Young R H
Department of Pathology, Harvard Medical School, Boston, MA.
Am J Surg Pathol. 1993 Dec;17(12):1210-24. doi: 10.1097/00000478-199312000-00002.
Ovarian germ cell tumors are reviewed with emphasis on recent developments. In the primitive germ cell tumor group the recently recognized subtypes of yolk sac tumor, the hepatoid and glandular variants are described. Hepatoid tumors, which resemble hepatocellular carcinomas, are usually admixed with other patterns of yolk sac neoplasia but when the hepatoid component predominates, distinction from metastatic hepatocellular carcinoma may be difficult. Glandular yolk sac tumors include those with a cribriform pattern as well as tumors that may be confused with endometrioid carcinoma. Within the teratoma category, a recent paper exploring the occasional relation between immature teratomas and dermoid cysts is reviewed. Problems caused by some of the monodermal teratomas are also highlighted. Struma ovarii may be the source of many diagnostic problems. It may be cystic and microscopic examination may reveal inconspicuous numbers of clearly recognizable thyroid follicles, resulting in confusion with other cystic ovarian tumors. In noncystic strumas many patterns, such as solid or pseudotubular, may be seen and the presence of cells with abundant clear or eosinophilic cytoplasm may add to the diagnostic difficulty, particularly if other teratomatous elements are lacking. Immunohistochemical staining for thyroglobulin may be crucial in establishing the diagnosis of a struma in these situations. The problem of identifying reliable criteria for malignancy of struma ovarii is explored on the basis of recent information. The two most recently recognized subtypes of carcinoid tumor, strumal and mucinous, are reviewed as are primary neuroectodermal and sebaceous tumors of the ovary. Unusual clinical features of germ cell tumors are discussed under three main categories: endocrine syndromes, paraendocrine and paraneoplastic syndromes, and miscellaneous. Included in these categories are disorders such as sexual precocity in association with germ cell tumors containing syncytiotrophoblast cells, endocrine abnormalities associated with the recently described functioning ovarian tumors with peripheral steroid cell proliferation, hyperthyroidism with struma ovarii, the carcinoid syndrome, autoimmune hemolytic anemia associated with dermoid cysts, complications of dermoid cyst rupture, which may simulate disseminated carcinomatosis, and ascites and Meigs' syndrome associated with struma ovarii.
本文对卵巢生殖细胞肿瘤进行综述，重点关注近期进展。在原始生殖细胞肿瘤组中，描述了最近认识到的卵黄囊瘤亚型，即肝样型和腺管型。肝样肿瘤类似于肝细胞癌，通常与其他卵黄囊瘤模式混合存在，但当肝样成分占主导时，与转移性肝细胞癌的鉴别可能困难。腺管型卵黄囊瘤包括筛状模式的肿瘤以及可能与子宫内膜样癌混淆的肿瘤。在畸胎瘤类别中，回顾了一篇探讨未成熟畸胎瘤与皮样囊肿偶然关系的近期论文。还强调了一些单胚层畸胎瘤引起的问题。卵巢甲状腺肿可能是许多诊断问题的根源。它可能是囊性的，显微镜检查可能发现数量不明显但可清晰识别的甲状腺滤泡，从而与其他卵巢囊性肿瘤混淆。在非囊性卵巢甲状腺肿中，可见多种模式，如实性或假管状，具有丰富透明或嗜酸性细胞质的细胞的存在可能增加诊断难度，特别是在缺乏其他畸胎瘤成分时。在这些情况下，甲状腺球蛋白免疫组化染色对于确立卵巢甲状腺肿的诊断可能至关重要。根据近期信息探讨了确定卵巢甲状腺肿恶性可靠标准的问题。回顾了类癌肿瘤最近认识到的两种亚型，即甲状腺肿型和黏液型，以及卵巢原发性神经外胚层肿瘤和皮脂腺肿瘤。生殖细胞肿瘤的不寻常临床特征在三个主要类别下进行讨论：内分泌综合征、旁内分泌和副肿瘤综合征以及其他。这些类别包括与含有合体滋养层细胞的生殖细胞肿瘤相关的性早熟、与最近描述的具有外周类固醇细胞增殖的功能性卵巢肿瘤相关的内分泌异常、卵巢甲状腺肿伴发的甲状腺功能亢进、类癌综合征、与皮样囊肿相关的自身免疫性溶血性贫血、皮样囊肿破裂的并发症（可能模拟播散性癌病）以及与卵巢甲状腺肿相关的腹水和梅格斯综合征。
