卵巢妊娠黄体瘤的临床病理研究及文献复习

摘要

背景与目的:妊娠黄体瘤(pregnancy luteoma,PL)是罕见的卵巢瘤样病变,易误诊,长期以来未被重视,且国内外文献多为个例报道,本文主要探讨PL的生物学行为,临床病理特征和组织学起源及其鉴别诊断.方法:观察5例PL的临床病理特征、免疫组化及网状纤维染色的特点,并复习相关文献.结果:5例PL患者均为初产妇,无妊娠史,2例有声音低沉的临床表现.HE染色见瘤细胞均呈多角或不规则形,细胞质丰富,充盈嗜酸性细颗粒,散在分布含伊红色胶质样物的滤泡洋结构,间质由薄壁小血管和纤细的纤维组织构成.1例行网状纤维染色,阳性着色位置为瘤细胞巢周围而非单个肿瘤细胞周围.免疫组化检测结果显示,Vimentin、α-inhibin、calretinin、WT-1、CD99和AE1/AE3呈阳性表达,EMA不表达.结论:PL为妊娠后期卵巢黄素化细胞的结节状增生,并非真性肿瘤,于产后可自行消退,孕妇或女婴可能会有男性化表现.妊娠期出现卵巢明显增大,无论伴或不伴有男性化体征时,均应首先考虑到本病的可能性,必要时术中可做活检行快速冰冻切片检查,以避免误诊致切除卵巢或过早终止妊娠等过度治疗.%Background and purpose: Luteum of pregnancy is a rare kind of tumor-like lesions of ovarian,easily cause misdiagnosis, has not been seriously and widely reported.This study aimed to investigate the biological behavior, clinical pathologic characteristics, histological origin and differential diagnosis of PL.Methods: The clinical and pathological characteristics of 5 cases of PL were reviewed.The characteristics of immunohistochemistry and reticular fibers staining and the related literatures were reviewed.Results: Five cases were all primiparas with no pregnancy history, and 2 cases had clinical manifestations expressing deep voice.HE staining tumor cells were multilateral or irregular, which had abundant cytoplasm and eosinophilic filling fine particles.The Iraqi Red gumlike mass of follicle-like structure was scattered.The interstitial composed of thin-walled small blood vessels and delicate fibrous tissue.One case for reticular fibers staining, positive staining around the cell nests of tumor rather than individual tumor cells.Immunohistochemistry result showed, the expression of vimentin, α-inhibin, calretinin, WT-1,CD99 and AE1/AE3 were positive, and EMA was negative.Conclusion: PL is nodular hyperplasia of luteinized cells in the late pregnancy, and could be self-cured after post-partum.Pregnant women or female baby might have masculine performance.Ifthe ovarian increases significantly during pregnancy, either with the signs of masculine or not, shall we consider about PL firstly.If necessary, biopsy can be done by rapid intraoperative frozen section examination to avoid misdiagnosis caused by over-treatment such as removal of ovaries or premature termination of pregnancy.