Nogales F F, Bergeron C, Carvia R E, Alvaro T, Fulwood H R
Department of Pathology, University Hospital, Granada, Spain.
Am J Surg Pathol. 1996 Sep;20(9):1056-66. doi: 10.1097/00000478-199609000-00003.
The clinical, morphological, and immunohistochemical findings in six cases of ovarian endometrioid tumors (five endometrioid carcinomas and one carcinosarcoma) with a yolk sac tumor (YST) component are described. The age of the patients ranged from 31 to 73 years (average, 53), and only two patients were premenopausal. Two cases were stage Ia tumors, three stage III, and one stage IV. A substantial postoperative elevation of alpha-fetoprotein (AFP) was seen in two patients and a mild increase in another two. All six patients had surgery and postoperative cisplatin-based chemotherapy regimens, four of whom died of tumor 3 to 14 months after surgery without response to treatment. Only a stage Ia patient is alive and well 1 year after surgery. The tumors were large (average, 17 cm). Benign endometrioid lesions were found in the homolateral ovary in two cases and in the contralateral ovary in another two. All cases had endometrioid ovarian carcinomas (EOC) of various types admixed with typical YST components. Immunohistochemically, EOC areas differed from YST in their positivity for OC 125, CA 19.9, and nuclear estrogen and progesterone receptors and in their negativity for AFP, which was conspicuously positive in the YST areas. The clinicopathological profile of ovarian endometrioid tumors with YST also differs from that of YST in that it occurs in the same age range as EOC, it shows coexistence of benign endometrioid lesions, and it has a poor response to chemotherapy. The histological pattern in transitional areas may be difficult to differentiate from "endometrioid-like" (enteroblastic) YST and clear cell tumors. Ovarian endometrioid tumors with YST component should be considered a variant of endometrial carcinoma. Its recognition is necessary in view of its unusually aggressive behavior and poor prognosis.
描述了6例伴有卵黄囊瘤（YST）成分的卵巢子宫内膜样肿瘤（5例子宫内膜样癌和1例癌肉瘤）的临床、形态学及免疫组化结果。患者年龄31至73岁（平均53岁），仅2例为绝经前患者。2例为Ia期肿瘤，3例为III期，1例为IV期。2例患者术后甲胎蛋白（AFP）显著升高，另2例轻度升高。所有6例患者均接受了手术及术后以顺铂为基础的化疗方案，其中4例在术后3至14个月死于肿瘤，治疗无效。仅1例Ia期患者术后1年仍存活且状况良好。肿瘤体积较大（平均17cm）。2例在同侧卵巢发现良性子宫内膜样病变，另2例在对侧卵巢发现。所有病例均有不同类型的子宫内膜样卵巢癌（EOC）与典型YST成分混合存在。免疫组化显示，EOC区域与YST区域在OC 125、CA 19.9、核雌激素和孕激素受体的阳性表达以及AFP的阴性表达方面存在差异，AFP在YST区域显著阳性。伴有YST的卵巢子宫内膜样肿瘤的临床病理特征也与YST不同，其发病年龄与EOC相同，存在良性子宫内膜样病变，对化疗反应较差。过渡区的组织学模式可能难以与“子宫内膜样”（成肝细胞样）YST及透明细胞肿瘤相鉴别。伴有YST成分的卵巢子宫内膜样肿瘤应被视为子宫内膜癌的一种变体。鉴于其异常侵袭性的行为及不良预后，对其进行识别很有必要。
