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- 73y, 绝经后出血，发现卵巢肿瘤
标签：卵巢肿瘤 绝经后流血
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×参考诊断
黄素化卵泡膜瘤
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lutinized celluar fibrothecoma. Cellular thecoma with stromal lutinization. If you see crystals of Reike, you may consider to call stromal-leydig cell tumor.
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xinzhu1492: 黄素化卵泡膜细胞瘤，卵泡膜细胞瘤的间质细胞黄素化。如果见到Reinke晶体，则称为间质leydig细胞瘤2012-12-01 08:37
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本帖最后由 xinzhu1492 于 2012-12-01 08:48:30 编辑
引用 7 楼 cqzhao 在 2012-12-01 04:15:46 的发言:
The lutinized cells can be stronly positive for calretinin, inhibin. Synap stain is not specific and can be positive in many tumors
黄素化细胞calretinin, inhibin表达强阳性，Synap为非特异性表达，许多肿瘤可呈阳性表达。
感谢Dr. Liu分享这个好病例和图片。
翻译了大概意思，不妥之处见谅
Interesting case!Luteinized thecomas and stromal Leydig cell tumors are indistinguishable except for the presence of crystalloids of Reinke in the latter. In view of the prolonged search that is necessary to find these structures in some stromal Leydig cell tumors and their well-known absence in the majority of testicular Leydig cell tumors, it is reasonable to assume that an unknown proportion of tumors in the luteinized thecoma category are unrecognized stromal Leydig cell tumors.
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本帖最后由 xinzhu1492 于 2012-12-01 21:48:21 编辑
引用 10 楼 年华似水 在 2012-12-01 11:21:42 的发言:
Interesting case!Luteinized thecomas and stromal Leydig cell tumors are indistinguishable except for the presence of crystalloids of Reinke in the latter. In view of the prolonged search that is necessary to find these structures in some stromal Leydig cell tumors and their well-known absence in the majority of testicular Leydig cell tumors, it is reasonable to assume that an unknown proportion of tumors in the luteinized thecoma category are unrecognized stromal Leydig cell tumors.
有趣的病例，黄素化卵泡膜细胞瘤与间质leydig细胞瘤除了后者含有Reinke晶体之外，几乎很难区别。由此看来，一些间质leydig细胞瘤需要花很多时间寻找这种晶体结构是必然的。并且众所周知的，大多数睾丸间质leydig细胞瘤缺少这种晶体结构，这就可以理解在黄素化卵泡膜细胞瘤中有多少是未被识别的间质leydig细胞瘤了。
本例为一会诊病例。后患者家属遵嘱取来子宫内膜切片，显示“内膜腺囊性增生，腺上皮为假复层排列”。这显然是高雌激素的表现。说明该卵巢肿瘤具有分泌雌激素的功能。而且那些黄素化的瘤细胞内没有林克结晶或类似物，可以排除间质莱迪细胞瘤，后者一般表现为雄激素升高。
本例最为让人困惑的是SYN强阳性。以前曾遇到过几例性索-间质肿瘤有灶状或弱阳性syn表达，但是如此高表达还是第一次见。后来请教了赵老师，才下定决心签发报告的。本例最后诊断为黄素化卵泡膜瘤。放在这里，主要是想和大家分享一下性索-间质肿瘤中syn的“异位表达”，希望以后的鉴别诊断中大家脑子里多一条思路。
谢谢大家的参与和讨论，谢谢赵老师点评及xinzhu的准确翻译。
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xinzhu1492: 谢谢老师详细的解析，原来SYN的表达才是重点，学习了，真的要好好学习免疫组化2012-12-04 10:32
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