Costa M J, Morris R, DeRose P B, Cohen C
Department of Pathology, University of California, Davis.
Arch Pathol Lab Med. 1993 Aug;117(8):802-8.
Ovarian myxomas recently have been reported as new, distinct pathologic entities that show a myxoid, moderately cellular proliferation of spindle and stellate cells interspersed with areas of fibrosis, hemorrhage, and delicate vascular spaces. These histologic features are frequently seen in the thecoma-fibroma group of ovarian stromal tumors. For this reason, we propose that ovarian myxomas are part of the spectrum of differentiation in thecomas-fibromas of the ovary. To provide histologic and immunohistochemical evidence for this proposal, four ovarian myxomas were compared with 48 primary ovarian stromal tumors in the thecoma-fibroma group from 46 patients. The thecoma-fibroma group of stromal tumors included 23 thecomas, 23 fibromas, and two sclerosing stromal tumors. We found significant (> 25% of histologic appearance) myxoid change in six thecomas and one sclerosing stromal tumor. This myxoid change resembled the histologic appearance of an ovarian myxoma. Immunohistochemical studies on paraffin-embedded material showed vimentin immunostaining in all tumors. Smooth-muscle actin was present in all of the myxomas, in two of the two sclerosing stromal tumors, and in 20 (90%) of the 23 thecomas, but it was present in only 11 (48%) of the 23 fibromas. Desmin staining was not present in any of the four ovarian myxomas or in the two sclerosing stromal tumors, and only three (13%) of the 23 thecomas showed focal staining for desmin. Nine (39%) of the 23 fibromas expressed desmin. S100 protein was expressed in one fibroma and one thecoma, weakly. None of the ovarian myxomas or the thecoma-fibroma group of stromal tumors expressed cytokeratins as detected by three different monoclonal antibody cocktails, ie, cytokeratin AE1/AE3, cytokeratin CAM 5.2, or cytokeratin MAK-6. The ovarian thecoma-fibroma group of stromal tumors form a histologic spectrum of lesions in which clear-cut distinguishing points between various entities are difficult to define. The myxoid change, present in the thecoma-fibroma group of tumors, was indistinguishable histologically and immunohistochemically from ovarian myxoma. For this reason, we propose that ovarian myxomas may be at one end of the spectrum of differentiation in the thecoma-fibroma group of tumors, in which no remaining stromal tumor is detectable.
卵巢黏液瘤最近被报道为一种新的、独特的病理实体，表现为黏液样、中等细胞密度的梭形和星状细胞增生，其间散在纤维化、出血和细小血管间隙区域。这些组织学特征在卵巢间质瘤的纤维瘤-卵泡膜瘤组中很常见。因此，我们认为卵巢黏液瘤是卵巢纤维瘤-卵泡膜瘤分化谱系的一部分。为了为这一观点提供组织学和免疫组化证据，我们将4例卵巢黏液瘤与46例患者的48例纤维瘤-卵泡膜瘤组原发性卵巢间质瘤进行了比较。纤维瘤-卵泡膜瘤组间质瘤包括23例卵泡膜瘤、23例纤维瘤和2例硬化性间质瘤。我们发现6例卵泡膜瘤和1例硬化性间质瘤有显著（>25%组织学表现）的黏液样改变。这种黏液样改变类似于卵巢黏液瘤的组织学表现。对石蜡包埋材料的免疫组化研究显示，所有肿瘤均有波形蛋白免疫染色。平滑肌肌动蛋白在所有黏液瘤、2例硬化性间质瘤中的2例以及23例卵泡膜瘤中的20例（90%）中存在，但仅在23例纤维瘤中的11例（48%）中存在。4例卵巢黏液瘤和2例硬化性间质瘤中均无结蛋白染色，23例卵泡膜瘤中仅3例（13%）有结蛋白局灶性染色。23例纤维瘤中有9例（39%）表达结蛋白。S100蛋白在1例纤维瘤和1例卵泡膜瘤中弱表达。通过三种不同的单克隆抗体混合物，即细胞角蛋白AE1/AE3、细胞角蛋白CAM 5.2或细胞角蛋白MAK-6检测，卵巢黏液瘤或纤维瘤-卵泡膜瘤组间质瘤均不表达细胞角蛋白。卵巢纤维瘤-卵泡膜瘤组间质瘤形成了一个组织学病变谱系，其中不同实体之间的明确区分点难以界定。肿瘤纤维瘤-卵泡膜瘤组中存在的黏液样改变在组织学和免疫组化上与卵巢黏液瘤无法区分。因此，我们认为卵巢黏液瘤可能处于纤维瘤-卵泡膜瘤组肿瘤分化谱系的一端，在这一端没有可检测到的剩余间质瘤。
