应用多项肿瘤标记物检测卵巢恶性肿瘤的研究

目的为了提高卵巢恶性肿瘤诊断的特异性及敏感性,加强术后患者的病情追踪。我们应用５项肿瘤标记物ＳＡ,ＬＳＡ,ＣＡ１２５,ＣＰ２,６Ｂ１１Ａｂ２进行临床观察。方法对６７例卵巢恶性肿瘤及３３例卵巢良性肿瘤患者进行血清检测,以３８例正常妇女进行对照。结果单纯应用ＣＡ１２５诊断卵巢恶性肿瘤的敏感性及特异性分别为８３６％及８５９％,而５项肿瘤标记物中以任意３项及３项以上阳性为标记物诊断阳性时,检测卵巢恶性肿瘤的敏感性及特异性分别为８６６％及９４４％。临床Ⅰ、Ⅱ期患者的５项肿瘤标记物联合检测的特异性及敏感性,较ＣＡ１２５单项检测有明显提高。结论５项肿瘤标记物联合检测,对提高卵巢恶性肿瘤诊断的准确性及术后监测有一定意义     

卵巢上皮性癌155例的治疗与预后

目的：探讨卵巢上皮性癌的治疗与影响预后的因素。方法：对１９７０年１月至１９９２年１２月在我院治疗的１５５例卵巢上皮性癌进行回顾性分析。全部手术切除标本经病理检查诊断并按ＦＩＧＯ分期标准进行分期，４２例行２次手术，４例行３次手术。除６例外，余１４９例均于手术后行化疗，３２例于第２次术后再次行化疗，９例因复发再次化疗。结果：２年、５年、１０年的生存率分别为Ⅰ期９２．４％、８７．０％、７０．６％；Ⅱ期９１．９％、６３．６％、４７．８％；Ⅲ期５９．９％、３８．２％、１９．２％；Ⅳ期２５．０％、２５．０％、０．０％（Ｐ＜０．００１）。６例未化疗者均在术后２年内死亡。结果表明，预后与临床分期、细胞分化、残留癌灶大小有关。５年生存率中，Ⅰ期为８７．０％和Ⅲ期为３８．２％（Ｐ＜０．００１）；Ｇ１的５年生存率为９５．９％，Ｇ３为１１．８％（Ｐ＜０．００１）；无残留癌灶者为９７．６％，残留癌灶＞２ｃｍ者为２１．２％（Ｐ＜０．００１）。结论：在卵巢上皮性癌初次手术时残留癌灶＜２ｃｍ，并于术后尽早开始化疗，可提高生存率。     

原发性生殖器恶性黑色素瘤15例临床分析

目的：探讨原发性生殖器恶性黑色素瘤的诊断、治疗特点及影响预后的因素。方法：对我院收治的１５例原发性生殖器恶性黑色素瘤的临床资料进行回顾性分析。结果：发生于外阴、阴道，宫颈的黑色素瘤分别为４例、９例、２例。１１例行手术切除辅以化疗加免疫疗法，４例行化疗和免疫等疗法。１５例中，１例失访，５例生存＜１年，７例＜２年，２例＞３年，其中１例存活１９年。结论：原发性生殖器恶性黑色素瘤预后差。其治疗以手术为主，并辅以化疗和免疫疗法的综合治疗。     

腹膜浆液性乳头状癌9例分析

目的 分析卵巢外腹膜浆液性乳头状瘤的临床特点,诊治及预后。方法 选自１９９５年１月至１９９８年１２月在我院收治的９例ＥＰＳＰＣ病人,对其病例资料进行回顾性分析。结果 所有病人均行肿瘤细胞减灭术,术中腹腔放５－ＦＵ１．０ｇ。术后行ＣＡＰ化疗６￣８个疗程。９例中２例正在化疗,２例复发且正在化疗,５例死亡。平均存活期２１．１个月。结论 ＥＰＳＰＣ为女性腹膜原发恶性肿瘤,与卵巢乳头乐液性腺癌同源,其预后与     

卵巢上皮性癌155例的治疗与颈后

目的：探讨卵巢上皮性癌的与影响预后的因素。方法：对１９７０年１月至１９９２年１２月在我院治疗的１５５例卵巢上一癌进行回顾性分析。全部手术切除标本经病理检查诊断并按ＦＩＧＯ分期标准进行分期，４２例行２次手术，４例行３次手术，除６例外，余１４９例均于手术后行化疗，３２例于第２次术后再次行化疗，９例因复发再次化疗。结果：２年、５年、１０年生存率分别为Ｉ期９２．４％、８７．０％、７０．６％；Ⅱ期９１．９％     

错配修基因hMSH2蛋白在人卵巢恶性肿瘤组织中的表达及其临 …

目的 检测ｈＭＳＨ２基因在人卵巢恶性肿瘤组织中的表达及其与卵巢恶性肿瘤临床病理特征的关系。方法 应用免疫组织化学链酶菌抗生物素蛋白－过氧化物酶连接检测４２例卵巢恶性肿瘤组织中错配修复基因ｈＭＳＨ２蛋白的表达。结果 ２６例卵巢恶性肿瘤组织有ｈＭＳＨ２蛋白表达（６２％）,多发生于浆液性腺癌和粘液性腺癌（８０％的８０％）,而在子宫内膜样癌和恶性生殖细胞肿瘤中表达较少（１／６和１／６,Ｐ〈０．０５）,其中     

《中国实用妇科与产科杂志》2000年各期中心内容预告

１胎儿窘迫与宫内复苏新生儿窒息诊断与急救（新生儿复苏）２镇痛分娩３绝经后子宫出血４异位妊娠的诊断及治疗进展５剖宫产有关问题６各种标记抗原与生殖器肿瘤７妊娠合并心脏病（含先心病、风心病及心肌炎等）８羊水过多与过少９性激素在妇产科的临床应用１０药物性流产...     

不孕症患者诱导排卵治疗致卵巢癌二例临床分析

不孕症患者使用促排卵药物发生卵巢癌的报道逐渐增多 ,已引起了临床医师对促排卵药的潜在致肿瘤作用的关注。我院自 1990年 9月至 2 0 0 0年 9月采用克罗米芬 (ＣＣ)促排卵治疗不孕症患者 4 10 0例 ,联合应用绝经后促性腺激素(ｈＭＧ) 14 0例 ,其中 2例发生卵巢恶性肿瘤。现就其发生、临床特点及对促排卵治疗的不孕症患者的监测问题探讨如下。一、病例报告例 1　患者 ,2 9岁 ,孕 0产 0 ,月经稀发 11年 ,结婚 8年 ,因多囊卵巢综合症 ,多次使用ＣＣ促排卵治疗未孕。 1994年 11月11日经腹腔镜检查证实为双侧输卵管积液 ,盆腔粘连 ,于1995年 12…     

卵巢恶性肿瘤腹膜后淋巴结转移率及危险因素的临床研究

目的：研究卵巢恶性肿瘤腹膜后淋巴结转移率及危险因素，为开展腹膜后淋巴清除术提供依据。方法：收集并分析１９８７年１１月至１９９４年１月在１在我院经淋巴清除术治疗的１１７例原发性卵巢恶怀肿瘤病例，采用单因素及多因素分析方法，探讨临床及病理因素与淋巴关系。结果：病理检查证实４４例（３７．６％）有淋巴结转移。盆腔淋巴结转移率（２９．９％），与腹主动脉旁淋巴经（２０．９％）相比较，差异无显著性（Ｐ〉０．０５     

54例卵巢恶性肿瘤的超声诊断

卵巢癌的发现仍以临床检查为主,加强临床诊断实属必要。本文通过54例卵巢恶性肿瘤的超声检查,探讨临床与超声结合能否提高卵巢恶性肿瘤的诊断准确性及超声检查对卵巢癌诊断和处理的应用价值,以进一步明确卵巢恶性肿瘤的声学特点及扫查内容,明确盆腔肿块的超声诊断要点。     

Endometrial Adenocarcinoma Complicated by Malignant Pericardial Effusion

A case of malignant pericardial effusion associated with endometrial adenocarcinoma is presented. A total abdominal hysterectomy with bilateral salpingo-oophorectomy and partial omentectomy was performed 8 months before the occurrence of cardiac tamponade. The treatment of malignant pericardial effusion consisted of emergency pericardiocentesis and systemic chemotherapy and a clinical response for 6 months was achieved.     

Malignant pericardial effusion with cardiac tamponade in ovarian adenocarcinoma

Background  Malignant pericardial effusion with cardiac tamponade is an uncommon metastatic manifestation of gynecologic cancers. We describe a patient with ovarian cancer who developed pericardial effusion with cardiac tamponade and was successfully treated with pericardiocentesis and intrapericardial instillation of thiotepa. Case  A 52-year-old woman with stage IV ovarian adenocarcinoma presented with worsening cough, dyspnea, and fatigue. Chest X-ray and echocardiogram confirmed the presence of pericardial effusion with cardiac tamponade. Pericardial fluid cytology revealed adenocarcinoma. Treatment consisted of pericardiocentesis with thiotepa sclerotherapy. She survived 12 months post-therapy without recurrent pericardial tamponade. Conclusion  Patients with gynecologic cancers may develop a pericardial effusion with cardiac tamponade. Malignant pericardial effusion should be included in the differential diagnosis in patients with recurrent ovarian cancer who present with cardiac tamponade.     

Malignant pericardial effusion secondary to ovarian adenocarcinoma: a case report

BACKGROUND: The treatment for ovarian cancer has continued to improve, resulting in disease recurrence associated with previously unusual locations. However, there are still very few documented cases involving treatment for ovarian cancer metastatic to the pericardium. CASE: A 46-year-old woman was diagnosed with and treated for primary ovarian cancer in 1999. She underwent optimal cytoreductive surgery and received adjuvant chemotherapy. In 2003 she developed ovarian cancer metastatic to the breast and was treated with additional chemotherapy. In 2005 she presented with a malignant pericardial and pleural effusions, which were treated with a thoracotomy and pericardial window. The pericardial effusion recurred and was then successfully treated with intrapericardial mitoxantrone. CONCLUSION: There are a limited number of reported cases involving malignant pericardial effusions originating in an ovarian primary. Consequently, there is even less information documenting successful management of this disease. Thoracotomy, pericardial window and intrapericardial mitoxantrone instillation appear to constitute effective treatment.     

Malignant pericardial effusion with cardiac tamponade in a patient with metastatic vaginal adenocarcinoma

Malignant pericardial effusion with cardiac tamponade is a rare manifestation of metastatic gynecological cancer. A 35-year-old female was diagnosed with clear cell adenocarcinoma of the vagina. Four years after partial vaginectomy, she developed regional recurrence and was treated with surgical excision followed by platinum-based chemotherapy and radiation therapy. Six years later, the patient was diagnosed with lung metastases and received a combination adriamycin and platinum-based chemotherapy. Shortly after completing treatment, she presented with weakness and was found to be hypotensive on physical exam. Computed tomography scan confirmed a pericardial effusion with evidence of bilateral heart failure. She underwent an emergent pericardiocentesis and eventual pericardial window procedure. Metastatic adenocarcinoma of the vagina can present with malignant pericardial effusion with cardiac tamponade. Therefore, gynecologists and gynecological oncologists need to be familiar with the diagnosis and management of this disease process.     

Metastatic ovarian tumors: a review of 64 cases

OBJECTIVE: The goal was to review cases of metastatic ovarian tumor with respect to their clinical features. METHODS: Sixty-four patients with pathologically confirmed metastatic ovarian carcinoma, who were treated between 1978 and 2002 at Osaka Medical Center for Cancer and Cardiovascular Diseases (OMCC), were reviewed and the clinical features examined. RESULTS: We found that metastatic tumors accounted for 21.1% (64/304) of malignant ovarian tumors. Of 64 metastatic ovarian tumors, 26 originated from gynecologic organs, and 38, from nongynecologic organs. Gynecologic primary sites were the uterine body (23%), uterine cervix (14%), and fallopian tube (3%). Eight of nine cervical cancers with ovarian metastases were adenocarcinomas. Adenocarcinoma of the uterine cervix metastasized to the ovaries more frequently than squamous cell carcinoma (5.6% vs 0.1%, respectively; P < 0.01). Among 38 cases of metastatic ovarian tumors from nongynecologic organs, Krukenberg tumors, pathologically characterized by the presence of typical signet-ring cells, were found in 11 patients (29%). Most (8/11) had originated in the stomach. Half (19/38) were preoperatively diagnosed as metastases. The 5-year survival rate after resection of metastatic ovarian tumors from gynecologic organs was significantly higher than the rate after resection of such tumors from nongynecologic organs (47% vs 19%, respectively; P = 0.026). CONCLUSIONS: Metastatic ovarian tumors are likely to be relatively common in Japan because of the high incidence of gastric cancer. In cases of pelvic tumor, metastatic ovarian tumor should always be included in the differential diagnoses. As the 5-year survival after resection of metastatic ovarian tumor is 19%, even for tumors from nongynecologic organs, it seems worthwhile to consider tumorectomy as the second cytoreduction.     

Cardiac tamponade due to ovarian carcinoma

Summary We describe a patient with ovarian carcinoma who presented with cardiac tamponade with subsequently development of cardiac arrest as the initial symptom. After successful resuscitation and pericardiocentesis our patient was given an intrapericardial infusion of bleomycin and there was no recurrence of pericardial effusion at 14 months follow-up.     

C—反应性蛋白测定用于妇科恶性肿瘤诊断的初步观察

通过检测51例妇科良性肿瘤及32例妇科恶性肿瘤患者血清C—反应性蛋白(CRP),发现妇科恶性肿瘤病人血清CRP含量明显增高。良性肿瘤病人血清CRP均为阴性,CRP含量的变化反映妇科恶性肿瘤的严重程度,CRP含量越高妇科恶性肿瘤患者期别越晚。其中卵巢癌病人C—反应性蛋白的阳性检测率100％,但3例恶性葡萄胎病人CRP为阴性,其原因有待于进一步探讨。本文提示:CRP的检测可用于妇科恶性肿瘤的辅助诊断、良恶性肿瘤的鉴别、恶性肿瘤的预后及恶性肿瘤病人化疗疗效的预测。     

盆腔动脉灌注化疗联合放疗治疗晚期 妇科恶性肿瘤近期疗效分析

目的：分析盆腔动脉灌注化疗联合放疗治疗晚期妇科恶性肿瘤的近期疗效。方法：应用以顺铂为主的联合化疗药物,为３２例晚期妇科恶性肿瘤（宫颈癌１５例、卵巢癌８例、子宫内膜癌７例、子宫肉瘤２例）进行选择性盆腔动脉灌注,同时给予放射治疗。结果：３２例患者共行动脉灌注６７次,平均每例２．１次;放射剂量３８－６７Ｇｙ,平均５２Ｇｙ。３２例中４例完全缓解（ＣＲ）,１３例部分缓解（ＰＲ）,有效率为 ５３． １％、其中 ３例宫颈癌、２例子宫内膜癌放疗后行根治术, １例卵巢癌放疗后行剖腹探查术。结论：盆腔动脉灌注化疗联合放疗治疗晚期妇科恶性肿瘤的近期疗效较好,副作用较轻,值得临床推广应用;顺铂对放疗有增敏作用。     

Abdominal Burkitt lymphoma mimicking the ovarian cancer. Case report and review of the literature

Primary Burkitt lymphoma is a lymphoblastic B-cell malignant tumor with very aggressive course. Its abdominal form involving internal genital organs is very rare. CASE: We report the case of 27-year-old woman treated for abdominal Burkitt lymphoma. The patient presented bilateral ovarian tumors with ascites, pain and elevated CA 125 over 900 IU/ml. During laparotomy an advanced neoplasmatic disease involving internal genital organs has been diagnosed. Bilateral salphingo-oophorectomy and omentectomy have been performed. Additionally, the neoplasmatic tumor from ileo-coecal region has been ressected in order to prevent ileus. Pathologic examination has revealed an abdominal Burkitt lymphoma. After surgery, polychemotherapy has been administered (COP followed by CODOX-M+IVAC). The patient, 36 months after surgical treatment, remains under the control of our Department. No signs of recurrence have been detected so far. CONCLUSIONS: The presence of primary abdominal Burkitt lymphoma may include clinical and laboratory findings suggesting the presence of ovarian cancer. Chemotherapy appears to be an essential therapeutic management for all forms of Burkitt lymphoma. Clinically advanced Burkitt lymphoma may be successfully managed with chemotherapy.     

Malignant pericardial effusion in endometrial adenocarcinoma

A case of endometrial adenocarcinoma in a 62-year-old woman with malignant pericardial effusion is presented. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic node dissection, and paraaortic node biopsy. Postoperatively, she was placed on a combination chemotherapy regimen of cisplatin, doxorubicin, and cyclophosphamide. The patient developed cardiac tamponade during the course of chemotherapy. Although we first suspected cardiotoxic effect of doxorubicin, cytologic examination revealed adenocarcinoma cells in the pericardial fluid. A review of the literature revealed no other cases of cardiac metastasis from endometrial carcinoma diagnosed during life.