国际妇产科学杂志

国际妇产科学杂志 ›› 2024, Vol. 51 ›› Issue (5): 578-583.doi: 10.12280/gjfckx.20240491

• 妇科肿瘤研究: 论著 • 上一篇    下一篇

五例卵巢Brenner瘤诊治分析

金晓蕾, 许飞雪()   

  1. 730000 兰州大学第一临床医学院（金晓蕾）；兰州大学第一医院妇产科，甘肃省妇科肿瘤重点实验室（许飞雪）
  • 收稿日期:2024-05-27 出版日期:2024-10-15 发布日期:2024-10-17
  • 通讯作者: 许飞雪，E-mail：xfx.sxq@163.com
  • 基金资助:
    甘肃省自然科学基金(21JR7RA378)

Five Cases of Diagnosis and Treatment of Ovarian Brenner Tumors

JIN Xiao-lei, XU Fei-xue()   

  1. The First School of Clinical Medicine of Lanzhou University, Lanzhou 730000, China (JIN Xiao-lei); Department of Obstetrics and Gynecology, The First Hospital of Lanzhou University, Key Laboratory of Gynecological Tumor of Gansu Province, Lanzhou 730000, China (XU Fei-xue)
  • Received:2024-05-27 Published:2024-10-15 Online:2024-10-17
  • Contact: XU Fei-xue, E-mail: xfx.sxq@163.com

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摘要：

目的：总结卵巢Brenner瘤的临床特征、病理特点和治疗情况。方法：回顾性分析2000年1月—2023年12月在兰州大学第一医院手术并经术后石蜡病理确诊为卵巢Brenner瘤的5例患者的病例资料，总结其临床特征、病理特点及治疗经验。结果：5例患者发病年龄为46~72岁，中位年龄70岁；体质量指数（body mass index，BMI）为19.11~28.77 kg/m2，中位BMI为25.64 kg/m2。其中2例为卵巢交界性Brenner瘤（borderline Brenner tumor，BdBT），3例为卵巢恶性Brenner瘤（malignant Brenner tumor，MBT）。2例MBT患者出现糖类抗原125（carbohydrate antigen 125，CA125）水平显著升高。5例患者肿物最大直径均大于2 cm，且均为单侧。影像学结果均提示囊实性占位。镜下见，卵巢BdBT由移行细胞上皮巢及纤维间质组成，细胞层次增多，细胞核存在不典型性，但无间质浸润。卵巢MBT细胞明显异型，细胞质嗜酸性或透亮，瘤组织浸润生长。5例患者的细胞角蛋白7（cytokeratin 7，CK7）、GATA3、P63均为阳性；CK20、肾母细胞瘤基因1（Wilms tumor gene 1，WT1）均为阴性。1例BdBT患者的Ki-67增殖指数<5%，其余4例患者的Ki-67增殖指数约为20%~40%。5例患者均行手术治疗，2例患者辅以化疗。除1例卵巢MBT患者失访，其余4例随访时间均存活未复发。结论：术前影像学及CA125检查对卵巢Brenner瘤无明确诊断价值，需依据组织病理学和免疫组织化学检查确诊。MBT与BdBT的鉴别在于细胞的异型程度及有无间质浸润。手术是治疗卵巢Brenner瘤的主要手段。

关键词: Brenner瘤, 卵巢肿瘤, 免疫组织化学, 病理学, 诊断

Abstract:

Objective: To summarize the clinical features, pathological characteristics, and treatment of ovarian Brenner tumors. Methods: A retrospective analysis was performed on the clinical data of five patients who underwent surgery and were subsequently diagnosed with ovarian Brenner tumors through postoperative paraffin pathology at the First Hospital of Lanzhou University from January 2000 to December 2023. We aimed to summarize their clinical features, pathological characteristics, and treatment experiences. Results: The ages of the five patients ranged from 46 to 72 years, with a median age of 70 years. The body mass index (BMI) ranged from 19.11 to 28.77 kg/m2, with a median BMI of 25.64 kg/m2. Among them, two cases were classified as borderline Brenner tumors (BdBT) and three as malignant Brenner tumors (MBT). Two patients with MBT exhibited significantly elevated carbohydrate antigen 125 (CA125) levels. All five patients had a maximum tumor diameter greater than 2 cm, and all tumors were unilateral. Imaging results indicated cystic solid lesions. Microscopic examination revealed that the ovarian BdBT consisted of transitional cell epithelium nests and fibrous stroma, with increased cellular layers and atypical nuclei but no stromal invasion. The cells in ovarian MBT showed pronounced atypia, and the cytoplasm was eosinophilic or clear, with infiltrative growth of tumor tissues. All five patients tested positive for cytokeratin 7 (CK7), GATA3, and P63, while CK20 and Wilms tumor gene 1 (WT1) were negative. The Ki-67 proliferation index was less than 5% in one BdBT patient, while the remaining four patients had a Ki-67 index of approximately 20% to 40%. All five patients underwent surgical treatment, and two patients received adjunctive chemotherapy. Except for one patient with ovarian MBT who was lost to follow-up, the other four patients remained alive without recurrence during the follow-up period. Conclusions: Preoperative imaging and CA125 tests have no definitive diagnostic value for ovarian Brenner tumors, which should be diagnosed based on histopathological and immunohistochemical examinations. The differentiation between MBT and BdBT lies in the degree of cellular atypia and the presence or absence of stromal invasion. Surgery is the primary treatment modality for ovarian Brenner tumors.

Key words: Brenner tumor, Ovarian neoplasms, Immunohistochemistry, Pathology, Diagnosis