原发性卵巢高钙血症型小细胞癌伴肾功能不全临床病理分析

发布时间：2018-05-21 04:28

本文选题：卵巢肿瘤 + 小细胞癌　；参考：《临床与实验病理学杂志》2015年05期

【摘要】：目的探讨卵巢高钙血症型小细胞癌(ovarian small cell carcinoma hypercalcemic type,OSCCHT)伴急性肾功能不全的临床病理学特征、诊断及鉴别诊断。方法回顾性分析1例OSCCHT伴急性肾脏功能不全患者的临床资料、组织学形态、免疫表型、超微结构等,并复习相关文献。结果患者女性,29岁。因无明显诱因出现食欲不振伴明显消瘦1个月余。实验室检查示肾功能异常;影像学示盆腔肿块,考虑附件来源。血液透析肾功能部分恢复后行手术。右侧卵巢见一12 cm×10 cm×10 cm大小肿瘤,镜下见瘤细胞呈弥漫实性分布,被纤维条索分割成多结节状,部分细胞间可见小滤泡样、假腺样结构,腔内可见嗜酸性分泌物,瘤细胞中等偏大,胞质嗜酸性,核圆形、卵圆形,核呈空泡状,核质比高,核分裂象多见。免疫表型:癌细胞EMA和CK、C-erb B-2均(+),CA125(灶+),ER、PR、Syn、Cg A、PTH、Inhibin、CD99、AFP、PLAP、CD30和CD20均(-),Ki-67增殖指数约60%。结论 OSCCHT临床少见,同时伴急性肾脏功能不全更为罕见。OSCCHT是一种进展迅速、高度恶性的卵巢恶性肿瘤,确诊主要根据其临床特点(血钙升高等)、病理学特征及免疫表型,必要时可结合电镜和分子生物学检测辅助诊断。
[Abstract]:Objective to investigate the clinicopathological features, diagnosis and differential diagnosis of ovarian hypercalcinemic small cell carcinoma (SCC) with acute renal insufficiency. Methods the clinical data, histological morphology, immunophenotype and ultrastructure of one case of OSCCHT with acute renal insufficiency were retrospectively analyzed. Results the female patient was 29 years old. Loss of appetite and apparent wasting occurred without obvious inducement for more than one month. Laboratory examination showed abnormal renal function, and imaging showed pelvic masses, considering the source of attachments. Hemodialysis was performed after partial recovery of renal function. In the right ovary, a 12 cm 脳 10 cm tumor was seen. Under microscope, the tumor cells were distributed diffusely. The tumor cells were divided into many nodules by fibrous strips. Some of the cells could be divided into small follicles, pseudoglandular structures and eosinophilic secretions in the lumen. The tumor cells were medium large, eosinophilic in cytoplasm, round in nucleus, oval in shape, vacuolated in nucleus, high in ratio of nucleus to cytoplasm, and more frequent in mitotic appearance. Immunophenotype: the proliferative index of EMA and CK-erb B-2 in cancer cells were about 60%. The proliferative index of EMA and CKC C-erb B-2 were about 60% (P < 0.01), and the proliferative index was about 60% (P < 0.01). The proliferative index of EMA and CK-erb B-2 in cancer cells were about 60% (P < 0.01). The proliferative index of EMA and CKC C-erb B-2 were about 60%. Conclusion OSCCHT is a rapidly developing and highly malignant ovarian tumor. The diagnosis is mainly based on its clinical features (elevated serum calcium, histopathological features and immunophenotype). If necessary, it can be combined with electron microscopy and molecular biological detection to assist diagnosis.
【作者单位】：南京军区南京总医院妇科;南京军区南京总医院病理科;
【分类号】：R737.31

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