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双侧卵巢肿瘤

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楼主 发表于 2010-04-22 16:24|举报|关注(0)
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姓    名: ××× 性别:  女 年龄:  6岁
标本名称:  双侧卵巢活检
简要病史:  早熟
肉眼检查:  淡黄色半透明小组织各一块
  • 双侧卵巢肿瘤图1
    图1
  • 双侧卵巢肿瘤图2
    图2
  • 双侧卵巢肿瘤图3
    图3
  • 双侧卵巢肿瘤图4
    图4
  • 双侧卵巢肿瘤图5
    图5
  • 双侧卵巢肿瘤图6
    图6
  • 双侧卵巢肿瘤图7
    图7
  • 双侧卵巢肿瘤图8
    图8
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zjb0325 离线

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1 楼    发表于2011-04-16 21:50:00举报|引用
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 ding
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蔷薇 离线

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2 楼    发表于2011-04-14 22:54:00举报|引用
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 Gonadoblastoma with dysgerminoma overgrown ?
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超越自我,自由飞翔!

华子 离线

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3 楼    发表于2010-04-27 21:24:00举报|引用
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 也顶一顶,共同学习!
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pursue79 离线

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4 楼    发表于2010-04-26 16:21:00举报|引用
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 期待各位老师更详细的讲解,期待最终诊断
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就是喜欢病理,没有办法。

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5 楼    发表于2010-04-25 18:56:00举报|引用
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谢谢杨老师,先上传部分免疫组化结果
  • 图1
  • 图2
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  • 图6
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杨斌 离线

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6 楼    发表于2010-04-23 21:53:00举报|引用
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My top differential diagnosis is "Gonadoblastoma with dysgerminoma overgrown", based on histopathology, patient's age, bilaterality and abnormal hormone phenotype. But there are much more I need to know before rendering appropriate diagnosis. I would like to know the following information if you can provide: 1) Size of tumor on each side; 2) Is this tumor homogenous just like what you provided microphotographically? In another word, I would like to see low power photos of areas with different morphology, such as sharply delineated nests with dense fibrosis, focal calcification and so on, so forth.

3) Did clinically AFP to rule out yolk sac tumor, although it is less likely based on photos here. I am thinking of that because ganadoblastoma is mostly benign clinically and yolk sac tumor is aggressive one and should be ruled out even the chance is very low here.

As we all know, ganadoblastoma is composed of two elements, primitive germ cells resembling those of dysgerminoma and sex cord-stromal cells resembling immature Sertoli or granulosa cells. Each one of these two components can be predominant in any given ganadoblastoma. When germ cells dominate, it just look like a dysgerminoma.  Since this is just a biopsy specimen, not resected tumor, we have no idea how much each component attributing to this tumor. The hormonal production is usually derived from sex cord-stromal element of the tumor, even it is a small portion. Pathologists should  sample the tumor thoroughly and more diligently searching sex cord-stromal elements in those fibrous stromal bands. Grossly, most ganadoblastoma are rather small. It can be very big in size when dysgeminomatous component overgrowth. In contrast, dysgerminoma is often big in size. Bilaterality is rather common in ganadoblastoma (30-50% in literatures), compared about 5-15% in dysgerminoma.

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曹大夫 离线

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7 楼    发表于2010-04-23 12:02:00举报|引用
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看起来是gonadoblastoma with dysgerminoma, 做个SALL4, OCT4,PLAP, EMA, CK 

鉴别:germ cell-sex cord-stromal tumors, unclassified

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8 楼    发表于2010-04-23 06:16:00举报|引用
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本帖最后由 于 2010-04-23 06:17:00 编辑  谢谢曹大夫,我们也考虑无性细胞瘤,但在纤维间质中似乎没有看到淋巴细胞,另外单纯的无性细胞瘤很少合并高激素水平的临床症状,临床仅送检小块卵巢组织,切片中结构比较一致,不知道是否广泛取材后会有新的发现,但目前无法做到
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