■大多数卵巢肿瘤表现出纯粹的组织学特征。然而,具有相同组织遗传学起源但不同组织学亚型的肿瘤组合比较常见.此外,具有不同组织遗传学起源的肿瘤的同时发生非常罕见。通常,这些混合肿瘤包括混合上皮肿瘤,混合性上皮间质肿瘤,混合性生殖细胞-性索-间质肿瘤,和混合生殖细胞肿瘤。然而,混合性上皮-性索间质-淋巴造血系统肿瘤是罕见的。目前,临床医生对这类肿瘤的了解有限,和流行病学,诊断,这种疾病的治疗方法尚未建立。
■我们报告一例73岁女性腹胀疼痛3个月。影像学评估显示盆腔肿块较大,超声提示良性卵巢囊肿和平滑肌瘤。此外,计算机断层扫描(CT)和磁共振成像(MRI)显示为恶性肿瘤。血液测试显示CA125和CA199水平显着增加。该患者接受了全腹子宫切除术和双侧附件卵巢切除术。在手术过程中,在右侧卵巢观察到一个大的多结节性囊性实性肿块,最大结节直径为14.2cm。肿块的实心区域呈灰白色和灰褐色,而囊性区域包含透明液体,光滑的壁厚0.2厘米,没有囊内固体区域。左卵巢有单发结节,最大的是直径4厘米。右侧卵巢的显微镜检查显示三种不同的细胞类型。第一种类型的细胞面积是类似的,圆形,梭形,和交错的混合细胞,边界不清,核仁或有丝分裂罕见。第二种类型的细胞区域是囊性扩张区域。囊肿壁被单层扁平上皮覆盖,丰富的嗜酸性细胞浆,均匀核染色质,没有乳头状结构.第三种类型是弥漫性淋巴区域,具有均匀的中等大小的细胞,核染色质粗糙,核仁和有丝分裂明显。左卵巢细胞形态单一,这与右卵巢中第一种类型的细胞区域一致。右卵巢的免疫组织化学显示第一个区域表达波形蛋白,抑制素-α,calretinin,SF-1、WT-1和CD56,Ki-67为5%,没有CKpan表达式。第二个区域表示CKpan,Ki-67为1%。第三区表达CD20、Pax-5、Bcl-6、Bcl-2、MUM1、CD45和C-myc,Ki-67为70%,IGH克隆基因重排阳性。最后,病理诊断为右侧卵巢混合卵巢肿瘤,包括肌瘤-纤维瘤,浆液性囊腺瘤,弥漫性大B细胞淋巴瘤,和左侧卵巢的纤维瘤。15个月后对患者进行的随访检查显示,身体其他部位无肿块或淋巴结肿大,未观察到复发或转移。
■我们介绍了一例绝经后妇女,患有罕见的囊瘤-纤维瘤,卵巢浆液性囊腺瘤和弥漫性大B细胞淋巴瘤。据我们所知,这是此类组合的首例报道。典型的病理形态学和免疫组织化学对该病的诊断至关重要。由于对这种疾病的知识有限,其发病机制和组织起源不明。临床医生应该对此类患者保持谨慎。我们相信此病例报告可能为此类肿瘤患者的诊断和治疗提供一些新的见解。
UNASSIGNED: Most ovarian tumors exhibit a pure histological characteristic. Nevertheless, a combination of tumors with the same histogenetic origin but different histologic subtypes is relatively common. Additionally, co-occurrence of tumors with different histogenetic origins is very rare. Typically, these mixed tumors include mixed epithelial tumors, mixed epithelial-stromal tumors, mixed germ cell-sex cord-stromal tumors, and mixed germ cell tumors. However, mixed epithelial-sex cord stromal-lymphohematopoietic system tumors are rare. Currently, clinicians have limited knowledge of this type of tumor, and the epidemiology, diagnosis, and treatment of this disease are yet to be established.
UNASSIGNED: We report a case of a 73-year-old woman with abdominal distension and pain for three months. Imaging evaluation revealed a large pelvic mass, with ultrasound suggesting a benign ovarian cyst along with leiomyoma. Furthermore, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a malignant tumor. Blood tests showed significant increases in CA125 and CA199 levels. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. During the surgery, a large multinodular cystic solid mass was observed in the right ovary, and the maximum nodular diameter was 14.2 cm. The solid areas of the mass appeared gray-white and taupe, whereas the cystic areas contained clear liquid with smooth walls 0.2 cm thick and no intracystic solid areas. The left ovary had solitary nodules, the largest being 4 cm in diameter. Microscopic examination of the right ovary revealed three different cell types. The first type of cell area was analogous, round, fusiform, and staggered mixed cells with unclear boundaries and rare nucleolus or mitosis. The second type of cell area was the cystic dilatation area. The cyst wall was covered with a single layer of flat epithelium, rich eosinophilic cytoplasm, uniform nuclear chromatin, and no papillary structures. The third type was a diffuse lymphoid region with uniform medium-sized cells, rough nuclear chromatin and evident nucleoli and mitosis. The morphology of the left ovarian cell was single, which was consistent with the first type of cell area in the right ovary. Immunohistochemistry of the right ovary indicated that the first region expressed vimentin, inhibin-α, calretinin, SF-1, WT-1 and CD56, with Ki-67 at 5 %, and no CKpan expression. The second region expressed CKpan, with Ki-67 at 1 %. The third region expressed CD20, Pax-5, Bcl-6, Bcl-2, MUM1, CD45, and C-myc, with Ki-67 at 70 %, and positive IGH clonal gene rearrangement. Lastly, the pathological diagnosis was a mixed ovarian tumor in the right ovary, comprising thecoma-fibroma, serous cystadenoma, diffuse large B-cell lymphoma, and a thecoma-fibroma in the left ovary. A follow-up examination of the patient after 15 months showed no mass or lymph node enlargement in other parts of the body, and no recurrence or metastasis was observed.
UNASSIGNED: We present a case of a postmenopausal woman with a rare combination of thecoma-fibroma, serous cystadenoma and diffuse large B-cell lymphoma in the ovary. To the best of our knowledge, this is the first reported case of such a combination. Typical pathological morphology and immunohistochemistry are crucial for the diagnosis of this disease. Owing to the limited knowledge of the disease, its pathogenesis and tissue origin are unknown. Clinicians should be careful about such patients. We believe this case report may provide some novel insights into the diagnosis and therapy of patients with this type of tumor.