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The cystic nature of a mature teratoma of ovary is seen here. The most common tissue element of these teratomas is skin, so large amounts of hair and sebum are produced, leading to a challenging cleanup problem in surgical pathology following dissection of these tumors. If these tumors are mostly solid, then they are often "immature" teratomas with less differentiated tissue and are more aggressive. Rarely, there are frankly carcinomatous areas.

图示:卵巢成熟畸胎瘤囊。畸胎瘤的大多数共同组织成分是皮肤,大量的毛发和皮脂,导致外科病理学上切开后难以清除干净。如果肿瘤以实体为主,则常是未成熟畸胎瘤,分化程度较低,并有更大的侵袭性。很少有纯粹的癌区域。

There is a large unilateral mature cystic teratoma seen here at the right (in left ovary--the uterus is opened anteriorly). The uterus has an intramural and a subserosal leiomyoma. The other ovary is replaced by a fibroma.

右图见一大的单侧的成熟畸胎瘤(左边的卵巢-子宫已经被打开)。子宫壁内和浆膜下各有一平滑肌瘤。另一卵巢被纤维瘤替代。

Microscopically, this teratoma has cartilage, adipose tissue, and intestinal glands at the right, while at the left is a lot of thyroid tissue. This condition can be termed struma ovarii. Rarely, a struma ovarii can even be a cause for hyperthyroidism.

镜下畸胎瘤右边有软骨、脂肪组织、和肠内腺体,左边有很多甲状腺组织,被称为卵巢甲状腺肿,很少引起甲状腺机能亢进。

Metastatic tumors to ovary are uncommon, but there is one situation in which a metastatic adenocarcinoma to ovary appears as a large mass and resembles a primary tumor: a so-called "Krukenberg" tumor of ovary which has a signet ring histologic pattern and usually is metastatic from a primary in gastrointestinal tract. Seen here extending out of the pelvis at autopsy is a large right ovarian mass. Metastases are also present in the lower right portion of liver.

卵巢转移性肿瘤不常见,但卵巢转移性腺癌呈现为大肿块,类似原发瘤即卵巢Krukenberg瘤。卵巢Krukenberg瘤组织学上其实是富于粘液的印戒细胞癌,多由胃肠道粘液癌转移而来。尸解中可见突出盆腔的是右侧卵巢巨大的团块。在右下肝叶也存在转移。

This is only a second trimester pregnancy, but note how large for dates the uterus is because of a molar pregnancy. An ultrasound in this case revealed no fetus, only a "snowstorm" effect.

中期妊娠孕妇葡萄胎使此期子宫明显增大。超声检查显示没有胎儿,仅是一个“暴风雪”效应。

This is a hydatidiform mole. Molar pregnancies are uncommon and occur when there is fertilization of an ovum by a sperm but loss of maternal chromosomes, leaving a 46XX karyotype composed only of paternal chromosomes, enough to form a placenta, but not a fetus. The result is a mass of tissue with grape-like swollen villi.

图示:葡萄胎。不常见的,受精时母性染色体丢失,核型为46XX, 仅由父性染色体构成,虽然能够形成胎盘,但不能形成胎儿,因此形成葡萄状肿胀的绒毛组织。

The grape-like villi of a hydatidiform mole are seen here. With molar pregnancy, the uterus is large for dates, but no fetus is present. HCG levels are markedly elevated. Patients with a hydatidiform mole are often large for dates and have hyperemesis gravidarum more frequently. Patients may present with bleeding, and may pass some of the grape-like villi.

图示:葡萄胎葡萄状绒毛。葡萄胎时,子宫随时间而变大,但没有胎儿。HCG明显升高。病人看起来常比同期正常孕妇子宫大,常伴妊娠剧吐。病人可出现阴道流血,可排出部分葡萄状绒毛。

Histologically, the hydatidiform mole has large avascular villi and areas of trophoblastic proliferation. Of course, ultrasound confirms the diagnosis before currettage is done to evacuate this tissue seen here.

组织学上,葡萄胎有粗大无血管的绒毛和增生的滋养层。超声确诊后,行清宫术。

The pathologist determines the histologic diagnosis of the trophoblastic disease, most importantly, if choriocarcinoma is present. In this hydatidiform mole there is atypical trophoblastic proliferation, but villi are still present. The patient is then followed with serial HCG levels.

病理学家依据组织学确诊胚胎滋养层疾病。图示葡萄胎有典型的滋养层增生,但绒毛仍然存在。追踪观察病人HCG水平。

This is a partial mole that occurs when two sperms fertilize a single ovum. The result is triploidy (69 XXY). Only some of the villi are grape- like, and a fetus can be present, but rarely survives past 15 weeks.

两个精子与一个卵子受精时产生部分性葡萄胎。结果是三倍体(69XXY)。仅有一些绒毛呈葡萄状,胎儿可以存在,但很少活过15周。


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