这个是年会的片子,结果诊断是无性细胞瘤.

 to  Dr.杨斌：

Deciduoid mesothelioma (黄体样恶性间质细胞瘤）

对应的中文似应为：蜕膜样（恶性）间皮瘤？谢谢！

 A very challenging case indeed!

 I liked the differential diagnosis posted by Dr. Yang and mjma. It is very thorough. The small cell carcinoma of the hypercalcemic type is a very good thought. Basically this case need some immunostains to rule out or rule in lymphoma, deciduoid mesothelioma, metastatic carcinoma, and melanoma. I just want to add the following: we all know that WHO classify primary ovarian tumors into the following 3 broad categories: 1) surface epithelial tumor; 2) sex-cord stromal tumor; and 3) germ cell tumor. Considering the age of this patient, the later two categories are more likely. The morphology is not quite fit any obvious sex-cord stromal tumor, thus immunostains for germ cell tumor need to be added. On low-power, the histology shows a corded appearance with some edematous stroma which make you think about dysgeminoma, but it lacks the typical lymphoid infiltrate or granuloma, also the mitotic figures are too much. Embryonal carcinoma is exceedingly rare. Please add PLAP, OCT-4, CD117, EMA, and CD30 in your work-up. Another suggestion is to sample the mass extensively, at least 1 cm per section. Please keep us posted. Thanks you

非常有挑战性的一个病例。我喜欢杨博士和mjma上传的鉴别诊断，十分全面。高血钙型小细胞癌是一个非常好的思路，这个病例主要靠免疫染色与淋巴瘤、蜕膜细胞型间皮瘤、转移癌、黑色素瘤相鉴别和诊断。我只想加入以下的一些内容：众所周知，WHO将卵巢原发肿瘤主要分为以下三大类别：1）表面上皮间质肿瘤；2）性索间质肿瘤；3）生殖细胞肿瘤。考虑到患者的年龄，十分可能为后两种类型。但肿瘤形态学上与任何一种明显的性索间质肿瘤都不符合，因此与对于生殖细胞肿瘤需要加入免疫染色来诊断。在低倍镜下，组织学呈现出堆积的形状并伴有水肿的间质，会使你考虑为无性细胞瘤。但却缺少典型的淋巴细胞浸润或肉芽肿结构，而且核分裂像过多。胚胎性癌极其少见。请在诊断检查中加入PLAP, OCT-4, CD117, EMA, CD30 。另外的建议就是广泛取材，至少每隔1cm取一块。请继续上传讨论，谢谢。