Young R H, Scully R E
Department of Pathology, Harvard Medical School, Boston, Massachusetts.
Int J Gynecol Pathol. 1990;9(3):231-52. doi: 10.1097/00004347-199007000-00004.
Twenty-one cases in which sarcomas metastasized to the ovaries are reported. The patients ranged from 18 to 79 (average 42) years of age; only five of them were over 50 years old. Eleven tumors were primary in the uterus and 10 outside the genital tract. Three uterine tumors were leiomyosarcomas, and eight, endometrial stromal sarcomas. The extragenital primary tumors were leiomyosarcoma of the stomach (1) and small intestine (2), retrovesical leiomyosarcoma (1), fibrosarcoma of the anterior abdominal wall (1), sarcoma of the mesentery of smooth muscle or neural type (1), hemangiosarcoma probably primary in the heart (1), osteosarcoma of the maxilla (1), chondrosarcoma of the rib (1), and Ewing's sarcoma of the pubic bone (1). The ovarian tumors, most of which were large, were discovered at the same time as the primary tumors in 11 cases; in seven cases, the ovarian tumor was discovered 7 months to 9 years after diagnosis of the primary tumor. In three cases, the ovarian tumors were discovered 4, 7, and 10 months before detection of the primary neoplasm. Two of these tumors were endometrial stromal sarcomas, and one, an epithelioid leiomyosarcoma of the stomach. Eleven ovarian metastases were bilateral. On microscopic examination, the greatest difficulty in pathologic interpretation was posed by the metastatic endometrial stromal sarcomas because of their simulation of sex cord-stromal tumors. Features helpful in their distinction from these tumors included the frequent presence of extra-ovarian disease, bilaterality, and a characteristic content of small arteries resembling the spiral arteries of the late secretory endometrium. The other tumor that caused major diagnostic difficulty was the metastatic epithelioid leiomyosarcoma from the stomach, which had a pattern that initially suggested the solid-tubular pattern of a Sertoli cell tumor.
报告了21例肉瘤转移至卵巢的病例。患者年龄在18岁至79岁之间（平均42岁）；其中只有5例年龄超过50岁。11例肿瘤原发于子宫，10例原发于生殖道外。3例子宫肿瘤为平滑肌肉瘤，8例为子宫内膜间质肉瘤。生殖道外原发性肿瘤包括胃平滑肌肉瘤（1例）、小肠平滑肌肉瘤（2例）、膀胱后平滑肌肉瘤（1例）、前腹壁纤维肉瘤（1例）、平滑肌或神经型肠系膜肉瘤（1例）、可能原发于心脏的血管肉瘤（1例）、上颌骨骨肉瘤（1例）、肋骨软骨肉瘤（1例）和耻骨尤文肉瘤（1例）。卵巢肿瘤大多较大，11例与原发性肿瘤同时发现；7例卵巢肿瘤在原发性肿瘤诊断后7个月至9年发现。3例卵巢肿瘤在原发性肿瘤检测前4个月、7个月和10个月发现。其中2例肿瘤为子宫内膜间质肉瘤，1例为胃上皮样平滑肌肉瘤。11例卵巢转移为双侧性。在显微镜检查中，转移性子宫内膜间质肉瘤因其模拟性索间质肿瘤而给病理诊断带来最大困难。有助于将它们与这些肿瘤区分开来的特征包括卵巢外疾病的频繁出现、双侧性以及类似于分泌晚期子宫内膜螺旋动脉的小动脉特征性内容物。另一种造成主要诊断困难的肿瘤是来自胃的转移性上皮样平滑肌肉瘤，其模式最初提示支持细胞瘤的实性管状模式。
