6例卵巢Brenner瘤病理特征分析

doi:10.12280/gjszjk.20230327

摘要/Abstract

摘要：

目的：探讨卵巢Brenner瘤（ovarian Brenner tumor）的临床病理特征及免疫组织化学特点。方法：回顾苏州大学附属苏州九院（我院）2019年1月—2023年2月收治的6例卵巢Brenner瘤患者的临床资料、病理特征、免疫表型、分子特点并进行分析总结。结果：6例患者年龄54~73岁，中位年龄66岁，其中4例为卵巢良性Brenner瘤，2例为卵巢恶性Brenner瘤。4例良性及1例恶性卵巢Brenner瘤患者生化指标未见异常，但另1例卵巢恶性Brenner瘤患者糖类抗原125（carbohydrate antigen 125，CA125）水平明显增高。镜下见卵巢良性Brenner瘤由移行细胞上皮巢及纤维间质组成，瘤细胞无异型，细胞核卵圆形，核仁较小，卵巢恶性Brenner瘤镜下见有明确的间质浸润，瘤细胞明显异型，核质比大，核分裂易见，同时可伴有卵巢良性Brenner瘤和卵巢交界性Brenner瘤成分。免疫组织化学表型示6例患者的瘤细胞细胞角蛋白7（cytokeratin 7，CK7）、P63、GATA结合蛋白3（GATA binding protein 3，GATA3）均为阳性，配对盒基因8（paired box 8，PAX8）、肾母细胞瘤基因1（Wilm′s tumor gene 1，WT1）、CK20均为阴性，Ki-67在卵巢良性Brenner瘤中增殖指数<1%，在卵巢恶性Brenner瘤中约20%~60%。4例卵巢良性Brenner瘤患者均行患侧附件切除术，预后较好；1例卵巢恶性Brenner瘤行腹腔镜卵巢分期手术，随访11个月未见复发及转移；另1例卵巢恶性Brenner瘤因未在我院手术而失访。结论：卵巢Brenner瘤诊断需依据组织病理学和免疫组织化学检查，良、恶性Brenner瘤的鉴别在于细胞的异型程度及有无间质浸润，Ki-67增殖指数也可作为参考指标。

关键词: 卵巢肿瘤, Brenner瘤, 免疫表型分型, 病理学，临床, 诊断，鉴别

Abstract:

Objective: To investigate the clinicopathological and immunohistochemical characteristics of ovarian Brenner tumor. Methods: The clinical data, pathological features, immunophenotypes, and molecular characteristics of six patients with ovarian Brenner tumor between January 2019 and February 2023 at Suzhou Ninth Hospital Affiliated to Soochow University (our hospital) were retrospectively analyzed. Results: The age of the six patients varied from 54 to 73 years, with a median age of 66 years. Among these patients, four were diagnosed with benign ovarian Brenner tumor, while two were malignant. Biochemical indicators of 4 patients with benign ovarian Brenner tumor and one with malignant ovarian Brenner tumor were within normal ranges, while the level of carbohydrate antigen 125 (CA125) in another one patient with malignant ovarian Brenner tumor was significant increased. Microscopic examination revealed that the tissue of benign ovarian Brenner tumor was consisted of transitional cell epithelial nests, accompanied by fibrous stroma. These cells did not display any atypia and had oval nuclei with small nucleoli. In contrast, the tissue of malignant ovarian Brenner tumor exhibited clear stromal infiltration, evident atypia, a high nuclear plasma ratio, and increased mitotic activity, which was accompanied by benign ovarian Brenner tumor and borderline ovarian Brenner tumor components. Immunohistochemical staining showed that the tumor cells were positive for cytokeratin 7 (CK7), P63 and GATA binding protein 3 (GATA3), but negative for paired box 8 (PAX8), Wilm′s tumor gene 1 (WT1) and CK20. Ki-67 proliferation index was lowered 1% in benign ovarian Brenner tumor and about 20%-60% in malignant ovarian Brenner tumor. Four patients with benign ovarian Brenner′s tumor underwent adnexectomy on the affected side, with a good prognosis. One case of malignant ovarian Brenner′s tumor underwent laparoscopic ovarian staging surgery, and no recurrence or metastasis was found after 11 months of follow-up. Another case of ovarian malignant ovarian Brenner tumor was lost due to not undergoing surgery in our hospital. Conclusions: The diagnosis of ovarian Brenner tumor depends on the histopathological characteristics and immunohistochemistry. The differential diagnosis of benign and malignant ovarian Brenner tumor is based on the degree of cell atypia and stromal invasion. In addition, Ki-67 proliferation index can be used as a reference index.

Key words: Ovarian neoplasms, Brenner tumor, Immunophenotyping, Pathology, clinical, Diagnosis, differential

马燕红, 展瑞. 6例卵巢Brenner瘤病理特征分析[J]. 国际生殖健康/计划生育杂志, 2023, 42(6): 446-449.

MA Yan-hong, ZHAN Rui. Pathological Characteristics of 6 Cases of Ovarian Brenner Tumor[J]. Journal of International Reproductive Health/Family Planning, 2023, 42(6): 446-449.

图/表 1

图1 卵巢Brenner瘤的病理图注： A 良性Brenner瘤可见移行细胞上皮巢被纤维间质包绕，细胞大小一致，界限清楚，细胞核无异型，胞质透明，无间质浸润（HE染色×100）；B 恶性Brenner瘤可见明显间质浸润，瘤细胞层次明显增多，呈不规则巢状，核深染、异型，可见病理性核分裂像（HE染色×100）；C 良性Brenner瘤的肿瘤细胞CK7呈阳性（EnVision两步法染色×100）；D 良性Brenner瘤的肿瘤细胞GATA3呈阳性（EnVision两步法染色×100）；E 良性Brenner瘤的肿瘤细胞P63呈阳性（EnVision两步法染色×100）；F 良性Brenner瘤的肿瘤细胞PAX8呈阴性（EnVision两步法染色×100）；G 恶性Brenner瘤的肿瘤细胞CK20呈阴性（EnVision两步法染色×100）；H 良性Brenner瘤的肿瘤细胞增殖指数Ki-67偏低（EnVision两步法染色×100）；I 恶性Brenner瘤的肿瘤细胞增殖指数Ki-67偏高（EnVision两步法染色×100）。

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