摘要
目的 探讨双侧卵巢同时性分别发生高、低级别浆液性癌的临床特点、诊断与鉴别诊断、病理特征与基因表达关系、治疗及预后.方法 回顾性分析1例双侧卵巢同时性分别发生高、低级别浆液性癌患者的HE染色、免疫组织化学染色、基因检测特征,并进行相关国内外文献复习.结果 HE染色结果显示左侧卵巢呈高级别浆液性癌的形态,细胞核大,核浆比高,肿瘤细胞排列成乳头样、实性,可见大片坏死.右侧卵巢肉眼所见呈囊性,镜下见良性浆液性囊腺瘤区域以及交界性肿瘤的区域,符合低级别浆液性癌的镜下表现.左侧卵巢免疫组织化学染色显示PAX8、WT1阳性,PCK阳性,vimentin阴性,p53显示突变型,Ki-67增殖指数约50％.基因检测结果显示两侧卵巢均存在TP53 p.V122fs基因突变,未见KRAS和BRAF突变.结论 高、低级别浆液性癌发病机制仍不明确,两者有共同分子学改变时低级别浆液性癌有向高级别转化的可能;双侧卵巢同时性分别发生高、低级别浆液性癌十分罕见;临床诊治需结合组织学形态、免疫组化染色及分子学检测综合判断.
Abstract
Objective To explore the clinical characteristics,diagnosis and differential diagnosis,pathological features,gene ex-pression relationship,treatment,and prognosis of simultaneous high-grade and low-grade serous carcinoma occurring in both ovaries.investigate the clinical features,diagnosis and differential diagnosis,relationship between pathological features and gene expression,treatment and prognosis of simultaneous high and low grade serous carcinoma of both ovaries.Methods A retrospective analysis of one case of simultaneous high-grade and low-grade serous carcinoma in both ovaries was conducted,involving HE staining,immunohisto-chemical staining,and genetic testing characteristics,along with a review of relevant domestic and international literature.Results HE staining revealed that the left ovary exhibited high-grade serous carcinoma morphology with large nuclei,high nuclear-to-cytoplasmic ratio,and tumor cells arranged in papillary and solid patterns,with extensive necrosis observed.Gross examination of the right ovary showed a cystic structure,and microscopy revealed areas of benign serous cystadenoma and borderline tumors,consistent with the microscopic appearance of low-grade serous carcinoma.Immunohistochemical staining of the left ovary showed positivity for PAX8,WT1,and PCK,negativity for vimentin,and mutant p53,with a Ki-67 proliferation index of approximately 50％.Genetic testing re-vealed TP53 p.V122fs mutations in both ovaries,with no KRAS or BRAF mutations detected.Conclusion The pathogenesis of high-grade and low-grade serous carcinomas remains unclear.The presence of common molecular alterations suggests that low-grade serous carcinoma may transform into high-grade;the occurrence of simultaneous high-grade and low-grade serous carcinoma in both ovaries is extremely rare;clinical diagnosis and treatment should be based on a comprehensive assessment combining histological morphology,immunohistochemistry,and molecular testing.
维普
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