鉴别诊断：

1、卵巢印戒细胞间质肿瘤，

2、与妊娠有关的支持-间质细胞肿瘤

3、krukenberg tumor

学习。

年轻，妊娠史，

肿瘤大，分叶状，切面灰黄色或桔黄色。血AFP很高；

镜下：肿瘤呈片状、梁索状或腺样排列，细胞胞浆透亮印戒状或胞浆内红色颗粒；

考虑：

1、性索间质肿瘤，leydig细胞瘤？两性母细胞瘤：leydig细胞、颗粒细胞瘤？

2、性索间质肿瘤伴生殖细胞肿瘤（AFP很高，伴卵黄囊瘤？）

3、印戒细胞癌？转移？细胞异型性不明显，不太支持。

4、其它。

年轻，妊娠史，

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。

镜下：肿瘤呈片状、梁索状或腺样排列，细胞胞浆透亮印戒状或胞浆内红色颗粒；第2张片子似有菊行团

考虑：幼年性粒层细胞肿瘤。

期待免疫组化结果。

 谢谢海上明月老师！

想多分享2010第十七届上海-大阪-墨尔本读片研讨会病例，

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.