交界性卵巢肿瘤的诊治进展

交界性卵巢肿瘤(BOTs),约占所有卵巢上皮性肿瘤的10%～15%,许多研究结果表明其有着比较好的预后.由于交界性卵巢肿瘤病理学及临床特性较独特,在诊断和治疗上具有不同于卵巢癌的特点.该肿瘤常发生于生育年龄妇女,诊断时大多数处于早期.手术切除是治疗交界性卵巢肿瘤的主要方法,由于诊断常发生在术中,缺乏确切的术前诊断标准,而且大多数患者都要求保留生育能力,因此交界性卵巢肿瘤的早期诊断、保守性治疗及术后化疗都存在着争议.     

286例妊娠合并卵巢肿瘤的临床分析

目的:探讨妊娠合并卵巢肿瘤的临床病程特点,以及相应的诊断和处理对母儿结局的影响。方法:回顾分析2003年3月至2010年12月在上海市第一妇婴保健院住院分娩的286例妊娠合并卵巢肿瘤患者的临床资料,分析比较诊断时孕周,妊娠期间卵巢肿瘤的特点、对妊娠结局影响、分娩方式,病理特点等,并对上述因素进行相关分析。结果:妊娠合并卵巢肿瘤的孕妇阴道分娩54例,剖宫产232例,剖宫产率81.12%;剖宫产获得的232例病理结果中,良性肿瘤227例,交界性肿瘤5例。良性肿瘤行卵巢肿瘤剥除术或患侧附件切除术,交界性肿瘤行患侧附件切除术或肿瘤减灭术;妊娠合并卵巢交界性肿瘤组新生儿体重及分娩孕周均明显低于妊娠合并卵巢良性肿瘤组(P<0.05)。结论:妊娠合并卵巢肿瘤以良性肿瘤最常见。因早期妊娠时缺乏典型的临床症状而不易早期诊断,故应加强孕前及早孕期间的检查;妊娠早期应行B超检查提高卵巢肿瘤检出率;剖宫产术中应仔细探查双侧附件,及时发现卵巢肿瘤;妊娠合并交界性肿瘤,由于终止妊娠时期早,故围产期母儿并发症较高,其处理原则需根据患者年龄、生育情况、组织类型、肿瘤期别、妊娠期限、胎儿成熟度评价等而异。     

卵巢交界性肿瘤有关问题

卵巢交界性肿瘤又称低度恶性潜能肿瘤,是介于良性肿瘤和恶性肿瘤之间的一组特殊类型的卵巢肿瘤。发病年龄轻,多数疾病为早期,预后较好,晚期及伴有浸润性种植者预后相对较差。主要病理类型为浆液性和黏液性交界性肿瘤。交界性肿瘤一般应行全面分期手术,年轻患者可行保留生育功能的手术。早期和低危病例无需术后辅助治疗,晚期和浸润性种植者可行术后辅助化疗。交界性肿瘤多远期复发,需长期随访。     

Ⅰ期交界性卵巢肿瘤的治疗

交界性卵巢肿瘤在恶性上皮性卵巢肿瘤中占15％,75％～85％的病例在临床早期确诊,约1/3患者年龄在40岁以下;一般预后极佳,5年和10年生存率为80％～90％,但也有报道即使为1期仍有15％的患者复发甚至死亡;对交界性卵巢肿瘤的合理治疗方式仍有争议,传统术式为子宫、双附件、网膜和/或阑尾切除术,辅助性放、化疗似乎对预后无益,对年轻有生育要求的患者常采用保守性手术(囊肿切除术、一侧附件切除术加或不加对侧卵巢部分切除)已日趋首选。但目前对手术范围尚无统一标准,有关采用保守性手术治疗患者长期随访资料甚少。作者报道芬兰Kuopio大学医院1970年1月～1994年8月间收治的95例患者的诊断和治疗情     

晚期卵巢交界性肿瘤综合治疗与预后北大核心CSCD

交界性肿瘤占卵巢上皮性肿瘤的10％～15％,其中约25％为Ⅱ期以上,预后明显好于同期别卵巢癌。对于晚期交界性卵巢肿瘤,手术是主要的治疗方式。标准的手术方式为根治性手术,如果行保守性手术,需要严格选择患者。术后辅助治疗仍然存在争议。     

冰冻切片诊断卵巢肿瘤的准确性

对１９８６年１２月至１９９２年１２月１３６例卵巢肿瘤的术中冰冻切片（ＦＳ）诊断和最后石蜡切片诊断进行对比研究。其中良性肿瘤５２例、交界性肿瘤２２例、恶性肿瘤６２例。ＦＳ诊断恶性肿瘤的准确率为９３．５％，良性肿瘤为１００．０％，交界性肿瘤最低，为７７．３％。对恶性肿瘤的预测值为１００．０％，交界性和良性肿瘤分别为８５．０％和８９．６％。ＦＳ诊断的９例假阴性中，８例为取材错误所致，多发生在交界性粘液性     

儿童及青少年卵巢肿瘤67例临床分析

目的 分析儿童及青少年卵巢肿瘤的临床特点、诊治及预后。方法 对1990年1月～2006年1月间年龄19岁以下经手术病理证实的卵巢肿瘤患者67例进行回顾性总结，其中年龄12岁以下者7例，为儿童组，13～19岁者60例，为青少年组。结果良性肿瘤占大多数（79．10％），恶性12例（17．91％）。交界性肿瘤2例（2．99％）。生殖细胞肿瘤最多，占50．75％（34／67），其中88．24％为畸胎瘤。上皮细胞肿瘤占28．35％。儿童组中恶性比例为42．86％，青少年组中恶性及交界性肿瘤比例为18．33％（11／60）。B超及肿瘤标志物对诊断卵巢肿瘤及判断良恶性有一定帮助。所有患者均手术治疗，恶性者大部分辅以化疗。生殖细胞恶性肿瘤均行保留生育功能的手术方式。初治失败者预后差。结论 对儿童及青少年应开展定期体检，必要时行B超等影像学检查。对恶性生殖细胞肿瘤应尽量行保留生育功能的手术，术后辅以放化疗。     

卵巢肿瘤组织中端粒酶活性测定及其临床意义的研究

目的：研究测定端粒酶活性在诊断和预测卵巢肿瘤患者预后方面的意义。方法：应用改良的非放射性同位素端粒重复序列扩增实验记录（ＮＲＩＴＲＳＡＰ）检测２６份卵巢肿瘤组织（卵巢良性肿瘤６份,卵巢交界性或低度恶性肿瘤５份,卵巢恶性肿瘤１５份）的端粒酶活性。结果：６份卵巢良性肿瘤组织中均未测出端粒酶活性。５份卵巢交界性或低度恶性肿瘤组织中３份（６０％）端粒酶活性阳性表达;１５份卵巢恶性肿瘤组织中１４份（９３３％）端粒酶活性阳性表达。卵巢恶性肿瘤组织中,端粒酶活性阳性率均高于卵巢交界性肿瘤及卵巢良性肿瘤组织中者（Ｐ＜００５）;卵巢交界性肿瘤组织中者高于卵巢良性肿瘤组织中者（Ｐ＜００５）,卵巢恶性肿瘤组织中强阳性率（）及（）高于卵巢交界性肿瘤组织中者（Ｐ＜００５）。在卵巢上皮性恶性肿瘤组织中,在组织类型、组织学分级及肿瘤分期之间差异无显著性,但总的端粒酶活性阳性率,浆液性癌中（）及（）表达者高于其他类型,低分化者高于高分化者,晚期者高于早期者。结论：端粒酶活性的检测不仅有助于卵巢肿瘤的诊断和鉴别诊断,而且有助于预测患者的预后。     

年轻恶性及交界性卵巢肿瘤患者保留生育功能的研究进展

随着全民健康意识的提高及医疗技术的发展,越来越多的年轻卵巢肿瘤患者得到早期诊断,伴随着晚婚晚育、二孩政策的放开及医学模式的转变,卵巢功能及生育力的保留成为目前医学亟待解决的问题。对目前年轻上皮性卵巢癌、恶性生殖细胞肿瘤、恶性性索间质肿瘤及交界性卵巢肿瘤患者保留生育功能的现状、术后化疗及卵巢功能保护、妊娠结局及随访等方面进行了总结,认为对于合适的年轻恶性及交界性卵巢肿瘤患者行保留生育功能手术是安全可行的,且有较满意的妊娠率。     

卵巢交界性肿瘤的诊疗现状

卵巢交界性肿瘤(borderline ovarian tumor,BOT)是指组织病理学特征和生物学行为介于良性肿瘤和恶性肿瘤之间的一组低度恶性潜能的卵巢肿瘤,具有发病年龄轻、早期发现、预后好的特点,但术前诊断困难,虽然血清肿瘤标志物、盆腔超声及术中快速冰冻病理切片可协助诊断,但准确率不高。手术是治疗BOT的主要方法,近年来,对BOT的手术治疗方式逐渐由根治性手术向保留生育功能的手术转变,术后一般不需辅助化疗。然而,关于其早期诊断、手术方式的选择、术后妊娠结局及预后等问题一直存在广泛争议,就BOT诊断、治疗、预后的研究现状进行综述,以期为今后BOT的临床诊疗及新的诊疗技术研究提供参考。     

"Can laparoscopy really complete full surgical staging?" A case of early recurrence and malignant transformation of borderline ovarian tumor

Ovarian borderline tumor (BOT) with noninvasive implants traditionally is considered to be non-aggressive. Recurrences are delayed and transformations to high-grade carcinoma are rarely documented. We report on a patient with BOT with early recurrence and high-grade carcinoma transformation in a short interval after complete laparoscopic staging. A 27-year-old unmarried woman presented with a 26 cm in size ruptured left ovarian mass. Laparoscopic left salpingo-oophorectomy with right ovarian biopsies, multiple peritoneal biopsies, omental biopsy and washing cytology were performed. FIGO Stage I ovarian serous borderline tumor with microinvasion was confirmed. About ten months later, a 15 cm in size left BOT recurred and was resected by laparoscopic cystectomy including staging surgery. Seven months after the second surgery, we found a pelvic mass by sonogram and elevated CA125. A third diagnostic laparoscopy revealed invasive serous carcinoma with multiple peritoneal implants. In spite of radical surgery and adjuvant chemotherapy, the patient died of a progressive metastatic liver tumor. A case of early recurrence with malignant transformation of BOT is presented together with a brief review.     

卵巢交界性肿瘤治疗进展

卵巢交界性肿瘤(BOT)占卵巢上皮性肿瘤的10%～20%,其生物学行为介于卵巢良性肿瘤与恶性浸润性肿瘤之间,为低度恶性卵巢肿瘤。近年来,国内外学者认为大多数患者接受了过度治疗。主张对部分有生育要求的年轻患者行保守性手术治疗。目前对于BOT的治疗尚无明确的标准和治疗规范,在具体的临床实践中,仍存在许多问题及争议。就BOT在手术治疗(全面分期手术、保守性手术、再分期手术、腹腔镜手术的应用)、术后辅助治疗以及复发后治疗方面进行综述。     

卵巢交界性上皮性肿瘤临床分析

目的分析卵巢交界性上皮性肿瘤的临床特点、治疗及预后情况,并探讨影响卵巢交界性肿瘤复发及预后的相关因素。方法回顾性分析1980年1月至2009年8月间在北京大学人民医院诊断的卵巢交界性上皮性肿瘤130例,所有患者均经手术治疗及术后病理证实。且经正规肿瘤术后随访12～240个月。结果平均发病年龄为42.3岁;Ⅰ、Ⅱ、Ⅲ期分别为106、6、18例;浆液性、黏液性和其他病理类型各48、63、19例;49.0%(51/104)的患者CA125升高;1%有微乳头浸润,0.05%有浸润性种植;所有患者均进行手术治疗,其中42.3%保留生育功能。复发率为6%(8例),其中18例行卵巢肿物剥除术2例复发,34例单侧或双侧附件切除术未见复发。肿瘤分期手术与一侧附件切除及单纯肿物剥除术的5年及10年存活率分别为100%、100%、95%。结论卵巢交界性肿瘤发病年龄较轻,Ⅰ期为主,黏液性肿瘤多见,预后良好,手术是主要的治疗手段,对早期患者行保留生育功能的手术是安全有效的,术后需长期随访。FIGO分期、微乳头型病变,浸润性种植及初次术后是否残留是影响复发及预后的相关因素。     

卵巢交界性肿瘤患者保留生育功能的手术治疗进展

卵巢交界性肿瘤是一类组织病理学和生物学行为介于良性、恶性之间的卵巢肿瘤。患者多年轻、有生育要求,早期多见,且总体预后好。影响卵巢交界性肿瘤患者预后的主要因素是分期、是否存在腹膜浸润性种植、术后是否存在肿瘤残留等。早期患者行保留生育功能手术是安全有效的,不影响总生存率与生存时间;而对有生育要求的晚期患者,可在全面分期手术的基础上行保留生育功能的手术;对于复发患者,保留生育功能手术仍可酌情考虑。腹腔镜手术增加复发率,但并不影响生存率,对于早期患者,腹腔镜的保守手术也是安全可行的。     

Feasibility and limits of laparoscopic treatment of borderline ovarian tumours

Borderline ovarian tumours (BOT) are mainly diagnosed in young women with early stage disease. Due to the absence of specific pre operative criteria for BOT, a laparoscopy is usually performed. A review of the literature found no pejorative data on laparoscopic approach for BOT. Strict surgical procedures must be performed to avoid incomplete surgical staging, cells dissemination and port-site metastases. The limits of the laparoscopic management are the stage of disease and the tumour size. Laparoscopic treatment of BOT for women with early stage disease is feasible. This treatment should be evaluated in specialized centres for women with advanced stage diseases and/or peritoneal implants.     

Results after laparoscopic management of serous borderline tumor of the ovary with peritoneal implants

OBJECTIVE: The aim of this study is to assess the clinical outcomes of laparoscopic treatment of borderline ovarian tumor (BOT) with peritoneal implants. METHODS: Retrospective analysis of patients treated initially and/or for recurrent disease using a laparoscopic approach for a stage II or stage III BOT between January 2001 and January 2004. RESULTS: Nine patients underwent a laparoscopic pure treatment of stage II/III serous borderline tumor. Three of them had a previous history of BOT. Three patients had a stage II and 6 a stage III disease. A conservative management was performed in 7 patients. Laparoscopic treatment of peritoneal implants included: omentectomy (or omental biopsies) in 4 patients and/or large peritoneal resection in 5 patients (pelvic peritoneum in all patients associated with peritonectomies of paracolic gutters in 2 and of the peritoneum of the right diaphragmatic peritoneum in 3). Implants were nonivasive in 8 patients. Each of implant had a size <5 mm. Four patients recurred, 3 of them had a borderline ovarian recurrence after conservative management. Two patients had peritoneal disease found during a second-look surgery (associated with ovarian recurrence in 1). Three spontaneous pregnancies were observed. All patients are alive without evidence of disease with a median time of follow-up of 35 months following the laparoscopic treatment. CONCLUSION: Our series suggests that laparoscopic treatment of patients with BOT associated with small size non-invasive implants is feasible and seem to be safe. The main indication of this management consists in young patients treated conservatively to preserve their fertility.     

What are the individual perceptions of patients with borderline tumours of the ovary in regard to pathogenesis and prognosis? A structured survey on 60 women

Limited data exist about the perception of patients with borderline ovarian tumours (BOT). We assessed the individual perception of patients with BOT, with special focus on the biological-behaviour of the disease. Sixty patients with BOT who underwent surgery during January 2001 to June 2009 were interviewed by a 9-item-questionnaire, at the earliest, 12 months postoperatively. The aim was to assess their estimation regarding the malignant potential of BOT, its impact on their future fertility, the risk of recurrence and death and the possible causes of BOT. Seventeen women incriminated occupational-stress as a causative factor; 8 women genetic-predisposition, and 7 women personal-stress. Only 10 (16.7%) patients evaluated the BOT malignant potential as equivalent to that of a benign ovarian-cyst, while 28 (46.7%) and 20 (33.3%) patients believed carrying the same or equivalent recurrence- and mortality-risk, respectively, like patients with ovarian cancer (OC). Most fertile patients (19/23; 82.6%) felt adequately informed about the impact of BOT on their future fertility, while four patients stated being insufficiently informed. Despite the overall favourable BOT prognosis, affected patients appear to correlate their malignant potential close to that of OC with an equivalent high risk of recurrence. However, patients do not expect to die of BOT. There is a high need to intensify information process regarding BOT. Future trials are warranted to evaluate whether this may substantially influence the patients' perspectives.     

Prevention of Recurrent Mucinous Borderline Ovarian Tumor with Aromatase Inhibitor

BackgroundAromatase inhibitors (AIs) are used for estrogen-modulated conditions. Some borderline ovarian tumors (BOT) express estrogen receptors. We present 2 cases of progression from mucinous cystadenoma to mucinous BOT (mBOT) after prior cystectomies in whom an AI was used with recurrence prevention.CasesTwo patients underwent laparoscopic ovarian cystectomy for mucinous cystadenoma. Serial imaging demonstrated recurrent ovarian cysts for which both underwent fertility sparing surgery (FSS) with ovarian cystectomy for mBOT. Both patients were initiated on an AI and have been without recurrence.Summary and ConclusionBOT predominantly occur in reproductive aged females. FSS with cystectomy is an option, but recurrence occurs in 12-36% of cases. The use of AI in prevention of recurrent BOT shows promise, and more studies are needed to explore this treatment.     

Borderline-Tumoren des Ovars

Borderline ovarian tumors (BOT) are clinically and morphologically defined as being between cell-specific benign and malignant ovarian tumors. The hypothesis of a continuous carcinogenesis is theoretically supported by a model of the genesis of malignant ovarian tumors. The transferability to various ovarian malignancies has not yet been finally explained but the model also has relevant implications for the management of BOT. Women in child-bearing age are disproportionally more often affected by BOT so that the question of therapy is basically concerned with maintaining fertility. In addition to age and FIGO stage, cytoreduction by the primary operation seems to be the deciding prognostic factor and the residual postoperative tumor mass is an independent prognosis factor. In addition to these aspects the current situation with respect to BOT and prognosis will be discussed.