Xing Deyin, Jenson Erik G, Zwick Christopher A, Rodriguez Fausto J, Kurman Robert J
Departments of Pathology (D.X., E.G.J., F.J.R., R.J.K.) Gynecology and Obstetrics (R.J.K) Oncology, The Johns Hopkins Medical Institute, Baltimore, MD (R.J.K.) Department of Pathology, Aurora St Luke's Medical Center, Milwaukee, WI (C.A.Z.).
Int J Gynecol Pathol. 2018 Jan;37(1):52-56. doi: 10.1097/PGP.0000000000000389.
A 59-year-old woman with a remote history of invasive ductal carcinoma of the breast was found on a follow-up computed tomography scan of her brain to have a 1-cm lesion in the right frontal lobe in 2008. In the ensuing years, before her current admission, multiple imaging studies of the brain revealed that the lesion was stable and it was, therefore, interpreted as a small area of encephalomalacia related to a thrombosed cortical vein, a cavernoma, or treated metastatic breast cancer. In 2013, the patient underwent a bilateral salpingo-oophorectomy for ovarian tumors that were diagnosed as bilateral serous cystadenofibromas. A partial omentectomy showed no evidence of implants. In June 2016, the brain lesion was completely excised and diagnosed as an atypical proliferative (borderline) serous tumor. Immunohistochemical staining demonstrated that the tumor cells were immunoreactive for Pax8, WT-1, ER, and CK-7 and negative for Gata-3, PR, TTF-1, CDX-2, Napsin A, and CK-20, which was consistent with that diagnosis. We present a brief review of possible mechanisms to account for this unusual presentation and speculate that the most likely one is exfoliation of fallopian tube epithelial cells into the peritoneal cavity, which then gain access to lymphatics resulting in cells implanting in the brain and subsequently progressing to an atypical proliferative (borderline) serous tumor.
一名59岁女性，有远处乳腺浸润性导管癌病史，2008年脑部计算机断层扫描随访时发现右额叶有一个1厘米的病灶。在随后几年直至本次入院前，多次脑部影像学检查显示该病灶稳定，因此被解释为与血栓形成的皮质静脉、海绵状血管瘤或已治疗的转移性乳腺癌相关的小面积脑软化。2013年，患者因双侧卵巢肿瘤接受双侧输卵管卵巢切除术，肿瘤被诊断为双侧浆液性囊腺纤维瘤。部分大网膜切除术未发现种植证据。2016年6月，脑部病灶被完整切除，诊断为非典型增生性（交界性）浆液性肿瘤。免疫组化染色显示肿瘤细胞对Pax8、WT-1、雌激素受体（ER）和细胞角蛋白7（CK-7）呈免疫反应，对Gata-3、孕激素受体（PR）、甲状腺转录因子1（TTF-1）、尾型同源盒转录因子2（CDX-2）、天冬氨酸蛋白酶A（Napsin A）和细胞角蛋白20（CK-20）呈阴性，与该诊断相符。我们简要回顾了对此不寻常表现的可能机制，并推测最可能的机制是输卵管上皮细胞脱落在腹腔内，然后进入淋巴管，导致细胞植入脑部并随后发展为非典型增生性（交界性）浆液性肿瘤。
