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卵巢癌病理类型?

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楼主 发表于 2010-09-27 17:18|举报|关注(2)
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姓    名: ××× 性别: 年龄:  47
标本名称:  
简要病史:  
肉眼检查:  左卵巢囊性肿瘤8*6*5厘米,内壁弥漫性乳头状突起,最大的直径1.0厘米,花菜样,切面见囊壁浸润。左输卵管腔内少许花菜样肿瘤组织。

镜下检查:部分乳头状区,部分实性区内有腺样结构,灶性钙化。

免疫组化:选实性区标记  ck7+  ck20-  p53+  p63-

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本帖最后由 于 2010-09-27 17:25:00 编辑
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×参考诊断
卵巢混合性囊腺癌(浆液性/移行细胞癌)。

天山望月 离线

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1 楼    发表于2010-09-27 19:35:00举报|引用
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 实性、乳头状,分化差,核分裂多,浆乳癌,P53阳性率多少?
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广州金域病理

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2 楼    发表于2010-09-27 20:03:00举报|引用
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 Agree with 天山望月 ,based on photos, it is  high grade serous ca

About 80-90% high grade serous ca are positive for  p53 ans WT1

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3 楼    发表于2010-09-27 20:27:00举报|引用
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前几幅图是否象移形细胞癌?

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4 楼    发表于2010-09-27 21:11:00举报|引用
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 确实像!

明显有两种形态。

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华夏病理/粉蓝医疗

为基层医院病理科提供全面解决方案,

努力让人人享有便捷准确可靠的病理诊断服务。


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5 楼    发表于2010-09-27 21:22:00举报|引用
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 还是觉得是浆乳癌
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Liu_Aijun 离线

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6 楼    发表于2010-09-27 22:14:00举报|引用
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低分化的浆乳癌与移行细胞癌常常带给我们鉴别诊断的难题,本例即如此。下面这篇文献或许可供参考。Am J Surg Pathol. 2004 Apr;28(4):453-63.Transitional cell carcinoma of the ovary: a morphologic study of 100 cases with emphasis on differential diagnosis.Eichhorn JH, Young RH.

Abstract

Transitional cell carcinoma (TCC) of the ovary is a recently recognized subtype of ovarian surface epithelial-stromal cancer, and studies of its morphology are few. As a result, the criteria for its diagnosis and spectrum of its morphology are not clearly established. One hundred consecutive consultation cases of ovarian carcinoma with a pure or partial transitional cell pattern (excluding malignant Brenner tumor) diagnosed between 1989 and 2001 were evaluated for the frequency of various pathologic features and the relation of TCC to other surface epithelial-stromal carcinomas. The women were 33 to 94 years of age (mean, 56 years). A total of 47 tumors were stage I, 21 stage II, 31 stage III, and 1 stage IV; 13% of the stage I tumors and 41% of tumors of all stages were bilateral. The tumors ranged from 3.0 to 30 cm in greatest dimension (mean, 10 cm); 60% of them were solid and cystic, 24% solid, and 16% cystic. TCC was the exclusive or predominant component in 93% of the tumors and showed undulating (93%), diffuse (57%), insular (55%), and trabecular (43%) patterns. In four tumors with an insular growth, the pattern focally mimicked a Brenner tumor. Necrosis was present in 57% of the cases. Features that were seen in the tumors that in aggregate produced a relatively consistent appearance were "punched out" microspaces (87%), often the size of Call-Exner bodies, large cystic spaces (73%), and large blunt papillae (63%). Features that were sometimes seen, usually as a focal finding, included slit-like fenestrations (49%), bizarre giant cells (35%), small filiform papillae (18%), gland-like tubules (17%), squamous differentiation (13%), and psammoma bodies (4%). In 23 cases, TCC was a component of a mixed epithelial carcinoma, the additional components being serous adenocarcinoma in 16, endometrioid in 5, mucinous in 1, and clear cell carcinoma in 1. The tumor cells of the TCC component often were relatively monomorphic; 6% of the tumors were grade 1, 43% grade 2, and 51% grade 3. The nuclei were oblong or round and often had large single nucleoli (69%) or longitudinal grooves (48%). The cytoplasm was typically pale and granular but was rarely strikingly clear or oxyphilic. TCC of the ovary usually occurs in pure form but is also common as a component of a surface epithelial carcinoma of mixed cell type. In either situation, TCC has a constellation of architectural and cytologic features that readily distinguish it in most cases from other types of ovarian cancer. Recognition of these features will lead to a more consistent diagnosis of this tumor and aid in determining whether it has distinctive clinical features, particularly with regard to its behavior.

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If you have great talents, industry will improve them; if you have but moderate abilities, industry will supply their deficiency. 如果你很有天赋,勤勉会使其更加完美;如果你能力一般,勤勉会补足其缺陷。

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7 楼    发表于2010-09-28 01:46:00举报|引用
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 Clearly there are a lot of areas showing classic papillary serous ca. It is true foci show transitional-like pattern. See carefully and you will notice that they are large papillary structure.

In addition, pur high grade papillary ca and high grade papillary serous ca mixed with transtional ca will not show difference in term of treatment and prognosis.

I will sign out the case as high grade seous ca and read next case.

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8 楼    发表于2010-09-28 06:05:00举报|引用
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 浆液性乳头状囊腺癌。
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9 楼    发表于2010-09-28 08:58:00举报|引用
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 1、卵巢浆液性乳头状癌?

2、卵巢移行细胞癌?

3、输卵管癌转移或浸润?

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10 楼    发表于2010-09-28 09:26:00举报|引用
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以下是引用天山望月在2010-9-27 19:35:00的发言:

 实性、乳头状,分化差,核分裂多,浆乳癌,P53阳性率多少?

支持。
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11 楼    发表于2010-09-28 09:41:00举报|引用
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 High grade adenocarcinoma, papillary serous and probably admixed with some endometrioid type in solid area.   Primary ovarian tumor or metastasis from adjacent organ such as endometrium?
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学浅 离线

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12 楼    发表于2010-09-28 19:58:00举报|引用
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 最后诊断:卵巢混合性囊腺癌(浆液性/移行细胞癌)。
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13 楼    发表于2010-09-28 21:35:00举报|引用
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 谢谢!学习了
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14 楼    发表于2010-09-28 22:35:00举报|引用
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以下是引用大海一栗在2010-9-28 21:35:00的发言:

 谢谢!学习了

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人要干一行,爱一行,不能爱一行,干一行。我选择了病理,理所当然就爱上了病理。

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15 楼    发表于2010-09-28 22:46:00举报|引用
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以下是引用学浅在2010-9-28 19:58:00的发言:

 最后诊断:卵巢混合性囊腺癌(浆液性/移行细胞癌)。

 

移形细胞癌P63标记阳性,此例标记阴性,不知是否能解释?谢谢!

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广州金域病理

学浅 离线

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16 楼    发表于2010-09-29 19:58:00举报|引用
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 没有标记“移形细胞癌”的区域。混合性囊腺癌与浆液性的治疗和预后并无特别。

我不知道移形细胞癌P63标记阳性。当时选择p63是因为部分区域还有点“鳞”的意思,只是选的蜡块中不明显。

按理说,应该选择不同形态区域同时做标记,本例诊断只是根据形态学,有点不求甚解。

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17 楼    发表于2010-10-03 11:21:00举报|引用
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以下是引用天山望月在2010-9-28 22:46:00的发言:

以下是引用学浅在2010-9-28 19:58:00的发言:

 最后诊断:卵巢混合性囊腺癌(浆液性/移行细胞癌)。

 

移形细胞癌P63标记阳性,此例标记阴性,不知是否能解释?谢谢!

前几天接待外宾,没顾得及仔细看这个病例。很同意Dr.天山望月的分析。P63表达阴性,不能诊断混合有尿路上皮癌的成分。换句话说,没有找到标记P63阳性的区域,不能诊断混合有尿路上皮癌。再说,已经看到高级别(低分化)浆液性乳头状癌,其恶性程度也可能高于尿路上皮癌。所以,还是诊断低分化浆液性乳头状癌比较合适。
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王军臣

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18 楼    发表于2010-10-03 11:27:00举报|引用
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 浆液性乳头状癌可以见到钙化沙砾或砂粒体结构,本例中可见(下左图),分化差时,也可见到实性区或实行乳头或筛状结构(下右图)。

 

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王军臣

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19 楼    发表于2010-10-03 12:41:00举报|引用
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 支持浆液性乳头状囊腺癌,沙粒体
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20 楼    发表于2010-10-03 12:48:00举报|引用
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 学习了
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