罕见颅内原发性内胚窦瘤（附四例报告）

作者运用光镜、免疫组化及电镜技术研究了4例原发性颅内内胚窦瘤。其组织学具有以下特征:空网状结构、内胚窦样结构、腺样结构、多泡性卵黄囊样结构及透明小滴。免疫组化染色,瘤细胞AFP、CEA和α_1-抗胰蛋白酶阳性。电镜下瘤细胞内外可见高电子密度的圆形物质,瘤细胞内见无定形基底膜样物质。作者还讨论了颅内原发性内胚窦瘤的组织发生。     

卵巢内胚窦瘤的AFP测定及临床观察：附12例分析

卵巢内胚窦瘤常见,恶性程度及死亡率高。除具有一般卵巢恶性肿瘤的特征外,AFP含量升高是其主要特点之一,本文报道12例卵巢内胚窦瘤患者血清AFP含量的变化、临床诊断、疗效观察及预后判断。     

卵巢内胚窦瘤50例临床病理分析

对５０例卵巢内胚窦瘤的临床及病理资料进行分析，该组病人平均年龄１７．５岁。主要状状为腹部包块，腹痛，腹胀。肿瘤发生在单侧者４０例，双侧者１０例。纯型内胚窦瘤３７例，混合其它生殖细胞肿瘤１３例。病理形态均有疏松网状粘液样结构或形成不规则小囊状结构，可见Ｓ－Ｄ小体及ＰＡＳ阳性滴。     

CA125、AFP及HCG—β联合检测在卵巢癌诊断中临床意义（附54例分析）

目的：探讨CA125、AFP及HCG－β联合检测对卵巢癌诊断价值。方法：54例卵巢 免疫放射法测定血清CA125、以放射免疫法测定血清AFP和HCB-β。结果：CA125、AFP和HCB-β检测总阳性率为90．07％,其中卵巢癌CA125、AFP和HCB-β阳性率分别是66．6％、12．96％和11．11％。CA125在卵巢浆液性腺癌、内胚窦癌阳性率分别为96．29％和75％,5例卵巢癌术后CA125阳性均已复发。内胚窦癌AFP阳性率为505,内胚窦癌及浆液性腺癌HCB-β阳性率分别为25％、11．11％。结论CA125对卵巢浆液性腺癌、子宫内膜样癌及内胚窦癌具有较高的诊断价值和预示预后的意义。AFP和HCB-β对内胚窦癌具有特异性诊断意义。CA125、AFP和HCB-β联合检测可提高卵巢癌的检出率。     

罕见颅内原发性内胚窦瘤(附2例报告)

本文报道2例罕见的颅内原发性内胚窦瘤。CT扫描等检查与术中所见一致。2例均具有性腺内发生的内胚窦瘤所具备的一切组织学特征,AFP和PAS阳性。作者对其发生机理及原发于松果体以外的内胚窦与异位松果体瘤的区别,从发生部位和形态学等方面进行了文献复习,证明本文2例内胚窦瘤并非属于异位松果体瘤的范围,从而进一步阐明了原发于性腺以外任何部位的内胚窦瘤,都可能与原始生殖细胞向生殖腺移行过程中,发生迷离或残留有关的论点。     

睾丸内胚窦瘤4例报告

[目的]探讨睾丸内胚窦瘤的临床特点.[方法]4例均行患侧睾丸肿瘤根治术及腹膜后淋巴结清扫术(RPLND),术后辅以化疗.[结果]4例病理均提示为睾丸内胚窦瘤,术后2个月复查AFP均下降至正常.术后随访3～8年,无复发及远处转移.[结论]根治术加化疗能明显提高睾丸内胚窦瘤的治愈率.对儿童患者首选化疗,而不必常规行RPLND术.AFP可作为诊断及判断早期复发的指标.     

CA125、AFP及HCG-β联合检测在卵巢癌诊断中临床意义(附54例分析)

目的　探讨 CA12 5、AFP和 HCG- β联合检测对卵巢癌诊断价值。方法　 5 4例卵巢癌以免疫放射法测定血清 CA12 5 ,以放射免疫法测定血清 AFP和 HCG- β。结果　 CA12 5、AFP和 HCG- β检测总阳性率为 90 .0 7% ,其中卵巢癌 CA12 5、AFP和 HCG- β阳性率分别是 6 6 .6 %、12 .96 %和 11.11%。CA12 5在卵巢浆液性腺癌、内胚窦癌阳性率分别为 96 .2 9%和 75 % ,5例卵巢癌术后 CA12 5阳性者均已复发。内胚窦癌 AFP阳性率为 5 0 %。内胚窦癌及浆液性腺癌 HCG- β阳性率分别为 2 5 %、11.11%。结论　 CA12 5对卵巢浆液性腺癌、子宫内膜样癌及内胚窦癌具有较高的诊断价值和预示预后的意义。AFP和 HCG- β对内胚窦癌具有特异性诊断意义。CA12 5、AFP和 HCG- β联合检测可提高卵巢癌的检出率     

血清AFP检测对卵巢内胚窦癌的早期诊断价值

 卵巢内胚窦可以合成AFP,内胚窦癌患者血清中含有AFP,这一事实为早期诊断该病提供了可靠而有效的依据。     

卵巢内胚窦瘤的治疗和预后

1974年6月至1986年6月收治卵巢内胚窦瘤19例.内胚窦瘤对VAC方案不敏感或仅短期缓解。根据内胚窦瘤转移长期局限在腹腔各脏器表层及VBP腹腔化疗的药理学特点,推测采用VBP腹腔化疗将是有希望的治疗方案。血浆中AFP是内胚窦瘤极敏感的肿瘤标记,然而,当肿瘤组织微小、产生的AFP不足标记或恶性成份不产生肿瘤标记时,组织学却可识别肿瘤,故而AFP测定不可代替二次探查术。     

婴儿色素性神经外胚瘤临床病理观察

目的：探讨色素性神经外胚瘤的病理形态、免疫组化及诊断和鉴别要点。对5例色素性神经外胚瘤病例进行临床病理、免疫组化及电镜观察。结果：色素性神经外胚瘤好发于1岁以内的婴儿，3例肿瘤发生在上颌骨，2例发生在附皋。镜下由两种细胞构成，即上皮样瘤细胞和小圆形似成神经细胞样瘤细胞。免疫组化示上皮样瘤细胞CK、HMB45阳性，小圆形瘤细胞NSE阳性，超微结构显示肿瘤细胞内分别可见前黑色素小体、黑色素小体和神经内分泌颗粒。结论：色素性神经外胚瘤是一种少见的原始性神经外胚层肿瘤，生物学行为属于潜在恶性或低度恶性肿瘤。     

Serum alphafetoprotein (AFP) in patients with germ cell tumors of the gonads and extragonadal sites: correlation between endodermal sinus (yolk sac) tumor and raised serum AFP

During the last 6 1/2 years, serum AFP has been determined by radioimmunoassay in 387 patients with germ cell tumors of the gonads and extragonadal sites. The histological appearances of all these neoplasms were carefully reviewed. Highly elevated levels of serum AFP were noted in patients with tumors containing endodermal sinus (yolk sac) tumor elements irrespective of the location of the neoplasm or presence or absence of metastatic disease. There was good correlation between the presence and quantity of endodermal sinus (yolk sac) tumor elements within the primary tumor or its metastases and elevated levels of serum AFP. All patients with tumors composed of pure seminoma or dysgerminoma, and teratoma, had normal serum AFP levels. Slightly elevated levels of serum AFP up to 60 ng/mg (upper limit of normal 20 ng/ml) were noted in a few patients with testicular tumors composed of pure embryonal carcinoma, whereas patients with tumors composed of or containing endodermal sinus (yolk sac) tumor elements had serum AFP levels that could be measured in 100's or 1000's of ng/ml. Serum AFP was elevated only in patients with active disease. Serum AFP was determined in 81 patients with gonadal tumors of non germ cell origin and was normal in all these patients. Serum AFP is a very good tumor marker in patients with germ cell tumors composed of or containing endodermal sinus (yolk sac) tumor, irrespective of their location. Serial serum SFP determinations can be used for diagnostic purposes, for monitoring the results of treatment, and for early detection of metastases and recurrences. Serial serum AFP determination is a useful procedure in all patients with germ cell neoplasms and is highly recommended.     

Cellular localization of alpha-fetoprotein and human chorionic gonadotropin in germ cell tumors of the testis using and indirect immunoperoxidase technique.

An immunohistologic study of 21 patients with germ cell tumors of the testis with measured serum levels of chorionic gonadotropin (HCG) and alpha-feto protein (AFP) was undertaken to correlate the various types of neoplasms with the presence of these tumor markers in the tissue and serum. AFP was demonstrated in mononuclear embryonal cells within embryonal carcinoma and endodermal sinus tumor. HCG was identified within syncytiotrophoblastic giant cells, frequently in association with embryonal carcinoma, and rarely with endodermal sinus tumor and seminoma, as well as in the syncytiotropho-blastic component of choriocarcinoma. Eighteen of the 21 patients (86%) had elevated tumor markers in their serum; serum HCG alone was elevated in five (24%), AFP alone in five (24%) and both were elevated in eight (38%). There was tissue localization of HCG in 12 of the 13 patients (92%) with elevated serum HCG while AFP was identified in the tumor in eight of the 13 patients (53%) with elevated serum AFP levels. Based on these findings, a tentative immunohistologic classification of germ cell tumors utilizing AFP and HCG is proposed. Thus, embryonal carcinoma, adult type, is frequently associated with both AFP and HCG, endodermal sinus tumor with AFP and choriocarcinoma with HCG, whereas pure seminoma and teratoma are unlikely to be associated with either marker.     

睾丸内胚窦瘤1例报告并文献复习

目的:探讨睾丸内胚窦瘤的生物学行为、临床病理特点、诊断治疗方法及其预后。方法:报告1例睾丸内胚窦瘤的诊断治疗及随访情况,并结合国内外文献进行分析。结果:本例患者肿瘤分期为Ⅰ期,行患侧睾丸肿瘤根治性切除术,术后给予PVB方案化疗3个疗程,效果良好,随访24个月,直至最后一次复查,患者AFP、HCG处于正常水平,相关影像学检查未见复发及远处转移。结论:睾丸内胚窦瘤临床罕见,恶性程度高,总体预后差,其确诊依靠病理,外科手术为主要治疗手段,运用手术加放、化疗的综合治疗措施可显著延长生存期。     

Endodermal sinus tumor of the omentum: case report

We report a case of primary endodermal sinus tumor of the omentum in a 46-year-old woman. The patient had been referred to our hospital for pain in the right abdomen. CT scan revealed a right-sided abdominal mass. At laparotomy, a large omental tumor extending to the bowel, uterus, ovaries and peritoneum was found, and it was totally resected. The tumor displayed the typical histological patterns observed in endodermal sinus tumor, and the immunohistochemical findings confirmed the diagnosis. Serum AFP level was 21.550 ng/ml prior to laparotomy, and decreased to 13.845 ng/mL after surgery, whereas the level of serum beta human chorionic gonadotropin was normal. Post-surgery, the patient received combination chemotherapy consisting of cisplatin, etoposide and bleomycin every 3 weeks for a total of 6 cycles. At the end of the treatment, all the findings, including AFP level, were normal.     

Case of yolk sac tumor decreasing in size and the normalizing of alph-fetoprotein level by anticancer chemotherapy

A 19-year old man was hospitalized suspected of a mediastinal tumor with superior vena caval syndrome. As the chest X-ray film and thoracic CT scan on admission revealed a huge anterior mediastinal tumor, and the value of serum alpha-fetoprotein (AFP) was high, we made a diagnosis of malignant mediastinal tumor from the germ cell. Radiation therapy was not effective, but a combination chemotherapy consisted of cis-platinum, adriamycin, and vincristine was clearly effective, decreasing the size of the tumor and normalizing the value of serum AFP. As the tumor acquired tolerance to the anticancer drugs before long, the chemotherapy became ineffective and the patient died 9 months after the initiation of the treatment. This tumor had endodermal sinus structure, Schiller-Duval body, and eosinophilic hyaline globulus which were histological characteristics of yolk sac tumor, and was confirmed to be originated from anterior mediastinum.     

Successful treatment of a primary endodermal sinus tumor of the liver.

A 27-year-old woman had a large hepatic tumor and a markedly increased serum alpha-fetoprotein (AFP) level. A diagnosis of endodermal sinus tumor was made after a needle biopsy was performed on the liver. Clinical and radiologic examinations did not show an alternative primary site. Treatment with cisplatin, etoposide, and bleomycin was started, but, after three cycles, was changed to cisplatin, vincristine, methotrexate, bleomycin, dactinomycin, cyclophosphamide, and etoposide because the serum AFP level was decreasing too slowly. After additional chemotherapy was given, the patient was well but had an increased AFP level and a large residual mass in the liver. A right hemihepatectomy was performed, but no viable tumor was present. The patient is alive and disease-free 5 years later. Thus, AFP levels may be misleading in the presence of large necrotic tumors. The authors stress the need to make a diagnosis of these rare tumors early because aggressive treatment with combination chemotherapy may result in cure.     

Mediastinal yolk sac tumor in a woman

Primary endodermal sinus tumor (yolk sac tumor) of the mediastinum is uncommon and most patients are young and male. We report a yolk sac tumor with a mature teratoma of the anterior mediastinum in a 28-year-old woman with an intrathoracic mass. Four courses of combination chemotherapy were given and the tumor was resected. The patient's serum alpha-fetoprotein (AFP) level was elevated, to more 100 000 ng/ml. To the best of our knowledge, this is the first report of serum AFP level exceeding 100 000 ng/ml in a yolk sac tumor with a mature teratoma.     

Alpha-1 antitrypsin (AAT) and alphafoetoprotein (AFP) in sera of patients with germ-cell neoplasms: value as tumour markers in patients with endodermal sinus tumour (yolk sac tumour).

Serum alphafoetoprotein (AFP) and serum alpha-1 antitrypsin (AAT) were determined in 24 patients with germ-cell neoplasms of the gonads and extragonadal sites and in two patients with hepatocellular carcinoma. In the majority of the patients serial determinations were performed. All seven patients with testicular seminoma and four patients without evidence of active disease had normal levels of serum AAT and AFP. The remaining 13 patients with germ-cell neoplasms had tumours containing endodermal sinus tumour (yolk-sac tumour) elemetns. All these 13 patients had elevated levels of serum AFP and the levels were high or very high in most cases. Nine of these 13 patients had raised serum AAT, although the elevation above normal levels was only slight in a number of cases. When serial determinations were performed serum AAT levels frequently followed the pattern of serum AFP levels, but the AAT levels were frequently within normal limits and therefore the interpretation of the results was difficult, and much less reliable as compared with those for serum AFP. The elevation of serum AAT levels following the recurrence of the tumour was found to occur much later and was much less marked than elevation of serum AFP, which occurred early, showed a large rise and was a reliable marker of tumour recurrence in patients with germ-cell neoplasms containing endodermal sinus tumour elements. It is therefore considered that, although there is good evidence that serum AAT is produced by endodermal sinus tumour elements, serum AAT is not a useful monitor of disease activity in these patients, especially when compared with serum AFP, the value of which is well recognized. Serum AAT may be a useful tumour marker in patients with hepatocellular carcinoma, and this aspect should be investigated further.     

Embryonal carcinoma of the ovary: a clinicopathologic entity distinct from endodermal sinus tumor resembling embryonal carcinoma of the adult testis.

The clinical and pathologic features of 15 examples of a hitherto undescribed germ cell tumor of the ovary are delineated. This tumor resembles the embryonal carcinoma of the adult testis and may be distinguished from the endodermal sinus tumor on the basis of its histologic and immunohistochemical characteristics. An indirect immunoperoxidase method for the localization of human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) was done on formalin-fixed paraffin-embedded tissue from 10 neoplasms; HCG was present in all 10 neoplasms, and AFP was found in seven. HCG was indentified only in cells resembling syncytiotrophoblast, whereas AFP was present only in mononuclear embryonal cells, indicating that the two protein antigens were localized in different cell types. Abnormal hormonal manifestations, consisting of precocious puberty, irregular bleeding, amenorrhea, or hirsutism, were present in nine (60%) of the patients. The actuarial survival for the entire group was 39%; for those with stage I tumors, 50%. We are proposing the term "embryonal carcinoma" for this neoplasm in order to distinuish it from the more common endodermal sinus tumor of the ovary and to emphasize the histologic similarity to embryonal carcinoma of the adult testis.     

Endodermal sinus tumor of sacrococcygeal region in the infant--clinico-pathologic analysis of 6 cases

Endodermal sinus tumor can be found in the ovaries, testes and extragonadal sites, such as sacrococcygeal, retroperitoneal, mediastinal regions or other mid line structures. Sacrococcygeal endodermal sinus tumor and its characteristics are presented. The age of patients with lesions in this region is youngest among all. Their ages ranged 10 months to 3 years in our series. Five of them were females. Most cases had difficulty in passing stools. When first seen in the clinic, all were in the advanced stage with the tumor infiltrating into the sacrococcygeal bones, presacral soft tissues and rectum already. The residual lesions recurred rapidly after operation. All cases were not treated systematically by chemotherapy or radiotherapy, and died within 1-15 months. Pathologically, the composition of the tumor is the same in every site, assuming patterns of reticular or solid, glandular or pseudopapillary appearance, Schillar-Duval bodies, hyaline bodies and so on. Positive serum AFP test may be helpful in the differential diagnosis and prognostic evaluation.