摘要
目的 探讨卵巢甲状腺肿的临床及病理组织学特征、诊断、鉴别诊断、治疗及预后。方法 收集大兴区人民医院1例卵巢甲状腺肿转移至腹膜后、阑尾等处的临床病例资料,观察原发灶及转移灶的临床表现、影像学、组织病理学、结合免疫组化、荧光PCR检测,对这种罕见病例进行分析,并复习相关文献。结果 患者35岁,体检时影像学发现右腹膜后占位,行右腹膜后占位及阑尾切除。患者3年前行右卵巢肿物切除术,术后右腹膜后占位、阑尾及回顾分析卵巢肿物镜下病理均示形态学呈良性甲状腺组织的表现。免疫组化TTF-1和TG(+),荧光PCR检测K-ras、N-ras、BRAF均未发现突变。分析超出卵巢出现周围播散镜下呈良性改变的卵巢甲状腺肿的病理诊断,可能为卵巢甲状腺肿破裂种植,也可能是来源于卵巢甲状腺肿的高分化滤泡癌(HDFCO)。镜下组织学呈良性,但生物学呈恶性表现。结论 卵巢甲状腺肿是一种高度特异性卵巢单胚层畸胎瘤,具有发病率低、恶变率低、临床特点不特异、术前诊断困难等特点,尤其是超出卵巢病变已有播散而镜下组织学呈良性的卵巢甲状腺肿发病率更低,具有较独特的临床病理学特征,需与颗粒细胞瘤、类癌等鉴别。明确诊断需结合组织病理学形态、临床及影像学等资料。治疗以手术切除为主,预后好,长期随访至关必要。
Purpose To investigate the clinical and histopathological features,diagnosis,differential diagnosis,treatment and prognosis of ovarian goiter.Methods The clinical data of one case of ovarian goiter metastasis to retroperitoneum and appendix in Daxing District People's Hospital were collected.The clinical manifestations,imaging,histopathology,immunohistochemistry and fluorescent PCR of primary and metastatic lesions were observed to analyze this rare case with review of related literature.Results The patient was 35 years old.At the time of physical examination,the right peritoneal mass was found in the right posterior peritoneum.The right retroperitoneal space and appendectomy were performed.The patient underwent right ovarian mass resection 3 years ago.Review the pathology of ovarian tumors showed that the morphology was benign thyroid tissue.Immunohistochemistry showed TTF-1 and TG(+).PCR-DNA detection of Kras,N-ras and BRAF showed no mutation.Analysis of the pathological diagnosis showed that ovarian goiter that was benign ovarian appearance might be implanted for ovarian goiter rupture,or a highly differentiated follicular carcinoma of ovarian origin(HDFCO),in which the histology was benign but biologically malignant.Conclusions Ovarian goiter is a highly specific ovarian monolayer fetal teratoma with low incidence,low malignant rate,unspecific clinical features,and difficult preoperative diagnosis,especially if the ovarian lesions have spread.Histology shows a benign ovarian goiter with a lower incidence,and unique clinical pathological features;It needs to be differentiated from granulosa cell tumors and carcinoids.The diagnosis should be combined with histopathological morphology,clinical and imaging data.The treatment is mainly surgical resection,and the prognosis is good.Long-term follow-up is necessary.
作者
乔星
祁晓莉
武迪
任平
王哲哲
卢晓红
QIAO Xing;QI Xiao-li;WU Di;REN Ping;WANG Zhe-zhe;LU Xiao-hong(Daxing Teaching Hospital of Capital Medical University,Beijing 102600,China)
出处
《诊断病理学杂志》
2019年第12期808-811,816,共5页
Chinese Journal of Diagnostic Pathology
关键词
卵巢甲状腺肿
腹腔播散种植
鉴别诊断
免疫组化
荧光PCR
治疗
预后
Ovarian goiter
Abdominal dissemination
Differential diagnosis
Immunohistochemistry
Fluorescent PCR
Treatment
Prognosis
