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目的探讨幼年型卵巢颗粒细胞瘤(JGCT)的临床病理特征及预后。方法回顾性分析1975—2005年间收治的10例 JGCT 患者(JGCT 组)的临床病理资料,并以同期随机(系统抽样法)选择的成年型卵巢颗粒细胞瘤(AGCT)患者10例作为对照(AGCT 组)。结果 JGCT 组患者的发病年龄为7～31岁,平均20.5岁,其中30岁以前发病者占90%;肿瘤直径为5.5～15.0 cm,平均9.8cm;肿瘤细胞排列为结节状,伴含有黏液的滤泡结构,瘤细胞黄素化明显;细胞核呈中～重度异型性,核分裂象常见[3～5个/10高倍镜视野(HPF)],未见核沟和 Call-Exner 小体。AGCT 组患者的发病年龄为14～74岁,平均45.1岁,70%的患者40岁以后发病;肿瘤直径为5.0～21.0 cm,平均11.7 cm;肿瘤细胞排列为多样性,滤泡规则无黏液,细胞黄素化少见;细胞核呈轻度异型性,核分裂象不多见(0～3个/10 HPF),核沟和 Call-Exner 小体常见。免疫组化检测结果显示,JGCT 组患者增殖细胞核抗原(PCNA)、p53蛋白阳性表达率分别为90%、70%,AGCT 组患者 PCNA、p53蛋白阳性表达率分别为20%、10%,分别比较,差异均有统计学意义(P<0.05);p53、PCNA 蛋白的阳性表达率随着细胞异型性程度的增加而递增,轻度与中～重度异型性细胞的 p53、PCNA 蛋白的阳性表达率(p53蛋白分别为1/8和58%,PCNA 蛋白分别为2/8和75%)分别比较,差异均有统计学意义(P<0.05)。JGCT 组患者的5年生存率为90%,AGCT 组患者为100%,两组比较,差异有统计学意义(P<0.05)。结论JGCT 患者与 AGCT 相比,其发病年龄较轻,肿瘤细胞的异型性明显、核分裂象多见,PCNA、p53蛋白阳性表达率高,预后较差。
Objective To investigate the clinicopathological features and prognosis of juvenile ovarian granulosa cell tumor (JGCT). Methods The clinicopathological data of 10 patients with JGCT admitted in our hospital from 1975 to 2005 were retrospectively analyzed. Ten patients with adult ovarian granulosa celloblastoma (AGCT) selected by random (systematic sampling) in the same period were selected as control group (AGCT group). Results The onset age of patients in JGCT group was 7 to 31 years (average 20.5 years), of which 90% were before 30 years of age. The diameter of tumor was 5.5-15.0 cm (average 9.8 cm). The tumor cells were arranged in nodules with mucus Of the follicular structure, tumor lutein significantly; nucleus was moderate to severe atypia, mitotic common [3 ~ 5/10 high power microscopy (HPF)], no nuclear ditch and Call-Exner bodies. The age of onset of patients with AGCT was 14-74 years (average 45.1 years). 70% of patients in the AGCT group developed disease after 40 years of age. The diameter of the tumors was 5.0-21.0 cm (average 11.7 cm). The tumor cells were arranged in a variety of ways, Luteinization is uncommon; nuclei are mildly atypical and mitosis is uncommon (0-3 / 10 HPF), common in both nuclear ditch and Call-Exner bodies. The results of immunohistochemistry showed that the positive rates of PCNA and p53 in JGCT group were 90% and 70%, respectively. The positive rate of PCNA and p53 protein in AGCT group was 20% and 10% respectively (P <0.05). The positive rates of p53 and PCNA protein increased with the degree of cell atypia, and the positive rates of p53 and PCNA protein in mild and moderate-severe atypical cells (P <0.05), respectively (1/8 and 58% for p53 protein and 2/8 and 75% for PCNA protein respectively). The 5-year survival rate was 90% in the JGCT group and 100% in the AGCT group. There was significant difference between the two groups (P <0.05). Conclusions Compared with AGCT, JGCT patients have younger age and obvious atypia of tumor cells. The mitotic figures are more common, and the positive rate of PCNA and p53 protein is higher, the prognosis is poor.