Selma ŞENGİZ, Çağnur ULUKUŞ, Sevil SAYHAN, Nilgün DİCLE, Kutsal YÖRÜKOĞLU

Ovaryumun seks kord stromal tümörlerinde immunhistokimya

Amaç: Seks kord stromal tümörler tüm ovaryum tümörlerinin yaklaşık olarak %6' sını oluşturmaktadır. Malign özellikte olan granüloza hücreli tümör ve Sertoli stromal tümörlerde olduğu gibi, histolojik paternleri oldukça değişken olmakla birlikte agresif klinik gidişleri tahmin edilemez. Bununla birlikte, tanısal açıdan zorluk yaratmayan olgular yanısıra, primer ya da metastatik tümörlerin histolojik paternleri ile benzerlik gösterebilen bu gruba ait tümörler izlenebilir. Bu gibi durumlarda immunhistokimyasal çalışmalar tanıya yardımcı olabilir. Bu çalışmanın amacı, seks kord stromal tümörlerde immunhistokimyanın ayırıcı tanıda yerini araştırmaktır. Gereç ve Yöntem: Bu çalışmada 1988-1999 yılları arasında Dokuz Eylül Üniversitesi Kadın Hastalıkları ve Doğum bölümü ile SSK Ege Doğumevi'nde çeşitli nedenlerle opere edilen ve seks kord stromal tümör grubu içinde tanı alan 21 hastadan elde edilen materyaller incelenmiş ve çeşitli immunhistokimyasal boyalar (keratin AE1, keratin AE3, yüksek ve düşük molekül ağırlıklı keratin, EMA, CEA, vimentin, aktin, desmin, S-100 ve NSE) uygulanmıştır. Bulgular: Granüloza hücreli tümörlerde, vimentin ve CEA dışında tüm antikorlarla değişik oranlarda olumlu boyanma elde edilmiştir. Sertoli hücreli tümörler yüksek ve düşük molekül ağırlıklı keratin, S-100 ve CEA ile olumsuz boyanmıştır. Sklerozan stromal tümörlerde keratin AE1, keratin AE3, aktin, desmin ve NSE ile olumlu boyanma gözlenmiştir. Sonuç: Seks kord stromal tümörlerin ayırıcı tanısında immunhistokimyasal panelin içinde EMA, keratin AE1, keratin AE3, yüksek molekül ağırlıklı keratin, vimentin, aktin, desmin, S-100 proteini ve inhibin yer almalıdır. Daha geniş serilerde bu panelin yararlılığı araştırılmalıdır.

Anahtar Kelimeler:

Stroma hücreleri, İmmünohistokimya, Tanı, ayırıcı, Yumurtalık neoplazmları, Granüler hücre tümörü

Immunohistochemistry in sex cord stromal tumors of the ovary

Aim: Sex cord stromal tumors account for approximately 6% of all ovarian tumors. Although the histologic patterns of these tumors are rather variable, agressive clinical course can not be predicted in granulosa cell and Sertoli cell stromal tumors. However, sex cord stromal tumors may show similarities to the histologic patterns of other primary or metastatic tumors. In these conditions, immunohistochemical studies may be usefull for diagnosis. The aim of this study is to investigate the impact of immunohistochemistry on differential diagnosis of ovarian sex cord stromal tumors. Materials and Methods: In this study, sections of 21 cases, who were operated with different causes and diagnosed as sex cord stromal tumors in Dokuz Eylül University Medical Faculty and SSK Ege Maternity Hospital between 1988-1999 are examined and immunohistochemical staining with several antibodies (e.g.keratin AE1, keratin AE3, high molecular weight keratin, low molecular weight keratin, EMA, CEA, vimentin, actin, desmin, S-100 and NSE) are applied. Results: In granulosa cell tumors, positivity for all antibodies with different rates, except for vimentin and CEA, were obtained. Sertoli cell tumors stained negative for high molecular weight keratin, low molecular weight keratin, S-100 and CEA. In sclerozing stromal tumors, positivity was observed for keratin AE1, keratin AE3, actin, desmin and NSE. In fibrothecoma, positivity was observed for EMA, actin, desmin and NSE. Conclusions: In the differential diagnosis of sex cord stromal tumors, EMA, keratin AE1, keratin AE3, high molecular weight keratin, vimentin, actin, desmin, S-100 and inhibin take place in the immunohistochemical panel. The usefulness of this panel should be searched in larger series.

Keywords:

Stromal Cells, Immunohistochemistry, Diagnosis, Differential, Ovarian Neoplasms, Granular Cell Tumor,

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