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性别 | 女 | 年龄 | 34 | 临床诊断 | 卵巢肿瘤 |
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一般病史 | 无 | ||||
标本名称 | 卵巢肿瘤 | ||||
大体所见 | 无 |
会诊病例,我仅有其中一张切片,也没有具体肿瘤大小信息,照片显示的是肿瘤的最严重的地方。
欢迎大家讨论。
lingjiejie 离线
此例是一例卵巢粘液性肿瘤,排除了转移的可能。有些区域肿瘤细胞去黏液分泌,所以看似象浆液性的上皮,但明显存在的杯状细胞还是提示是粘液性肿瘤。那么,此例的困难之处在于细胞的异型性较大,如果没有浸润则可诊断为上皮内癌。但卵巢粘液性肿瘤的浸润方式有两种,一种为破坏性浸润,在间质中出现不规则的小腺体或肿瘤细胞巢,伴有间质反应,这种比较容易诊断。但还有一种为膨胀型浸润方式,即腺体膨大,形成大量的腔内乳头和子腺体,较少或没有间质,判断上主观意味比较强,而且有学者以3mm来定义,有些以5mm,更有人认为大小没有决定性。这例确实存在有类似膨胀型浸润的地方,是诊断癌还是交界性肿瘤?
xinzhu1492 离线
vitamin-xbl 离线
wangruihui 离线
vitamin-xbl 离线
这一例是AFIP的会诊切片。
原切片的诊断是:Left ovary: Mucinous tumor of low malignant potential (Mullerian/endocervical-like) with extensive intraepithelial carcinoma (see comment)
COMMENT:
The staff essentially concurs with your diagnosis of a mucinous tumor of low malignant potential based on the atypical proliferative mucinous glands with prominent epithelial stratification and tufting as well as hyperchromatic, atypical nuclei. There is extensive glandular crowding and a confluent (back-to-back) growth pattern, without evidence of destructive/infiltrative stromal invasion, features of intraepithelial carcinoma. In the past at the AFIP, this type of lesion with its marked stratification, nuclear atypia and abundant mitoses would have been regarded as a mucinous cystadenocarcinoma. However, presently, tumors such as these without definite stromal invasion do not qualify as mucinous cystadenocarcinoma. Hence, the designation “mucinous tumor as one of low maglignant potential with extensive intraepithelial carcinoma” is preferred in this case (Am J Surg Pathol, 23(6):617-635, 1991 and Am J Surg Pathol 24(11):1447-64, 2000).