Departments of Pathology, Microbiology and Immunology (M.M.D., O.F.), Vanderbilt University Medical Center, Nashville, Tennessee Magee-Womens Hospital of University of Pittsburgh Medical Center (A.K., A.K.S.), Pittsburgh, Pennsylvania.
Int J Gynecol Pathol. 2014 Mar;33(2):186-90. doi: 10.1097/PGP.0b013e3182830a05.
Ovarian mucinous tumors with mural nodules are rare. The mural nodules are microscopically divergent neoplasms of varying sizes that may be benign (eg, sarcoma-like and carcinosarcoma-like), or malignant (eg, anaplastic carcinoma and sarcoma). The K-RAS gene mutation in ovarian mucinous neoplasms with mural nodules has not been previously reported. This is a case report of a 25-year-old female diagnosed with ovarian invasive mucinous adenocarcinoma with mural nodule of high-grade sarcoma. The mucinous tumor component demonstrated a K-RAS codon 12/13 mutation (p.G12V, c.35 G>T), whereas the sarcomatous component demonstrated a K-RAS codon 12/13 mutation (p.G12D, c.35 G>A). Although both tumor components revealed a mutation in codon 12 of K-RAS, they were of different nucleotide substitutions, indicating that these 2 tumor components were of different clonal origins. However, the fact that the 2 mutations identified in the tumor components are the most common mutations reported in mucinous tumors of the ovary, raises the possibility that sarcomatous mural nodules simply represent a form of dedifferentiation in mucinous tumors.
卵巢具有壁结节的黏液性肿瘤很少见。壁结节是显微镜下大小不一的具有不同性质的肿瘤，可能是良性的（如肉瘤样和癌肉瘤样），也可能是恶性的（如间变性癌和肉瘤）。卵巢具有壁结节的黏液性肿瘤中 K-RAS 基因突变此前尚未报道过。这是一例 25 岁女性的病例报告，该女性被诊断为卵巢侵袭性黏液性腺癌伴高级别肉瘤样壁结节。黏液性肿瘤成分显示 K-RAS 密码子 12/13 突变（p.G12V，c.35 G>T），而肉瘤样成分显示 K-RAS 密码子 12/13 突变（p.G12D，c.35 G>A）。尽管两个肿瘤成分都在 K-RAS 密码子 12 处发生了突变，但它们的核苷酸取代不同，表明这两个肿瘤成分具有不同的克隆起源。然而，肿瘤成分中发现的这两种突变是卵巢黏液性肿瘤中最常见的突变，这表明肉瘤样壁结节只是黏液性肿瘤去分化的一种形式。
