摘要目的 探讨卵巢核分裂象活跃的富于细胞性纤维瘤的临床病理学特征及鉴别诊断.方法 收集2008至2012年间11例卵巢核分裂象活跃的富于细胞性纤维瘤患者的临床病理资料,光镜观察并进行免疫组织化学EnVision法染色.结果 11例患者发病年龄21～ 65岁,平均46岁.肿瘤最大径6 ～ 16 cm,平均9.8 cm.镜下梭形瘤细胞丰富,交叉成束或旋涡状排列,形态温和,细胞轻至中度异型性,核分裂象(4～20)/10 HPF,平均8.4/10 HPF,无坏死.8例进行了波形蛋白检测,均阳性表达.5例检测了WT-1,均有弥漫或灶性阳性表达.α-inhibin和calretinin在检测的6例中仅有1例弥漫表达.6例检测了Ki-67的阳性指数5％～30％,其中1例约10％,1例核分裂象20/10 HPF的Ki-67阳性指数为30％.此外,细胞角蛋白、AE1/AE3、CD117、CD34、CD99和结蛋白在5例检测病例中均呈阴性.2例行网状纤维染色,显示网状纤维包绕在每个瘤细胞周围.10例随访4 ～ 38个月无复发或进展,1例术后94个月复发后仍存活.结论 在卵巢富于细胞性纤维瘤中,当核分裂象≥4/10 HPF、细胞温和、缺乏显著异型时,诊断为核分裂象活跃的富于细胞性纤维瘤比纤维肉瘤更为恰当.绝大多数病例临床呈良性经过,少数病例可复发,提示它是一种具有低度恶性潜能的肿瘤.

abstractsObjective To study the clinicopathologic characteristics of mitotically active cellular fibroma (MACF) of the ovary.Methods The clinicopathologic features of 11 cases of MACF from 2008 to 2012 years were retrospectively reviewed and immunohistochemic EnVision method was performed.Results The age of patients ranged from 21 to 65 years (mean =46 years).The maximum tumor diameter varied from 6 to 16 cm (mean =9.8 cm).The tumors were densely cellular and composed of intersecting bundles of spindle cells,sometimes associated with storiform pattern.The mitotic count ranged from 4 to 20 per 10 high-power field (mean =8.4).Atypical mitotic figures were not identified and coagulative tumor necrosis was not found.There was at most mild to moderate degree of nuclear atypia.Immunohistochemically,8 cases showed positive stain for vimentin and 5 cases expressed diffusely or focally WT-1.In 6 cases,Ki-67 positive index ranged from 5％-30％,including 1 case (10％),and 1 case (30％) in which mitotic figures were 20/10 HPF.CK,AE1/AE3,CD117,CD34,CD99 and desmin were negative in the detected 5 cases.Reticular fiber staining in 2 cases showed dense reticular fibers enveloping individual tumor cells.Ten patients who followed-up range from 4 to 38 months were alive without evidence of recurrence or disease progression.One patient was alive with local recurrence 94 months after surgery.Conclusions Cellular fibromatous neoplasm with mitotic count of≥4/10 HPF but relatively bland nuclear features should be considered as MACF rather than ovarian fibrosarcoma.MACF is a group of ovarian tumor which carries a low malignant potential and occasional chance of recurrence.