[摘要] 目的 探討卵巢颗粒细胞瘤的临床和病理学特征、生物学行为及治疗预后。 方法 通过组织学观察，结合免疫组织化学技术，对25例卵巢颗粒细胞瘤的临床病理资料进行回顾性分析。 结果 患者年龄32～77岁，表现为绝经后阴道流血16例，17例呈实性为主，少数区可见大小不一囊腔，仅1例肿瘤为单房囊性。病理组织学特点是瘤细胞呈小的多边形或椭圆形，细胞质稀少，淡红色，细胞核呈圆形或卵圆形，呈石榴子样，可见纵行核沟，呈咖啡豆样外观及14例部分区可见Call-Exner小体。免疫组化：α-inhibin表达阳性率为92.00%（23/25），CD99、CD56、Vimentin表达阳性率为100.00%（25/25），SMA阳性率为72.00%（18/25），CKPan 阳性率为44.00%（11/25），ER表达阳性率为48.00%（12/25），PR表达阳性率为60.00%（15/25）；Ki-67呈低表达；25例Syn、CGA、CK7、CEA均阴性。7例施根治术（包括切除子宫、双附件、大网膜、阑尾），16例患者全子宫及双侧附件切除，2例行单侧附件切除。术后辅助化疗7例，18例未化疗。23例随访6个月～12年，1例肿瘤破裂、部分区伴有支持细胞成份的73岁患者术后11个月因出现腹腔转移与腹水而死亡；1例因脑出血死亡；其余21例患者均存活；2例失访。 结论 卵巢颗粒细胞瘤较为少见，属于低度恶性的肿瘤，手术切除是主要治疗方法，临床分期、肿瘤是否破裂是影响患者预后的重要因素，术后应终身随访。
[关键词] 卵巢肿瘤；颗粒细胞瘤；免疫组织化学；鉴别
[中图分类号] R737.71 [文献标识码] B [文章编号] 1673-9701（2018）16-0127-05
[Abstract] Objective To explore the clinical and pathological features， biological behavior and prognosis of ovarian granulosa cell tumor（GCT）. Methods The clinical and pathological data of 25 cases of ovarian granulosa cell tumor were analyzed retrospectively by histological observation and immunohistochemical technique. Results The ages of the patients were 32-77 years old. Clinical Feature of 16 cases was postmenopausal vaginal bleeding， while that of another 17 cases was solid with different sizes of cystic cavity in few of them. There was only one case of single atrial cystic mass. As for histopathological characteristics， tumor cells were small polygonal or oval， cytoplasm sparse and light red. The nucleus were circular or oval and garnet-like with visible longitudinal nuclear grooves， looking like coffee beans. Call-Exner bodies could be seen in some parts of 14 cases. Immunohistochemistry： The positive expression rate ofα-inhibin was 92.00%（23/25）. The positive expression rates of CD99， CD56， Vimentin were 100.00% （25/25）. The positive expression rates of SMA， CKPan， ER and PR were 72.00%（18/25）， 44.00%（11/25）， 48.00%（12/25） and 60.00%（15/25）， respectively. The expression of Ki-67 was low. The expression of Syn， CGA， CK7 and CEA in 25 cases were negative. 7 cases were treated with radical resection （including resection of uterus， double attachments， omentum， appendix）. 16 patients were treated with total hysterectomy and bilateral adnexectomy. Two cases received unilateral adnexectomy. Postoperative adjuvant chemotherapy was performed in seven cases while 18 cases were not treated with chemotherapy. 23 cases were followed up for 6 months to 12 years. One 73-year old patient with tumor rupture and Sertoli cells in some areas died of abdominal metastasis and ascites 11 months after operation. One case died of cerebral hemorrhage， while the remaining 21 patients survived with two cases lost. Conclusion Ovarian granulosa cell tumor is relatively rare as a low-grade malignant tumor. Surgical resection is the main treatment. Clinical stage and tumor rupture are important factors that affect the prognosis of patients. Postoperative follow-up should be lifelong.
