女性，18岁，月经不规则5年，闭经4月

陶氏腔包块

送检碎组织直径16cm大小，共取材8块，形态基本相似，上传其中一张切片的图片

HE图像

免疫组化结果

 原单位免疫组化Vim为阴性，没有采图

报告发了，没有一个明确诊断意见

癌不确定：CK7和EMA均阴性，神经内分泌阴性

性索间质肿瘤排除了

生殖细胞源性肿瘤：除了一个畸胎瘤可以考虑，其它的好像不行

不考虑间叶来源肿瘤

进展如何？

输卵管型上皮，轻~中度不典型性的细胞，考虑是交界性浆液性肿瘤，卵巢是否有病灶，如果没有可谓盆腔腹膜原发。

浆液性上皮肿瘤往往表达WT1，90%以上为核阳性，该例典型表达；Vimentin在浆液性肿瘤也有表达，文献说大约有40%，该例阳性表达；EMA则是100%表达，该例阳性表达；PCK100%表达；Glypican-3没用过不知道；CD56没用过，据称在性索间质肿瘤很好，但是CD56也是很泛的。

 今天做了inhibin和Hepatocyte，均阴性

总结免疫组化结果

免疫组化染色WT1管状结构阳性

CD56，间质及管状结构均阳性

PCK，CD99，EMA染色有异质性，部分结构阳性，Glypican-3与前三者的表达组织似乎有相反
CK8/18阳性，Ki67增殖活性比较高

CK7表达模式与EMA相似

AFP,CDX2，Calretinin,Inhibin，Hepatocyte，ER,Syn,CD10，TTF1,CgA，CD30，OCT3/4，CK20均阴性

赞同赵老师的分析，考虑陶氏腔（盆腔最低处）腹膜第二苗勒系统肿瘤，交界性或低度恶性，很可能是浆液性，鉴别性索（支持细胞瘤）和类癌。

其他常见考虑包括间皮、生殖细胞和种植/转移，要探查卵巢。

临床表现具有内分泌紊乱，提示它可能是功能性肿瘤。

补充免疫组化结果：

CK8/18阳性，Ki67增殖活性比较高

CK7表达模式与EMA相似

CgA，CD30，OCT3/4，CK20阴性

Inhibin做漏了，下次补上

CK8/18

名称：图1
描述：CK8-18-100_调整大小.jpg

名称：图2
描述：CK8-18_调整大小.jpg

Ki67

名称：图1
描述：Ki67-40_调整大小.jpg

名称：图2
描述：Ki67-200_调整大小.jpg

名称：图1
描述：CK7.jpg

关注

还在等待之中，因为是会诊病例，没有蜡块，等待患者从原单位再切白片。

一旦有了新的染色我会及时上传的。

谢谢赵老师的关注。

Do u have more stains?

期待答案

恶性，向老师们学习

Interesting thought.

The reasons are ?

 EMA seems negative and Pan-CK patch positive

Vimetinin neg

WT1, CD56 strongly and diffusely positive

CD99 focally positive.

Importance is to distinguish it is epithelial tumor or sex cord stromal tumor or others (such as carcinoid).

Suggest to do 

1. inhibin stain. Sertoli cell tumor:  about 40-50% of the cases, calretinin can be negative, but almost all of them are inhibin positive. If both inhibin and calretinin are negative, the chance of sex cord stromal tumors will be very low.

2. chromogranin and synaptophysin: to r/o or rule in carcinoid

3. Add cam5.2 to rule out epithelial tumor

It is interesting case. Thank for sharing. Wish we can see your follow-up study results

本例形态比较纠结，包括所谓的畸胎瘤，多胚瘤，卵黄囊瘤，子宫内膜样肿瘤，颗粒细胞瘤，网状型支持细胞间质细胞瘤，交界性浆液性肿瘤

 I never use GPC stain and know nothing about it. Check internet to learn:

Glypican 3 (GPC3) is found in fetal tissues, but expression in adults is limited [5]. Experimental evidence using cell cultures suggests that silencing occurs in tumors derived from adult tissues which may normally express GPC3 (ovary, breast, lung, and mesothelium), and has therefore been considered to function as a tumor suppressor in these tissues although this notion is controversial [6-9]. In tissues with no adult expression, GPC3 may act as an oncofetal protein, and tumors derived from these tissues have increased levels of GPC3 mRNA (hepatocellular carcinoma, hepatoblastoma, Wilms tumor, neuroblastoma, and rhabdomyosarcoma), with protein studies limited to the first three [7,10-13]. The role of glypicans in malignant transformation and tumor progression has been further elucidated by genetic studies involving Drosophila and mice, which have shown that the activity of Wnts, Hedgehogs, and bone morphogenetic proteins are modulated by glypicans [1-4,14]. GPC3 in particular has been shown to increase Wnt signaling in hepatocellular carcinoma via interaction between Wnt and GPC3 core protein [4].

陶氏腔属于盆腔,是盆腔的最低处。一般有盆腔炎会出现陶氏腔积液。陶氏腔积液在又称为盆腔积液，分为生理性和病理性，生理性的盆腔积液多发生在排卵后或早孕期，多可自然消失，不必进行治疗。但大多数盆腔积液是由于炎症引起，即由慢性盆腔炎症渗出所致。也有少数因宫外孕破裂、黄体破裂、盆腔脓肿、巧克力囊肿、卵巢癌引起。因急慢性盆腔炎引起者，多伴有下腹痛（双侧或单侧），腰骶部疼痛，有人流或药流病史等。

免疫组化染色WT1管状结构阳性

CD56，间质及管状结构均阳性

PCK，CD99，EMA染色有异质性，部分结构阳性，Glypican-3与前三者的表达组织似乎有相反

AFP,CDX2，Calretinin,ER,Syn,CD10，TTF1均阴性。

EMA

名称：图1
描述：EMA.jpg

PCK

名称：图1
描述：CI12-00330-PCK-20倍-1.jpg

名称：图2
描述：CI12-00330-PCK-100倍-1.jpg

WT1

名称：图1
描述：CI12-00330-WT1-20倍-2.jpg

名称：图2
描述：CI12-00330-WT1-100倍-3.jpg

Glypican-3

名称：图1
描述：CI12-00330-Glypican3-20倍-3.jpg

名称：图2
描述：CI12-00330-Glypican3-100倍-3.jpg

Vim 

名称：图1
描述：Vim.jpg

 CD99

名称：图1
描述：CI12-00330-CD99-20倍-1.jpg

名称：图2
描述：CI12-00330-CD99-100倍-1.jpg

名称：图1
描述：CI12-00330-CD56-100倍-2 (2).jpg

名称：图2
描述：CI12-00330-CD56-20倍-3.jpg

 浆液性囊性癌

HE像是胚胎残件来源的肿瘤

 Favor serous  borderline tumor. Need to check carefully for microinvasion if it is borderline tumor

Banzhu please list all stains result