晚期与复发性卵巢恶性生殖细胞肿瘤129例治疗结果的分析

目的探讨改进晚期及复发性卵巢恶性生殖细胞肿瘤治疗的方法。方法回顾性分析１９５８～１９９３年我院收治的１２９例晚期与复发性卵巢恶性生殖细胞肿瘤的治疗结果。对１９８４～１９９３年间采用ＶＡＣ方案（长春新碱＋更生霉素＋环磷酰胺）、ＰＶＢ方案（顺铂＋长春花碱＋博莱霉素）及ＢＥＰ方案（博莱霉素＋足叶乙甙＋顺铂）治疗的患者生存情况,与１９５８～１９８３年间采用随意治疗方案的患者生存情况进行比较。结果１２９例晚期与复发性卵巢恶性生殖细胞肿瘤总的５年生存率为３０％（３９／１２９）,其中无性细胞瘤的５年生存率为６８％（１９／２８）,而非无性生殖细胞瘤为２０％（２０／１０１）。近１０年,卵巢非无性生殖细胞瘤患者的５年生存率已由３％提高到４２％。联合化疗对生存率的提高起着关键作用。３个联合方案,以ＢＥＰ方案疗效较好。结论卵巢内胚窦瘤的发生率在中国各类型卵巢恶性生殖细胞瘤中位居首位。为改善晚期与复发性卵巢恶性生殖细胞瘤患者的预后,应对所有患者尽早采用目前较有效的化疗方案——ＢＥＰ方案治疗。     

阴道内胚窦瘤的诊断和治疗——附二例报告

目的 探讨阴道内胚窦瘤的临床特点及化疗效果。方法 对２例阴道内胚窦瘤进行临床报告及分析。结果 阴道内胚窦瘤主要发生在儿童,临床表现主要为阴道出血和息肉状易脆的阴道肿物。血清甲胎蛋白（α－ＦＰ水平化疗前均异常升高,病理诊断主要依靠Ｓｃｈｉｌｅｒ－Ｄｕｒａｌ小体和α－ＦＰ染色阳性。２例口才分别对顺铂、长春新碱、博莱霉素（ＰＶＢ）方案和顺铂、鬼臼乙叉甙、博莱霉素（ＰＥＢ）方案化疗均有良好反应,２￣３个疗     

对卵巢生殖细胞恶性肿瘤当代处理的评价

近10～15年来,卵巢生殖细胞恶性肿瘤的预后有了非常显著的改观.若仅行手术治疗或手术加放疗,其预后极差.只有纯粹的无性细胞瘤及某些未成熟性畸胎瘤可能预后较好.而由于用了联合化疗使得恶性生殖细胞肿瘤提高到接近于90%的生存率.对卵巢生殖细胞瘤最常用的联合化疗是长春新硷、放线菌素D及环磷酰胺(VAC)或氨甲喋呤、放线菌素D及苯丁酸氮芥(MACb).晚近还有其他一些联合化疗方案;包括顺铂、博莱霉素及长春新硷(PBV),     

全面分期手术对卵巢恶性生殖细胞肿瘤初治患者预后的影响

目的探讨全面分期手术对卵巢恶性生殖细胞肿瘤（MOGCT）初治患者预后的影响。方法收集北京协和医院1980年6月-2003年6月收治的127例MOGCT患者的临床病理资料,分析其初治时的手术方式与预后的相关性。结果127例患者中,行全面分期手术者45例（35．4％）,未行全面分期手术者82例（64．6％）;术后残余瘤直径〈2cm（即手术彻底）者71例（55．9％）,直径≥2cm（即手术不彻底）者11例（8．7％）,不详者45例（35．4％）;采用顺铂＋长春新碱＋博莱霉素（PVB）或博莱霉素＋足叶乙甙＋顺铂（BEP）方案化疗者75例（59．1％）,长春新碱＋阿霉素＋环磷酰胺（VAC）方案化疗者18例（14．2％）,未化疗或行其他方案化疗者34例（26．8％）。随访期（2-254个月）内,行全面分期手术者复发率为16％（7／45）,未行全面分期手术者复发率为61％（50／82）,两者比较,差异有统计学意义（P〈0．05）。多因素分析结果显示,全面分期手术不影响无瘤生存时间（P=0．061）,化疗方案、手术彻底性是明显影响无瘤生存时问的因素（P〈0．05）。行全面分期手术者随访2—158个月,死亡率为7％（3／45）,未行全面分期手术者随访4～254个月,死亡率为15％（12／82）,两者比较,差异无统计学意义（P〉0．05）。全面分期手术不影响长期生存时间（P〉0．05）,化疗方案、手术彻底性明显影响长期生存时间（P〈0．05）。结论手术彻底和规范化疗明显影响MOGCT初治患者的预后,而是否实施全面分期手术对初治患者预后无明显影响。     

改良MTT法在卵巢恶性肿瘤化疗药物敏感试验中应用的研究

目的研究抗卵巢恶性肿瘤体外药敏测定与临床疗效的关系。方法收集卵巢恶性肿瘤２４例的３５份标本用改良的ＭＴＴ法研究卵巢恶性肿瘤对顺铂、卡铂、阿霉素、长春新碱、５－氟脲嘧啶、更生霉素的敏感性。结果不同个体之间对药物的敏感率差异有显著性（Ｐ＜０．０１）；单一药物的抑制率以铂类药物及阿霉素较高，顺铂的抑制率高于卡铂，联合用药较单一用药更为有效（Ｐ＜０．０１）。比较同一病例的实体瘤标本和腹水标本对药物的敏感率，发现二者密切相关（ｒ＝０．９２５）。测出敏感药物的１７例中１３例临床有效，未测出敏感药物的４例临床疗效较差，药敏组与不敏感组临床疗效差异有显著性（Ｐ＜０．０５）。体外药敏试验结果与临床疗效有良好的相关性（ｒ＝０．７８）。结论用改良ＭＴＴ法快速药敏选药可使化疗个体化，提高卵巢恶性肿瘤的治疗效果。     

卵巢恶性肿瘤的诊断与治疗进展

卵巢恶性肿瘤是死亡率最高的妇科恶性肿瘤。近 30年来 ,卵巢恶性肿瘤的诊断与治疗一直是我国妇科肿瘤领域研究的重点内容 ,并取得了可喜的进展。顺铂 +长春新碱 +博来霉素 (PVB) /顺铂 +鬼臼乙叉甙 +博来霉素 (PEB)化学药物治疗 (化疗 )方案的应用 ,使卵巢恶性生殖细胞肿瘤的治疗 ,达到了根治的疗效。手术技巧的提高 ,新型化疗药物的问世 ,也给卵巢上皮癌的治疗带来了多重生机。尽管卵巢上皮癌患者的 5年生存率并无明显提高 ,但患者的近期生存情况和生活质量有了明显的改善。卵巢恶性肿瘤诊断与治疗的规范化 ,加快了我国与国际水平接轨的…     

42例卵巢恶性生殖细胞肿瘤临床特征及预后分析

目的:探讨卵巢恶性生殖细胞肿瘤的临床特征与预后的关系。方法:收集我院2006年8月至2012年2月收治的42例卵巢恶性生殖细胞肿瘤的临床资料,分析其肿瘤类型、分期、治疗方案等预后相关因素,研究其临床特征与不良预后的关系。结果:42例卵巢恶性生殖细胞肿瘤包括混合性生殖细胞肿瘤16例(38.1%)、未成熟畸胎瘤12例(28.6%)、无性细胞瘤6例(14.3%),卵黄囊瘤4例(9.5%)、绒毛膜癌1例(2.4%)及胚胎癌1例(2.4%)等。42例患者全部进行手术治疗,其中30例在初次手术中保留了生育功能,34例在术后给予BEP方案(博来霉素+依托泊苷+顺铂)或BVP方案(博来霉素+长春新碱+顺铂)化疗。2年生存率97.5%(39/40),死亡1例(Ⅳ期混合性生殖细胞肿瘤),复发率37.5%(15/40),混合性生殖细胞肿瘤复发占66.7%(10/15);5年生存率88.2%(15/17),死亡2例(均为恶性混合性生殖细胞肿瘤)。不同病理分期、肿瘤直径、肿瘤类型和手术方式的5年生存率比较,差异均无统计学意义(P0.05)。结论:保留生育功能手术及规范化的BEP或BVP方案化疗,5年总体生存率较高,但混合性生殖细胞肿瘤预后相对较差。卵巢恶性生殖细胞肿瘤的病理分期、肿瘤直径及肿瘤类型与生存率的关系还需进一步研究。     

卵巢生殖细胞肿瘤的化疗

与卵巢上皮癌相比 ,卵巢恶性生殖细胞肿瘤较为少见 ,仅占卵巢恶性肿瘤的 5 %～ 15 %。但是 ,由于其多发于年轻女性 ,恶性程度大 ,病死率高 ,格外受到临床医生的重视。近 2 0年来 ,随着有效化疗方案的应用 ,卵巢恶性生殖细胞肿瘤的治疗模式发生了根本的变化 ,主要表现为以下三个方面 :①卵巢恶性生殖细胞肿瘤对化疗十分敏感 ,化疗已成为非常重要的治疗手段。②化疗使卵巢恶性生殖细胞肿瘤的预后大为改观 ,存活率由过去的 10 %～ 2 0 %提高到目前的 80 %～ 90 %。③化疗为卵巢恶性生殖细胞肿瘤患者保留生育功能提供了有效保证 ,无论任何期别 ,…     

卵巢恶性生殖细胞肿瘤的化疗及进展

卵巢恶性生殖细胞肿瘤是来源于卵巢生殖细胞的恶性肿瘤，约占所有卵巢恶性肿瘤的5％～20％，主要包括卵黄囊瘤、未成熟畸胎瘤、无性细胞瘤、胚胎癌、原发绒癌及混合性生殖细胞肿瘤。其多数对化疗极其敏感，化疗已经成为其非常重要的治疗手段。     

平阳霉素所致肺间质纤维化14例临床分析

平阳霉素（Pinyanmycin）即博莱霉素（bleomycin，BLE）所致弥漫性肺间质纤维化（diffusingpulmonaryinterstitialflbrosis，DPIF）的发生率为5％～10％，致死率为1％～2％[1，2]，目前尚无有效的治疗方法。因此，DPIF的早期诊断及预防日益受到重视。现将1986至1996年我院收治14例应用BLE所致的DPIF资料分析总结如下。1资料与方法1．1临床资料DPIF14例8～55y，平均24y。原发病诊断均经手术病理检查证实，其中卵巢恶性生殖细胞溜（ovarianmalignentsermalcelltumor）12例，卵巢恶性淋巴细胞瘤（ovarianmalignentlymphacytecelltumo…     

Combination chemotherapy in the management of ovarian germ cell malignancies

Twenty-four patients with ovarian germ cell malignancies received combination chemotherapy in the present series. Fifteen patients received intensive vincristine, actinomycin-D, and cyclophosphamide therapy for 12 to 18 courses, and 13 are alive and free of disease 34 to 86 months later. One patient with a stage III pure endodermal sinus tumor and one patient with a stage III mixed germ cell tumor composed predominantly of endodermal sinus tumor elements failed vincristine, actinomycin-D, and cyclophosphamide therapy, but each transiently responded to cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy. Nine patients subsequently were treated on a new protocol that used the intensive vincristine, actinomycin-D, and cyclophosphamide regimen for five to six courses for all stage I ovarian germ cell malignancies and cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy for advanced stage tumors containing endodermal sinus tumor. Each patient on the new protocol is alive and free of disease 14 to 26 months later. Short-term intensive vincristine, actinomycin-D, and cyclophosphamide therapy is recommended for all stage I ovarian germ cell malignancies requiring adjuvant chemotherapy. Preservation of ovarian and reproductive function is appropriate in the present group of patients. Vincristine, actinomycin-D, and cyclophosphamide therapy is also recommended for biomarker negative advanced stage ovarian germ cell malignancies. Cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy is recommended for advanced stage biomarker positive ovarian germ cell malignancies. Serial alpha-fetoprotein (AFP) titers accurately reflect the status of endodermal sinus tumor elements and may be used as a guide to discontinue treatment for patients with pure endodermal sinus tumor malignancies, obviating the need for second-look surgery.     

Gynecologic malignancies in women aged less than 25 years

OBJECTIVE: To describe the epidemiologic characteristics of gynecologic malignancies in patients 25 years of age or younger. METHODS: The Automated Central Tumor Registry (ACTUR), the cancer registry for the Department of Defense, was used to identify children, adolescents, and young adults diagnosed with gynecologic malignancies. Specifically, primary ovarian, uterine, cervical, vaginal, and vulvar malignancies diagnosed between 1990 and 2002 were included in the analysis. Data from the Department of Defense tumor registry were then compared with results obtained from the national Surveillance, Epidemiology, and End Report (SEER) program database. RESULTS: Two hundred fifty-one cases were identified in the Department of Defense tumor registry. The most common primary site was ovary, with 116 cases (46%), followed by cervix, with 108 cases (43%). The most common histological types were germ cell (35%) for ovary, squamous cell (52%) for cervix, choriocarcinoma (18%) for uterus, and squamous cell (30%) for vulva/vagina. The 21- to 25-year-old age group had the greatest number of cases for the entire cohort (23%). Most patients had only local disease at time of diagnosis, and the 5-year survival percentage was 86% (95% confidence interval 80-91) for all patients with ovarian and cervical carcinoma. Data from the SEER program demonstrated a similar distribution and incidence pattern. CONCLUSION: The ovary and cervix are the most common primary sites of gynecologic malignancies in patients 25 years of age or younger. Health maintenance programs for patients in this age group should continue to include pelvic exams and Pap test screening.     

Lower genital tract rhabdomyosarcoma: case series and literature review

OBJECTIVE: Rhabdomyosarcoma (RMS) of the lower genital tract is a rare tumor. It tends to occur in childhood in the vagina and in rare cases, RMS can originate in the uterine cervix, with a peak incidence in the 2nd decade. METHODS: A hospital-based tumor registry was searched to find all patients with female genital tract RMS, which were treated between 1999 and 2004. The medical records of all patients were reviewed. A single pathologist reviewed all pathologic specimens. RESULTS: Among the 1,528 patients with genital tract malignancies, six RMS were found: three vaginas, three cervixes. All patients presented with vaginal bleeding. Mean age of patients was 16(13-30). The lesions in vagina were clinically staged as stage I (2), stage II (1) and in cervix were stage I (2) and stage III(1). All of the patients were treated with surgery and adjuvant chemotherapy. One patient with cervical RMS was treated with adjuvant chemo radiation. Two patients with cervical RMS died from the large size and extent of the disease 9 and 11 months after diagnosis, but all patients with vaginal RMS remain alive after a mean follow-up of 38 months. CONCLUSION: Most patients present with vaginal bleeding and a palpable cervical or vaginal mass. While the optimal management of these tumors is uncertain, primary therapy with wide local excision and chemotherapy can result in prolonged survival and cure in patients with early stage RMS. Vaginal lesions have a better prognosis than cervical lesions. In patients with un-embrional RMS, large size of lesion, cervical origin and extent of disease, survival rates was decreased.     

卵巢卵黄囊瘤手术和化疗后自然周期体外受精-胚胎移植成功分娩一例并文献复习

卵巢卵黄囊瘤属卵巢恶性生殖细胞肿瘤,占卵巢恶性肿瘤的1%。由于卵巢恶性生殖细胞肿瘤多见于儿童及年轻女性,故保存生育能力是关键。卵巢卵黄囊瘤对化疗药物敏感,手术联合术后辅助化疗是标准治疗方案。对于对侧卵巢和子宫未受肿瘤累及,并且有生育需求的患者均应行保留生育功能的手术。但肿瘤本身、手术和放化疗均可能造成患者不孕,术后可能需要借助辅助生殖技术助孕,本文通过1例卵巢卵黄囊瘤患者手术和术后化疗后行自然周期-体外受精-胚胎移植(NC-IVF-ET)的个案报道和文献复习,探讨卵巢卵黄囊瘤患者的生育助孕策略。     

Conservative surgery plus adjuvant therapy for vulvovaginal rhabdomyosarcoma, diethylstilbestrol clear cell adenocarcinoma of the vagina, and unilateral germ cell tumors of the ovary.

Significant progress has been made in the 1980s in early-stage vulvovaginal rhabdomyosarcoma, diethylstilbestrol (DES) clear cell adenocarcinoma of the vagina, and unilateral germ cell tumors of the ovary. In an early state of vulvovaginal rhabdomyosarcoma, systemic vincristine, dactinomycin, and cyclophosphamide (VAC) chemotherapy followed by local excision or local radiation results in a high cure rate with retention of future fertility. Similarly, early-stage DES-related adenocarcinoma of the vagina treated by wide local excision and localized vaginal radiation also results in retention of fertility and a high cure rate. Finally, significant progress has been made in unilateral germ cell tumors of the ovary in which surgical treatment by unilateral salpingo-oophorectomy followed by cisplatin, etoposide, and bleomycin results in not only high cure rates and retention of fertility but will probably be standard therapy for all germ cell tumors of the ovary, including dysgerminoma, a disease most frequently treated in the past by radiation therapy with loss of subsequent fertility.     

Malignant germ cell tumors of the ovary

OBJECTIVE: To evaluate the efficacy of adjuvant therapy for ovarian germ cell tumors. METHODS: We reviewed records of women who had malignant germ cell tumors of the ovary from 1977-1997. RESULTS: Seventy-two women had surgical resections of malignant ovarian germ cell tumors and most received adjuvant therapy. Fifty-six women (78%) presented with stage I disease, and 16 (22%) had more advanced disease. Tumor subtypes included dysgerminoma (n = 20), yolk sac tumor (n = 8), immature teratoma (n = 29) and mixed germ cell tumor (n = 15). Surgical management of the 56 with stage I disease consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy, and extensive surgical staging in ten women, whereas a conservative surgical approach, consisting of unilateral adnexectomy with or without comprehensive surgical staging, was adopted in later years (n = 46). Fifty-six women were treated with postoperative chemotherapy, predominantly platinum-based regimens. The 5-year actuarial survival rate was 93%. None of the 36 women who presented after 1984 have died of disease. CONCLUSION: These data confirmed that platinum-based adjuvant treatments allow most women with ovarian germ cell malignancies to have conservative surgery without compromising survival.     

Endodermal sinus tumor of the ovary: the M. D. Anderson experience

Forty-one patients with pure endodermal sinus tumor of the ovary who were treated at the M. D. Anderson Hospital from 1944 to 1981 are retrospectively reviewed. The median age of these patients was 19 years. The most common presenting symptom was abdominal pain, occurring in 33 patients (80%). No bilateral ovarian involvement was noted at initial surgery. With the exception of 1 patient treated by surgery alone, only patients treated with postoperative combination chemotherapy survived. Twenty-one of the 41 patients are alive and well. Sixteen of 22 patients treated with vincristine, actinomycin-D, and cyclophosphamide have survived. The roles of second-look laparotomy and alpha-fetoprotein monitoring are discussed. Optimal treatment seems to consist of surgery followed by aggressive combination chemotherapy.     

20例成人型卵巢颗粒细胞瘤的临床病理特点与分析

目的 分析归纳成人型卵巢颗粒细胞瘤（AGCT）的临床病理特点,为疾病诊治提供参考。方法 回顾性分析20例经手术与病理证实为AGCT患者的临床病理资料,分析该病临床病理特点和治疗方案。结果 20例患者中,腹胀、腹痛7例,盆腔包块8例,阴道异常出血5例,雌激素升高者11例,疾病分期多为早期（Ⅰ期19例）,均行手术治疗,4例行术后化疗。术后回访无复发。结论 卵巢颗粒细胞瘤临床症状不明显,对于阴道异常出血、腹部包块、腹胀腹痛、雌激素水平升高者考虑AGCT的可能。诊断需参考影像学资料及病理组织学形态及免疫表型,注意与其他卵巢肿瘤的区别。以手术治疗为主,早期诊治复发率低,该疾病有远期复发特点,需长期随访。     

Clinical analysis of synchronous primary neoplasms of the female reproductive tract

OBJECTIVES: In this study, a histopathologic review of synchronous primary neoplasms including gynecologic malignancies is presented, and the possible correlation among discrete tumor subsets, natural history, and survival is evaluated. METHODS: Between the years 2000 and 2005, 20 patients suffering from synchronous primary cancers of gynecologic malignancy were identified. Clinical and pathologic information was obtained from medical records. Kaplan-Meier survival analyses were conducted. RESULTS: Patients with synchronous primary malignancies constituted 0.63% of all genital malignancies. The most frequently observed synchronous neoplasm was ovarian cancer coexistent with endometrial cancer (40%). The mean age of patients suffering from synchronous ovarian and endometrial cancer was 45.2 years. All patients with synchronous primary genital malignancies underwent hysterectomy with bilateral salpingo-oophorectomy and/or adjuvant therapy. The mean duration of survival was 57 months (S.E.: 10.0; 95% confidence interval: 37-77). CONCLUSION: Patients suffering from primary genital malignancies are sometimes co-afflicted with other primary cancers. Synchronous ovarian and endometrial cancer constitutes the most common of these cases, and is detected at a relatively early age, with generally favorable prognoses.