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目的探讨卵巢类固醇细胞瘤(SCT)的临床病理特征、免疫表型、诊断与鉴别诊断及治疗与预后。方法对19例卵巢SCT的临床表现、病理学形态、免疫组化等进行观察,并复习相关文献。结果患者年龄18~63岁(平均41岁),常因男性化表现就诊。肿瘤直径0.3~16 cm,包括非特异性类固醇细胞瘤和Leydig细胞瘤两类。前者以透明细胞为主体,类似肾上腺皮质结构;后者以嗜酸性细胞为主,细胞核密集分布区和稀疏区相间分布,可见血管壁纤维素样坏死,胞质内含有Reinke结晶或嗜酸性包涵体。免疫组化:多数病例α-inhibin、calretinin、CD99和melan-A不同程度(+),1例AE1/AE3局灶(+),另有1例Syn局灶(+)。仅有1例肿瘤出现腹腔内复发和转移。患者术后中位随访时间24个月,均呈无瘤生存状态。结论卵巢SCT诊断依赖于特征性临床表现、组织学及免疫组化染色特点。手术治疗总体预后良好,但个别病例可以发生局部复发或腹腔内转移。
Objective To investigate the clinical and pathological features, immunophenotype, diagnosis and differential diagnosis, treatment and prognosis of ovarian steroid tumor (SCT). Methods The clinical manifestations, histopathology and immunohistochemistry of 19 cases of ovarian SCT were observed and reviewed. Results Patients aged 18 to 63 years (mean 41 years), often due to masculine performance treatment. Tumor diameter 0.3 ~ 16 cm, including nonspecific steroid cell tumor and Leydig cell tumor two categories. The former is mainly composed of clear cells, similar to the adrenal cortex structure. The latter is mainly eosinophilic cells. The distribution of dense nuclei and the sparse area are distributed alternately. The vascular wall fibrosis is necrotic. The cytoplasm contains Reinke crystals or eosinophilic inclusion bodies . Immunohistochemistry: In most cases, α-inhibin, calretinin, CD99 and melan-A were different degrees (+), AE1 / AE3 foci (+), and another Syn Focal lesion (+). Only one tumor developed intraperitoneal recurrence and metastasis. The median follow-up time was 24 months after operation, showing no tumor-free survival. Conclusion The diagnosis of ovarian SCT depends on the characteristics of clinical manifestations, histological and immunohistochemical staining. Surgical treatment of the overall prognosis is good, but some cases of local recurrence or intra-abdominal metastasis may occur.