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- 51岁，双侧卵巢肿瘤
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| 姓 名： | ××× | 性别： | 女 | 年龄： | 51岁 |
| 标本名称： | 双侧卵巢肿瘤 | ||||
| 简要病史： | 检查胃肠道等无异常发现 | ||||
| 肉眼检查： | 双侧卵巢囊实性肿瘤，均约9cm*8cm*7cm大小 | ||||
标签：卵巢 恶性间皮瘤
知之者不如好之者，好之者不如乐之者。（语出幽梦影）
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Thank you for sharing this great case with us!
A recent study just published related to this case. I post the abstract for your reference.
| American Journal of Clinical Pathology | ||
| Issue: | Volume 130, Number 5 / November 2008 | |
| Pages: | 771 - 779 | |
| URL: | Linking Options | |
| A Useful Antibody Panel for Differential Diagnosis Between Peritoneal Mesothelioma and Ovarian Serous Carcinoma in Japanese Cases Yukio Takeshima A1, Vishwa J. Amatya A1, Kei Kushitani A1, Kouki Inai A1 A1 Department of Pathology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan Abstract: Malignant mesothelioma is increasing in incidence worldwide, including in Japan. However, the accurate pathologic diagnosis of pleural or peritoneal mesothelioma (PM) is sometimes difficult if adequate histologic and immunohistochemical analyses are not undertaken. The aim of this study was to identify a useful antibody panel for distinguishing PM from ovarian serous papillary adenocarcinoma (SC). We obtained 29 PMs (23 epithelioid mesotheliomas and 6 biphasic mesotheliomas) and 20 SCs from our surgical pathology files. Immunohistochemical analysis was undertaken using 13 commercially available antibodies. No significant sex differences in antigen expression among the 29 PMs were observed. The results identified calretinin and thrombomodulin as positive markers and Ber-EP4, MOC-31, CA19-9, and estrogen receptor as negative markers with relatively high sensitivity and specificity for the differential diagnosis of PM and SC. The combination of these positive and negative markers may contribute to accurate diagnosis and adequate therapy for PM and ovarian SC. |
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stevenshen 离线
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Thanks very much for providing final diagnosis. I guess it could be 恶性间皮瘤, but ovarian 恶性间皮瘤 must be extremely rare. The diagnosis of malignant mesothelioma almost always need immunohistochemical confirmation. Most peoples suggest to do at least two markers for mesothelioma and two for carcinoma. In ovary the suggestion of WT1, ER and PR might be helpful. Great case!
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stevenshen 离线
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favor 原发性上皮性恶性性肿瘤，不能分类: consider high grade serous or transtional (malignant Brenner tumor). Main goal will be rule out metastasis (clinical more effective). Less likely to be sex cord stromal or malignant germ cell tumor. Good to see Dr. Bing Yang's comments. Great lecture last Saturday.
IHC
ck7, ck20, ae1/ae3, CDX2
ER, PR
AFP, CD30, EMA
WT1, calretinin, inhibin, ck5/6
Above IHC stains should tell the tumor is primary , secondary tumors or mesohtelioma; If it is an ovarian primary tumor the IHC stains can tell it is an epithelial tumor, sex cord-stromal tumor, or germ cell tumor.
If IHC stains confirm it is ovarian epithelial malignancy. Differential dx: include serous and clear cell tumor.
Serous: p53,WT1, p16 are strongly positive.CCC can be positive for these markers, but they are weak and focal in most cases. The chance of endometrial tumor is low based on the photos.
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Whenever you have a bilateral malignant tumor with high grde features like this one, you should first to rule out a metastatic carcinoma. High grade serous adenocarcinoma is on the top differential list for primary ovarian carcinoma since bilaterality is not uncommon in serous adenocarcinoma. One of the useful markers is to see if tumor cells are positive for WT-1, a marker often labeling mullerian epithelium. Also up to 50% of serous adenocarcinoma will be positive for ER and PR. For metastatic cancer (mostly from GI tract), CK20 is a good marker to differentiate metastatic carcinoma from coorectal or stomach from primary serous adenocarcinoma, provide no mucinous differentiation seen in this tumor anywhere else.
- 不坠青云之志，长怀赤子之心
