Eichhorn John H, Young Robert H
James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, and the Department of Pathology, Harvard Medical School, Boston, MA 02114, USA.
Am J Surg Pathol. 2004 Apr;28(4):453-63. doi: 10.1097/00000478-200404000-00004.
Transitional cell carcinoma (TCC) of the ovary is a recently recognized subtype of ovarian surface epithelial-stromal cancer, and studies of its morphology are few. As a result, the criteria for its diagnosis and spectrum of its morphology are not clearly established. One hundred consecutive consultation cases of ovarian carcinoma with a pure or partial transitional cell pattern (excluding malignant Brenner tumor) diagnosed between 1989 and 2001 were evaluated for the frequency of various pathologic features and the relation of TCC to other surface epithelial-stromal carcinomas. The women were 33 to 94 years of age (mean, 56 years). A total of 47 tumors were stage I, 21 stage II, 31 stage III, and 1 stage IV; 13% of the stage I tumors and 41% of tumors of all stages were bilateral. The tumors ranged from 3.0 to 30 cm in greatest dimension (mean, 10 cm); 60% of them were solid and cystic, 24% solid, and 16% cystic. TCC was the exclusive or predominant component in 93% of the tumors and showed undulating (93%), diffuse (57%), insular (55%), and trabecular (43%) patterns. In four tumors with an insular growth, the pattern focally mimicked a Brenner tumor. Necrosis was present in 57% of the cases. Features that were seen in the tumors that in aggregate produced a relatively consistent appearance were "punched out" microspaces (87%), often the size of Call-Exner bodies, large cystic spaces (73%), and large blunt papillae (63%). Features that were sometimes seen, usually as a focal finding, included slit-like fenestrations (49%), bizarre giant cells (35%), small filiform papillae (18%), gland-like tubules (17%), squamous differentiation (13%), and psammoma bodies (4%). In 23 cases, TCC was a component of a mixed epithelial carcinoma, the additional components being serous adenocarcinoma in 16, endometrioid in 5, mucinous in 1, and clear cell carcinoma in 1. The tumor cells of the TCC component often were relatively monomorphic; 6% of the tumors were grade 1, 43% grade 2, and 51% grade 3. The nuclei were oblong or round and often had large single nucleoli (69%) or longitudinal grooves (48%). The cytoplasm was typically pale and granular but was rarely strikingly clear or oxyphilic. TCC of the ovary usually occurs in pure form but is also common as a component of a surface epithelial carcinoma of mixed cell type. In either situation, TCC has a constellation of architectural and cytologic features that readily distinguish it in most cases from other types of ovarian cancer. Recognition of these features will lead to a more consistent diagnosis of this tumor and aid in determining whether it has distinctive clinical features, particularly with regard to its behavior.
卵巢移行细胞癌（TCC）是卵巢表面上皮 - 间质癌中最近才被认识的一种亚型，对其形态学的研究较少。因此，其诊断标准和形态学谱尚未明确确立。对1989年至2001年间诊断的100例连续的具有纯或部分移行细胞模式（不包括恶性勃勒纳瘤）的卵巢癌会诊病例进行评估，以分析各种病理特征的频率以及TCC与其他表面上皮 - 间质癌的关系。这些女性年龄在33至94岁之间（平均56岁）。共有47例肿瘤为I期，21例为II期，31例为III期，1例为IV期；I期肿瘤的13%以及所有阶段肿瘤的41%为双侧性。肿瘤最大直径为3.0至30厘米（平均10厘米）；其中60%为实性和囊性，24%为实性，16%为囊性。TCC是93%的肿瘤中的唯一或主要成分，呈现起伏状（93%）、弥漫状（57%）、岛状（55%）和小梁状（43%）模式。在4例呈岛状生长的肿瘤中，其模式局部类似勃勒纳瘤。57%的病例存在坏死。肿瘤中总体呈现相对一致外观的特征包括“穿孔状”微腔（87%），其大小常如Call-Exner小体，大囊性腔隙（73%），以及大钝圆乳头（63%）。有时可见的特征，通常为局灶性表现，包括裂隙状小孔（49%）、奇异巨细胞（35%）、小丝状乳头（18%）、腺样小管（17%）、鳞状分化（13%）和砂粒体（4%）。在23例病例中，TCC是混合性上皮癌的一个成分，其他成分分别为浆液性腺癌16例、子宫内膜样癌5例、黏液性癌1例和透明细胞癌1例。TCC成分的肿瘤细胞通常相对单一形态；6%的肿瘤为1级，43%为2级，51%为3级。细胞核呈椭圆形或圆形，常具有大的单个核仁（69%）或纵向沟纹（48%）。细胞质通常淡染且呈颗粒状，但很少显著清亮或嗜酸性。卵巢TCC通常以纯形式出现，但作为混合细胞型表面上皮癌的一个成分也很常见。在任何一种情况下，TCC都具有一系列结构和细胞学特征，在大多数情况下能轻易将其与其他类型的卵巢癌区分开来。认识这些特征将有助于更一致地诊断这种肿瘤，并有助于确定它是否具有独特的临床特征，特别是在其行为方面。
