发表于 2010-8-2 14:34 {
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- 卵巢肿物，恶性？交界性？
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| 姓 名： | ××× | 性别： | 女 | 年龄： | 39 |
| 标本名称： | 卵巢囊性肿物 | ||||
| 简要病史： | 肺癌术后2个多月，阴道不规则流血10余天，下腹痛3天， | ||||
| 肉眼检查： | 大体：肿物大小14x10x7cm，表面光滑，切面多囊如蜂窝样，囊内充满血液。整个切面均为红褐色，仅少许部分灰白色。 | ||||
术中所见：左侧卵巢囊性增大，18x16x15cm，色紫褐色，蒂部扭转一周，
镜下出血严重，中央区组织大多出血、坏死，许多上皮细胞脱落与红细胞混在一起，边缘可见多囊，上皮未脱落。细胞有异型性，但分裂相难找。
镜下出血严重，中央区组织大多出血、坏死，许多上皮细胞脱落与红细胞混在一起，边缘可见多囊，上皮未脱落。细胞有异型性，但分裂相难找。
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本帖最后由 于 2010-08-02 12:46:00 编辑
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wangdingding 离线
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Difficult case based on photos only. CCC should be considered. But cytomorphology is more like serous borderline tumor with focal stromal invasion. Depending on the areas of invasion, we can call low grade serous carcinoma or serous border line tumor with microinvasion.
The prognosis and treatment of ccc and serous border line tumor with microinvasion (or low grade serous ca) are different. So the pathology dx is very important. louzhu must be sure your dx before you release the case.
Another point is that ovarian serous ca includes high grade and low grade types. Most of the ovarian serous carcinoma are high grade type. Rare are low grade type. Serous borderline tumor can be progress to carcinoma--low grade serous ca.
This is real difficult case. Tumor grows in the cystic surface with micropapillary structure. The cells are relative uniform and hobnail-like appearance with round nuclei. The detached clusters of cells in the last photos show occasional clear cytoplasm. Photos 7-8 show stromal invasion of small tumor nests. The cytomorphologic feture are not like classic serous borderline or low grade seroud ca or classic ccc. The papilla in ccc generally show hyalinazed core, which is not present in this case.
Considering all morphologic features and grwoth pattern, I favor a dx of clear cell ca for this case. I cahnge my interpretation.
Anyway it is not an easy case. It will be much easier to read all sections of true glass slides.
Just for your reference.
| 以下是引用cqzhao在2010-8-6 8:12:00的发言：
This is real difficult case. Tumor grows in the cystic surface with micropapillary structure. The cells are relative uniform and hobnail-like appearance with round nuclei. The detached clusters of cells in the last photos show occasional clear cytoplasm. Photos 7-8 show stromal invasion of small tumor nests. The cytomorphologic feture are not like classic serous borderline or low grade seroud ca or classic ccc. The papilla in ccc generally show hyalinazed core, which is not present in this case. Considering all morphologic features and grwoth pattern, I favor a dx of clear cell ca for this case. I cahnge my interpretation. Anyway it is not an easy case. It will be much easier to read all sections of true glass slides. Just for your reference. 尝试翻译： 这是一例真正的疑难病例。肿瘤生长于囊内壁表面呈微乳头样结构。肿瘤细胞显示相对一致、鞋钉样改变、胞核圆形。在最后几张照片中的分离细胞群显示偶见的透明胞浆。图片7-8显示小细胞巢团的间质浸润。细胞形态特点不是很像典型的交界性浆液性肿瘤或低级别浆液性癌或典型的透明细胞癌。在透明细胞癌中的乳头样结构经常会显示透明的轴心结构，但在本例中没有表现。 考虑本例肿瘤所有的形态学特点和生长模式，赵老师比较倾向的诊断是透明细胞癌。改变了以前的意见。 无论如何，本例不是一个简单的病例。通阅切片将会使问题变得简单。 供参考 |
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本帖最后由 于 2010-08-07 23:07:00 编辑
谢谢赵老师及djdnx及其他各位对本病例的关心！！！我发报告是很小心的，至今未发，免疫组化虽然不特异，但我还是想参考一下。由于免疫组化送到外地去做，至今未出。我们一年最多能有1000例标本，多半是胃肠镜，做不起免疫组化。
看到djdnx的翻译心里很高兴，好朋友今天不在线，我没找着人帮忙翻译，这下看明白了，再谢一下djdnx。
另外，想告诉大家，其实这一例做过快速病理，当时取了5块，仅看到多囊，囊内好多的血性液，囊壁被覆细胞脱落，散在于红细胞中，没什么结构，乳头的地方都没取着，当时我只报了“可见散在异型细胞，建议石蜡明确诊断”，现在想想都很后怕，差一点就直接报了良性。石蜡取了20块，也只有4块比较有意义，而且是局部有意义。
