背景:与粘液性囊腺癌并存的成熟囊性畸胎瘤是一种罕见的肿瘤,迄今为止很少有病例报道。在这些情况下,良性畸胎瘤恶性转化为腺癌,或者在成熟的囊性畸胎瘤和粘液性肿瘤之间形成碰撞肿瘤,要么主要起源于卵巢的上皮基质表面,或继发于原发性胃肠道肿瘤。对这两种肿瘤进行个体化处理的意义对进一步的治疗管理具有显著的作用。
方法:在这种情况下,一名33岁伊朗女性的成熟囊性畸胎瘤与粘液性囊腺癌共存于同一卵巢.计算机断层扫描(CT)扫描与左卵巢肿块的额外对比提示畸胎瘤,而切除的卵巢肿块检查报告腺癌伴有囊性畸胎瘤。在手术标本的大体检查中发现了皮样囊肿,并伴有另一个包括粘液样物质的多间隔囊性病变。组织病理学检查显示成熟的囊性畸胎瘤与高分化的粘液性囊腺癌有关。后者显示CK7-/CK20+免疫谱。由于缺乏临床,放射学,以及归因于原发性下胃肠道肿瘤的生化发现,免疫谱提出了良性畸胎瘤的腺癌转化的机会。
结论:此案例显示了大样本的重要性,精确记录粗略的方面,组织病理学检查,免疫组织化学分析,以及放射学和临床结果的帮助,以正确诊断罕见的肿瘤。
BACKGROUND: Mature cystic teratoma co-existing with a mucinous cystadenocarcinoma is a rare tumor that few cases have been reported until now. In these cases, either a benign teratoma is malignantly transformed into adenocarcinoma or a collision tumor is formed between a mature cystic teratoma and a mucinous tumor, which is either primarily originated from epithelial-stromal surface of the ovary, or secondary to a primary gastrointestinal tract tumor. The significance of individualizing the two tumors has a remarkable effect on further therapeutic management.
METHODS: In this case, a mature cystic teratoma is co-existed with a mucinous cystadenocarcinoma in the same ovary in a 33-year-old Iranian female. Computed Tomography (CT) Scan with additional contrast of the left ovarian mass suggested a teratoma, whereas examination of resected ovarian mass reported an adenocarcinoma with a cystic teratoma. A dermoid cyst with another multi-septate cystic lesion including mucoid material was revealed in the gross examination of the surgical specimen. Histopathological examination revealed a mature cystic teratoma in association with a well-differentiated mucinous cystadenocarcinoma. The latter showed a CK7-/CK20 + immune profile. Due to the lack of clinical, radiological, and biochemical discoveries attributed to a primary lower gastrointestinal tract tumor, the immune profile proposed the chance of adenocarcinomatous transformation of a benign teratoma.
CONCLUSIONS: This case shows the significance of large sampling, precise recording of the gross aspects, histopathological examination, immunohistochemical analysis, and the help of radiological and clinical results to correctly diagnose uncommon tumors.