Department of Pathology, Shizuoka City Shimizu Hospital, Miyakami 1231 Shimizu-Ku, Shizuoka, 424-8636, Japan.
Arch Gynecol Obstet. 2010 Feb;281(2):345-8. doi: 10.1007/s00404-009-1132-y. Epub 2009 May 31.
Only one case of carcinosarcoma in the pouch of douglas has been reported in the English literature.
The author herein reports a case of carcinosarcoma of the pouch of douglas. A rapidly growing tumor (10 cm in diameter) was found in the pelvic cavity of a 51-year-old woman, and an operation was performed for the clinical diagnosis of left ovarian malignancy. However, it was found that the tumor was located in the pouch of douglas, free of ovarian involvement. Because the tumor was impossible to resect totally, an incisional biopsy was performed. Histologically, the tumor showed a mixture of squamous cell carcinoma, atypical epithelial cells occasionally forming tubules, myxomatous spindle cell sarcoma, and chondrosarcoma. The tumor showed abundant vessels, hemorrhage and necrosis. Immunohistochemically, the squamous cell carcinoma and atypical epithelium components were positive for cytokeratins, CEA, CA125, and p53 protein. The spindle cell sarcoma and chondrosarcoma components were positive for vimentin and p53 protein. The overall Ki-67 labeling was 30%. The author diagnosed the present case as carcinosarcoma of heterologous type.
The present case shows that carcinosarcoma can occur in the pouch of douglas. It may arise from misplaced Mullerian duct remnants in the pouch of douglas.
仅有 1 例文献报道的 Douglas 窝内的癌肉瘤。
作者报告了 1 例 Douglas 窝内的癌肉瘤病例。一位 51 岁女性的盆腔内发现一个快速生长的肿瘤（直径 10 厘米），临床诊断为左侧卵巢恶性肿瘤而行手术治疗。然而，发现肿瘤位于 Douglas 窝内，与卵巢无关。由于肿瘤无法完全切除，因此进行了切开活检。组织学上，肿瘤显示出鳞状细胞癌、偶尔形成小管的非典型上皮细胞、黏液样梭形细胞肉瘤和软骨肉瘤的混合。肿瘤有丰富的血管、出血和坏死。免疫组织化学染色显示，鳞状细胞癌和非典型上皮成分细胞角蛋白、CEA、CA125 和 p53 蛋白阳性。梭形细胞肉瘤和软骨肉瘤成分阳性表达波形蛋白和 p53 蛋白。总体 Ki-67 标记指数为 30%。作者诊断为异源性癌肉瘤。
本病例表明癌肉瘤可发生于 Douglas 窝内，可能来源于 Douglas 窝内错位的 Müllerian 管遗迹。
