卵巣癌肉腫と成熟嚢胞性奇形腫および一次卵管癌との関連性．

Ovarian Carcinosarcoma and Its Association with Mature Cystic Teratoma and Primary Tubal Carcinoma.

抄録

.癌肉腫は珍しいタイプの卵巣癌で、上皮性・間葉性混合腫瘍の一群に分類される。成熟嚢胞性奇形腫および卵管癌と同調する癌肉腫の発生は非常に稀です。.69 歳の女性が骨盤内の腫瘤を訴えて受診した．腹部コンピュータ断層撮影により15cmの右骨盤内腫瘤が検出され，デルモイド嚢胞の悪性化が示唆された。術中，両側卵巣腫瘤（左10cm，右12cm）が確認され，びまん性腹膜転移結節が認められた。組織学的に，左卵巣腫瘤は癌肉腫と成熟嚢胞性奇形腫の2成分からなり，右卵巣腫瘤は漿膜表面に高悪性度漿液性腺癌を伴う成熟嚢胞性奇形腫であることが判明した。左卵管は肉眼的には異常がなかったが，遠位部に5.0mmの高悪性度漿液性腺癌の焦点を有し，隣接して漿液性卵管上皮内癌を伴っていた。.最近，骨盤内あるいは卵巣の高悪性度漿液性腺癌の大部分は卵管が起源であることが提唱されているので，卵管癌は上皮間葉転換を経て卵巣癌肉腫の起源となる可能性がある。本症例では卵巣癌肉腫と奇形腫が共存していることから、衝突型腫瘍であると思われる。

. Carcinosarcoma is an uncommon form of ovarian cancers, classified as being part of the group of mixed epithelial and mesenchymal tumors. The occurrence of carcinosarcoma in association with a mature cystic teratoma and synchronous tubal carcinoma is very rare. . A 69-year-old woman presented with a pelvic mass. An abdominal computerized tomographic scan detected a 15 cm right pelvic mass which was suggestive of malignant transformation of a dermoid cyst. Intraoperative, bilateral ovarian masses (left 10 cm and right 12 cm) with diffuse peritoneal metastatic nodules were identified. Histologically, the left ovarian mass was composed of 2 components including carcinosarcoma and mature cystic teratoma, whereas the right ovarian mass represented a mature cystic teratoma with serosal surface involvement of high-grade serous adenocarcinoma. The left fallopian tube was macroscopically unremarkable but contained a 5.0 mm focus of high-grade serous adenocarcinoma in the distal part, with adjacent serous tubal intraepithelial carcinoma. . As the fallopian tube has recently been proposed to be an origin for a majority of pelvic or ovarian high-grade serous adenocarcinomas, tubal carcinoma may be the origin for ovarian carcinosarcomas through an epithelial-mesenchymal transition. The coexistence of ovarian carcinosarcoma and teratoma in the present case should represent a collision tumor.