卵巢未成熟畸胎瘤合并腹膜神经胶质瘤1例临床病理特征及文献复习
Clinicopathologic characteristics of ovarian immature teratoma combined with gliomatosis peritonei
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摘要: 目的:探讨卵巢未成熟畸胎瘤(OIT)合并腹膜神经胶质瘤病(GP)的临床病理特征、诊断、治疗及预后。方法:对1例OIT合并GP进行组织形态学、免疫组织化学分析,并复习国内、外文献。结果:CT示腹盆腔内一巨大囊实性肿块影。术中见肿瘤23.0 cm12.0 cm10.0 cm,呈囊实性,有蒂,且与左附件粘连,盆腔、网膜表面布满直径0.1~0.3 cm灰白色小结节。镜下肿瘤由3个胚层分化而成的成熟和未成熟组织组成,含大量神经胶质组织。盆腔、网膜和肿瘤包膜上密集的粟粒样结节,镜下均为成熟的神经胶质组织,边界清楚,无浸润。免疫组织化学染色结果:腹膜神经胶质结节GFAP(+)、S-100(+)和vimentin(+),结节表面被覆的间皮细胞CK(+)。临床行大部分大网膜和肿物切除,术后未予治疗,随访26个月未见肿瘤复发和转移。结论:OIT合并GP罕见,腹膜种植分化成熟的神经胶质提示OIT可能有分化成熟的趋势,其预后好。治疗主要根据OIT的分期及分级,选择适当的手术治疗和/或化疗。Abstract: Objective:To study the clinical pathological characteristics,diagnosis,therapy and prognosis of ovarian immature teratomas(OIT) combined with gliomatosis peritonei(GP).Methods:The histomorphology and immunohistochemistry results of a case with OIT and GP was analyzed under light microscope,and related literatures were reviewed.Results:A huge cystic and solid mass in the abdomined cavity was showed in a 12-year-old girl patient by CT 23.0 cm12.0 cm10.0 cm tumor with intact capsule and adhesion in left accessory was found in the course of operation,which was composed of mature and immature tissues,mostly neurogliatissue derived from epidermal,mesodermal and endodermal elements under microscope.Many grey-white nodules with 0.1 to 0.3 cm in diameter located on the surface of the tumor,pelvic cavity and omentum,which were mature neurogliatissue with clear boundary and no infiltrating.Immunohistochemically,the staining of glial fibrillary acidic protein(GFAP),S-100 protein,vimentin showed positive in the mature glial tissue and cytokeratin staining was positive in the mesothelial cells.The mass tumor and a part of omentum were excised.There was no tumor recurrence and metastasis in the follow-up 26 months.Conclusions:OIT with GP is extremely rare,mature neurogliatissue metastases in omentum indicates that OIT may differentiate up to mature and the prognosis for OIT with GP is good.Surgery and/or chemotherapy are employed according to the stage and pathological differentiation of OIT.