨大的骨盆内肿瘤。入院后不久,超声检查（US）和磁共振成像（MRI）显示她的左侧卵巢有一个大的多房性囊性肿瘤。基于卵巢癌的临床诊断，她做了左卵巢切除术,阑尾切除术,和部分网膜切除术.我们观察到一个由畸胎瘤组成的卵巢肿瘤，原始神经外胚层肿瘤（PNET），腺癌,各种类型的肉瘤，H和E染色切片上的透明细胞癌。透明细胞癌的成分显示针对PAX8和napsinA的核阳性反应，以及ARID1A的损失，提示典型的子宫内膜异位症来源的透明细胞癌。另一方面,ARID1A的表达在畸胎瘤中得以维持，PNET,非特异性腺癌,和各种类型的肉瘤，这表明这些肿瘤的起源不同于透明细胞癌。这些发现表明，该患者的卵巢肿瘤包含源自体细胞的透明细胞癌和畸胎瘤，该畸胎瘤转化为多种体细胞类型的肿瘤，在一个卵巢上共存。在这种情况下，适当使用免疫组织化学在诊断上是有效的。
