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首页> 外文期刊>Modern Pathology >Ovarian carcinomas, including secondary tumors: diagnostically challenging areas
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Ovarian carcinomas, including secondary tumors: diagnostically challenging areas

机译：卵巢癌，包括继发性肿瘤：诊断上具有挑战性的领域

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The differential diagnosis of ovarian carcinomas, including secondary tumors, remains a challenging task. Mucinous carcinomas of the ovary are rare and can be easily confused with metastatic mucinous carcinomas that may present clinically as a primary ovarian tumor. Most of these originate in the gastrointestinal tract and pancreas. International Federation of Gynecology and Obstetrics (FIGO) stage is the single most important prognostic factor, and stage I carcinomas have an excellent prognosis; FIGO stage is largely related to the histologic features of the ovarian tumors. Infiltrative stromal invasion proved to be biologically more aggressive than expansile invasion. Metastatic colon cancer is frequent and often simulates ovarian endometrioid adenocarcinoma. Although immunostains for cytokeratins 7 and 20 can be helpful in the differential diagnosis, they should always be interpreted in the light of all clinical information. Occasionally, endometrioid carcinomas may exhibit a microglandular pattern simulating sex cord-stromal tumors. However, typical endometrioid glands, squamous differentiation, or an adenofibroma component are each present in 75% of these tumors whereas immunostains for calretinin and alpha-inhibin are negative. Endometrioid carcinoma of the ovary is associated in 15–20% of the cases with carcinoma of the endometrium. Most of these tumors have a favorable outcome and they most likely represent independent primary carcinomas arising as a result of a Müllerian field effect. Although the criteria for distinguishing metastatic from independent primary carcinomas rely mainly upon conventional clinicopathologic findings, loss of heterozygosity and gene mutation analyses can be helpful. Transitional cell carcinomas are distinguished from undifferentiated carcinomas by the presence of thick, undulating papillae with smooth luminal borders, microspaces, and tumor cells with distinctive 'urothelial' appearance. Krukenberg tumors are metastatic adenocarcinomas traditionally perceived as composed of mucin-filled signet-ring cells associated with a striking proliferation of the ovarian stroma but many variations on this pattern occur.
机译：卵巢癌包括继发性肿瘤的鉴别诊断仍然是一项艰巨的任务。卵巢粘液癌很少见，很容易与转移性粘液癌混淆，后者在临床上可能表现为原发性卵巢肿瘤。这些大多数起源于胃肠道和胰腺。国际妇产科联合会（FIGO）的分期是唯一最重要的预后因素，而I期癌的预后良好。 FIGO分期在很大程度上与卵巢肿瘤的组织学特征有关。浸润性基质浸润被证明在生物学上比膨胀浸润更具侵略性。转移性结肠癌很常见，并且经常模拟卵巢子宫内膜样腺癌。尽管细胞角蛋白7和20的免疫染色有助于鉴别诊断，但应始终根据所有临床信息对其进行解释。有时，子宫内膜样癌可能会表现出模拟性索-间质肿瘤的微腺模式。然而，在这些肿瘤的75％中，典型的子宫内膜样腺，鳞状分化或腺纤维瘤成分均存在，而钙调蛋白和α-抑制素的免疫染色均为阴性。子宫内膜样癌在子宫内膜癌病例中占15–20％。这些肿瘤大多数都具有良好的预后，并且很可能代表由于Müllerian场效应而产生的独立原发癌。尽管区分转移性和独立性原发癌的标准主要取决于常规的临床病理发现，但杂合性缺失和基因突变分析可能会有所帮助。移行细胞癌与未分化癌的区别在于，存在具有平滑的管腔边界，微小空间的浓密起伏的乳头状瘤，以及具有明显的“尿路上皮”外观的肿瘤细胞。克鲁肯伯格肿瘤是转移性腺癌，传统上被认为是由黏蛋白填充的印戒细胞组成，与卵巢基质的惊人增殖有关，但是这种模式会发生许多变化。

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