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目的:探讨真两性畸形合并精原细胞瘤1例的临床病理学特征及诊断。方法:报告1例真两性畸形,合并精原细胞瘤的组织病理学及免疫组化检测结果,同时结合文献复习,进行回顾分析。结果:患者社会性别男性,42岁,因双侧腰背部疼痛不适入院,全腹CT示中下腹巨大肿块。术后病理巨检见子宫样组织一块,体积7 cm×2 cm×6 cm,可见子宫颈及子宫内膜样结构,双侧可见输卵管及卵巢样组织;其左侧可见睾丸一枚,体积4.0 cm×2.5 cm×1.5cm,右侧见一巨大肿物22 cm×9 cm×6 cm,包膜完整,切面灰白灰红相间,并见少量睾丸组织;镜下见肿瘤组织被纤维组织分割包绕呈巢状、片状,肿瘤细胞体积较大,胞质丰富透明,核大深染,染色质粗大、颗粒状,可见核分裂像,间质可见少量淋巴细胞浸润。染色体核型为46,XX。免疫组化结果显示PLAP、CD117均为阳性,而AFP、Vimentin、EMA、S100、CK-LMW、Desmin、CD34及CD30均为阴性,Ki-67为20%阳性。结论:真两性畸形合并精原细胞瘤较为罕见,联合组织病理学分析及免疫表型检测对其诊断和鉴别诊断具有重要价值。
Objective: To investigate the clinicopathological features and diagnosis of one case of hermaphroditism associated with seminoma. Methods: One case of true hermaphroditism was reported. The histopathology and immunohistochemistry results of the combined seminoma were retrospectively analyzed. Results: The gender of the patient, 42 years old, was admitted to hospital because of bilateral lower back pain. The full abdominal CT showed a large mass in the lower abdomen. Postoperative pathological gigantic see a piece of uterus-like tissue, the volume of 7 cm × 2 cm × 6 cm, visible cervical and endometrial-like structure, bilateral tubal and ovarian-like tissue; the left can be seen a testis, a volume of 4.0 cm × 2.5 cm × 1.5 cm. On the right side, a huge mass of 22 cm × 9 cm × 6 cm was seen. The capsule was intact with gray, gray and red sections, and a small amount of testicular tissue was seen. Microscopically, the tumor tissue was separated by fibrous tissue Wound around the nest, lamellar, larger tumor cells, abundant and transparent cytoplasm, deep nuclei, chromatin coarse, granular, visible mitosis, interstitial infiltration of a small amount of lymphocytes. Chromosomal karyotype 46, XX. Immunohistochemistry showed that PLAP and CD117 were positive, while AFP, Vimentin, EMA, S100, CK-LMW, Desmin, CD34 and CD30 were negative, Ki-67 was 20% positive. Conclusions: Acquired seminoma is rare in hermaphroditism. Combined histopathological analysis and immunophenotyping are of great value in diagnosis and differential diagnosis.