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| 名称： | |
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- 卵巢肝样肿瘤-罕见病例（2010上海-大阪-墨尔本病理读片会病例1，同济大学东方医院提供）
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| 姓 名： | ××× | 性别： | 女 | 年龄： | 25岁 |
| 标本名称： | 右卵巢肿块 | ||||
| 简要病史： | 足月顺产2个月后，自觉右下腹包块，无腹痛，无不规则阴道流血及异常阴道排液。妇科检查：右附件区扪及约10×7cm大小的肿块，质硬，活动差，无压痛。盆腔CT示右侧附件占位，伴有盆腔积液 | ||||
| 肉眼检查： | 右侧卵巢肿瘤大小约9.5×8.5×6cm，有包膜，表面光滑，略呈分叶状。切面灰黄色，部分呈桔黄色，局灶伴出血和微囊变，质地偏硬。 | ||||
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本帖最后由 于 2010-12-14 12:09:00 编辑
- 王军臣
×参考诊断
肝样SLCT。
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Alpha-fetoprotein producing tumors other than hepatoma and germ cell
tumors have been widely reported, especially in carcinoma with hepatoid
differentiation (hepatoid carcinoma). Hepatoid carcinoma has mostly
been found in the stomach, but also occurs in many other organs. A rare
case of hepatoid carcinoma of the ovary is presented. A 57-year-old
Taiwanese woman was admitted because of lower abdominal pain. Magnetic
resonance imaging showed a 10 cm right adnexal mass. She underwent a
total hysterectomy and bilateral salpingo-oophorectomy with
omentectomy. A right ovarian mass measuring 13 x 9 x 8 cm was found.
Microscopic examination showed characteristic features for hepatoid
carcinoma. Immunohistochemical staining was performed on the tumor
using a panel of eight markers (AFP, p-CEA, CD10, Hep Par 1, thyroid
transcription factor-1, CK7, CK19 and CK20). This study contradicts the
theory that hepatoid carcinoma derives from the surface epithelium of
the ovary. Hepatoid carcinoma of the ovary commonly contains a
population of clear cells, which may lead to the misdiagnosis of yolk
sac tumor or clear cell adenocarcinoma that may arise in many anatomic
sites. Histologically, it is also difficult to distinguish hepatoid
carcinoma from hepatoid yolk sac tumor. In such cases, demonstration of
CD 10, Hep Par 1, membraneous patterns of p-CEA and CK7 would be
invaluable for characterizing the tumor as hepatoid carcinoma. More
studies are needed to confirm this observation.
- 嫁人就嫁灰太狼，学习要上华夏网。
请将思路再放开一些。
请见国外一篇文章的前言，讲的是AFP不只是生殖细胞肿瘤，而在一些非生殖细胞的女性肿瘤中也可表达。
Elevated levels of alpha-fetoprotein (AFP), a foetal serum protein,occur on the development of hepatocellular carcinoma(HCC) or germ cell tumours, including yolk sac tumour (YST) and embryonal carcinoma of the ovary. Hence, AFP is a useful tumour marker for germ cell tumours of the ovary and is valuable for both diagnosis and follow-up.
There are non-germ cell tumours of the female genital tract that have been reported to produce AFP. These include different types of carcinomas, carcinosarcomas and sex cord stromal tumours. As the female genital tract is the site of germ cell tumours, it is important to be aware of other AFP-producing tumours, which should be considered in the differential diagnosis of tumours in patient with elevated serum AFP. This article reviews AFP-producing non-germ cell tumours reported in different parts of the female genital tract and discusses the distinction between these entities and YST.
- 王军臣
