卵巢性索间质肿瘤的CT表现与病理对照研究

目的 探讨卵巢性索间质肿瘤的CT表现并与术后病理进行对照分析,以提高术前诊断水平.方法 回顾性分析23例经手术病理证实的卵巢性索间质肿瘤的临床资料、CT表现、术后病理,对颗粒细胞瘤与卵泡膜细胞瘤-纤维瘤的平扫CT值与增强后强化程度ACT值进行比较分析.结果 (1)颗粒细胞瘤7例;(2)卵泡膜细胞瘤3例、纤维-卵泡膜纤维瘤11例12枚;(3)Sertoli-Leydig细胞瘤1例;(4)类固醇细胞瘤1例,在CT上具有一些特征性表现,且与术后病理相对应.颗粒细胞瘤与卵泡膜细胞瘤-纤维瘤的平扫CT值无明显差异(t=1.487,P=0.157),颗粒细胞瘤增强后强化程度△CT值较卵泡膜细胞瘤-纤维瘤高(t=2.528,P=0.041).结论 卵巢性索间质肿瘤具有一定的CT特点,符合其病理表现,结合临床资料,有助于术前初步诊断.     

不同方式治疗卵巢子宫内膜异位囊肿对IVF-ET结局的影响

目的:探讨不同方式治疗卵巢子宫内膜异位症不孕患者对体外受精-胚胎移植(IVF-ET)结局的影响。方法:2010年1月至2015年1月在四川省人民医院诊断为卵巢子宫内膜异位囊肿合并不孕,接受IVF-ET助孕的患者160例,根据IVF-ET前对子宫内膜异位囊肿治疗方式的不同,将其单盲随机分为手术组80例(开腹组和腹腔镜组)与穿刺组80例,另选80例单纯输卵管因素导致不孕行IVF-ET助孕者为对照组。对各组Gn用量、Gn天数、获卵数、受精率及临床妊娠率等进行分析。结果:手术组平均Gn天数及剂量(14.60±1.54天,39.10±6.66支)高于穿刺组(12.10±1.17天;34.80±6.64支)及对照组(11.70±0.98天;28.80±4.32支)(P0.05),腹腔镜组获卵数少于开腹组(7.30±1.63个vs 9.60±2.73个)(P0.05)。穿刺组临床妊娠率和对照组相近(53.75%vs51.25%),高于手术组(32.50%)(P0.05)。开腹手术组临床妊娠率高于腹腔镜组(45.00%vs20.00%)(P0.05)。结论:IVF-ET前行穿刺治疗卵巢子宫内膜异位囊肿的患者,IVF-ET助孕促排卵药用量少,临床妊娠率较高。     

Evaluation of Preoperative Serum Levels of CA 125 and Expression of p53 in Ovarian Neoplasms: A Prospective Clinicopathological Study in a Tertiary Care Hospital

Objectives

To assess the preoperative serum levels of CA 125 with its diagnostic role and to evaluate the p53 expression in patients of primary ovarian neoplasms. We also wished to judge their relationship with other parameters like clinical staging and histopathologic tumor type.

Materials and Methods

The present study was conducted on 86 patients during the study period of 2.5 years. Preoperative CA 125 levels were evaluated by an automated immunoassay analyzer. p53 expression was judged immunohistochemically with pre-diluted monoclonal antibody. An objective scoring was done depending on distinct nuclear immunopositivity.

Results

Median value of preoperative CA 125 levels was 32 U/mL in benign surface epithelial-stromal tumors (BSEST), 53 U/mL in borderline surface epithelial-stromal tumors (BOT), 346 U/mL in malignant surface epithelial-stromal tumors (MSEST) and 560 U/mL in serous adenocarcinomas (SAC). Most of ovarian tumors were in the FIGO stage I (64 cases, 74.4%), but higher stages (II, III, IV) were observed mostly in MSESTs. SACs displayed the maximum p53 expression. Considering the cut-off value of more than 35 U/mL in CA 125 levels, the sensitivity to diagnose MSESTs was 94.7%. Preoperative CA 125 levels strongly and positively correlated with FIGO staging and p53 expression. Similarly p53 expression strongly and positively correlated with FIGO staging and histopathological categories.

Conclusion

Higher values of preoperative CA 125 levels and higher expression p53 are associated with MSESTs and BOTs especially of serous type. They strongly correlate with each other and with tumor stage. But there is no serum CA 125 concentration that can clearly differentiate benign and malignant ovarian masses.     

达因35联合小剂量地塞米松治疗多囊卵巢综合征的效果分析

目的：通过观察达因35联合小剂量地塞米松治疗多囊卵巢综合征（ PCOS）的临床效果,探讨PCOS高雄激素血症的有效治疗途径。方法将68名高雄激素血症性PCOS患者随机分为两组,分别给予口服达因35（达因组）和达因35联合小剂量地塞米松（地塞米松组）治疗3～6个周期,比较治疗前后PCOS患者多毛痤疮、肥胖指数、卵泡发育和排卵率以及血清激素的变化,并进行统计学分析。结果达因35和达因35联合小剂量地塞米松能够明显降低PCOS患者体内促黄体生成素（ LH）、游离睾酮（ FT）、雄烯二酮（ A）、硫酸脱氢表雄酮（DHEA－S）、17－羟孕酮（17－OHP）的水平,治疗3个周期地塞米松组显著低于达因组（P＜0.01）,治疗6个周期两组比较差异无显著性（ P＞0.05）;治疗3个周期达因35联合小剂量地塞米松可明显改善PCOS患者多毛、痤疮、卵泡发育和排卵率,与达因组比较差异有显著性（ P＜0.05）。结论小剂量地塞米松可协同达因35治疗PCOS高雄激素血症并明显缩短达因35的治疗周期,同时显著改善高雄激素血症引起的慢性无排卵、多毛痤疮等临床症状。     

卵巢无性细胞瘤的MR表现

目的：评价卵巢无性细胞瘤的MR表现及其病理,以提高其诊断准确率。方法回顾性分析该院2009年12月—2015年3月经术后病理证实的15例卵巢无性细胞瘤的临床资料及MRI表现,观察肿块的大小、形态、境界、囊实性、平扫信号及强化特点、周围淋巴结情况等,并与病理结果相对照。结果15例无性细胞瘤患者共发现16个肿块,14例为单侧,1例为双侧,所有肿块均包膜完整,11个呈分叶状,3个呈椭圆形,2个呈不规则形,12个肿块为实性,4个肿块为囊实性。结论卵巢无性细胞瘤在MRI表现具有一定特征性,结合患者临床表现,能提高其诊断准确率。     

经阴道彩超对卵巢纤维瘤的诊断价值

目的：探讨经阴道彩超对卵巢纤维瘤的诊断价值。方法对经手术及病理证实的21例卵巢纤维瘤的病例,术前经阴道彩超声像图特点进行回顾性分析。结果21例卵巢纤维瘤患者术前均行经阴道彩超检查,其中单侧20例,双侧1例。声像图特征：均质低回声包块为18例,1例合并钙化,1例合并液化,2例为囊性包块。有9例伴腹水。结论经阴道彩超对于鉴别及诊断卵巢纤维瘤具有较高的准确率,对临床初步定性诊断较高价值。     

中西医结合治疗多囊卵巢综合征临床研究

目的:观察桂枝茯苓汤加味联合西药治疗多囊卵巢综合征的临床疗效。方法:将126例多囊卵巢综合征患者随机分为对照组和治疗组,每组63例。对照组在非月经期期间均服用甲福明片,每次1粒,每日3次,并在月经第5天起服用达英-35片,每次1粒,每日1次;观察组在对照组治疗基础上加服桂枝茯苓汤加味(药物组成:桂枝15 g,茯苓30 g,淫羊藿30 g,牡丹皮9 g,赤芍15 g,桃仁12 g)治疗,水煎取汁400 m L,分两次温服,每日1剂。用药3个月经周期后,比较两组患者的临床疗效、排卵率、妊娠率、子宫内膜厚度、性激素水平、空腹血糖、血清胰岛素含量及体质量指数。结果:两组患者临床疗效比较,差异有统计学意义(χ~2=6.939,P=0.031);排卵率比较,差异有统计学意义(χ~2=16.377,P0.001);妊娠率比较,差异无统计学意义(χ~2=7.208,P=0.007);两组患者的性激素水平均降低,子宫内膜均增厚,差异均有统计学意义(P0.05);观察组患者的空腹血清胰岛素含量及体质量指数均低于对照组,差异均有统计学意义(P0.05)。结论:桂枝茯苓汤加味联合西药可有效改善多囊卵巢综合征患者的临床症状,促进排卵,调节性激素水平,提高妊娠率。     

Effects of hexestrol on mouse ovarian morphology and ovulation

OBJECTIVE: To analyze histological aspects of ovaries as well as the ovulation of adult mice treated with the anabolic agent hexestrol. METHODS: Thirty adult mice were divided into three groups of 10 animals each: (GI) the animals received a dose of 3 mg/kg of hexestrol; (GII) the animals were given a dose of 6 mg/kg of hexestrol; (GIII) the animals were injected with distilled water (vehicle). Another 10-animal group (GIV) was included, and these mice were injected with propionate testosterone (1.25 mg) after 5 days from the day of birth. Hexestrol was administered intraperitoneally once a day and the treatment lasted 30 days. The mice were then sacrificed; their ovaries and oviducts were removed, submitted to histological routine and analyzed under light microscopy. RESULTS: In mice treated with hexestrol (6 mg/kg) (Group II), ovaries were smaller than those from the controls but highly vascularized; similar results were obtained in GIV. A great number of follicles in several stages of development were found -- however, with no corpora lutea -- in six animals in GII. No corpora lutea were found in GIV. The number of luteal bodies and oocytes in GII was lower than that in GI or GIII. No oocytes were detected in GIV. Finally, the nuclear volume of interstitial cells in GII and GIV was the largest. CONCLUSION: Our data suggest that the anabolic agent hexestrol in a high dose may decrease ovulation in mice.     

Molecular pathology of ovarian carcinomas

 There is evidence that ovarian cancer may be derived from the progressive transformation of benign and/or borderline tumours. Mutations involving different oncogenes and tumour suppressor genes accumulate during the process of malignant transformation, and the alterations of genes involved in the pathogenesis of familial ovarian cancer are probably early events in ovarian tumorigenesis. BRCA-1 and BRCA-2 act as classical tumour suppressor genes in hereditary tumours, but their role in sporadic tumours remains controversial; however, a high frequency of allele losses in BRCA-1 (17q) and BRCA-2 (13q) loci has been observed in both familial and sporadic tumours. The possible role of mismatch repair genes and microsatellite instability is also controversial, but a role for them has been proposed in borderline tumours. Mutations in K-ras are specific for mucinous tumours and may be related to mucinous differentiation. Finally, a role in tumour progression has been proposed for both c-erb B-2 and p53, but their practical value in prognosis remains questionable. Received: 29 May 1997 / Accepted: 2 April 1998