女性生殖道恶性中胚叶混合瘤（29例临床资料分析）

女性生殖道恶性中胚叶混合瘤发病率低，恶性程度高。上海医科大学妇产科医院１９６５年－１９９３年共收治２９例生殖道恶性中胚叶混合瘤，其中子宫２０例，宫颈２例，卵巢６例，输卵管１例。占同期妇科住院患者的０．３‰、妇科肿瘤患者的５．９‰。本病的临床表现主要有：阴道流血水、腹痛。在术前诊断中诊断性刮宫对有阴道流血水的病例有一定帮助，确诊率为７１％，而对其他病例则意义不大。本病预后较差，２９例中２年内死亡者１     

子宫恶性中胚叶混合瘤11例临床分析

子宫恶性中胚叶混合瘤是子宫肉瘤中较少见的一种，其病程短，恶性程度高，五年生存率低。本文回顾性分析11例患者的全部临床资料，结合文献对其临床特点、治疗及预后进行讨论。1资料与方法我院自1980年7月至1997年8月共收治子宫恶性中胚叶混合瘤11例。年龄22～60岁，11例患者均已婚，阴道不规则流血9例，下腹部肿块伴腹痛2例。妇科检查：宫颈口有紫红色肿物脱出4例，宫体形状不规则，质硬。术前刮宫或肿物活检7例，诊断为子宫恶性中胚叶混合瘤2例，子宫内膜腺癌3例，子宫内膜息肉并炎性球死2例。误诊为子宫肌瘤、卵巢肿瘤扭转各2例。11例患…     

子宫恶性中胚叶混合瘤一例

子宫恶性中胚叶混合瘤一例雷承宝闫平患者女，６５岁。４５岁闭经，于４个月前无明显诱因阴道流血，浅红色，且有血块，较以往月经量多。门诊刮宫病理诊断为内膜腺癌。既往健康，月经史及生产史无特殊。妇科检查：宫颈光滑，内诊子宫稍大，硬，活动欠佳。病理检查：全切子...     

10例子宫恶性中胚叶混合瘤临床病理分析

本文报告10例手术切除的子宫恶性中胚叶混合瘤。发病率占同期子宫肉瘤的33％。分析了其临床、病理与预后的关系,认为大体的息肉型、组织学的腺肉瘤预后较好。同源性与异源性预后无差别。治疗应尽早行子宫全切术。     

卵巢恶性中胚叶混合瘤12例临床分析

目的探讨卵巢恶性中胚叶混合瘤的临床特点、治疗及预后因素。方法对我院１９８３年～１９９７年收治的１２例卵巢恶性中胚叶混合瘤的临床资料进行回顾性分析。按ＦＩＧＯ分期（１９８５年）,Ⅱ期４例,Ⅲ期６例,Ⅳ期１例,不详１例。组织学分类：同源性８例,异源性４例。１２例均接受肿瘤细胞减灭术。术后辅助化疗１１例,其中３例又追加盆腔放疗。结果全组平均生存２４个月,２,５年生存率分别为３３．３％（４／１２）和８．３％（１／１２）。Ⅱ和Ⅲ期生存２年以上者均为２例,Ⅳ期１例在１年内死亡。同源性８例中,４例生存２年以上,异源性４例均在２年内死亡。综合治疗１１例中,５例在１年内死亡。单纯手术１例在６个月内死亡。结论卵巢恶性中胚叶混合瘤恶性度高,预后差。其组织学类型、分期及治疗方法与预后有关,应采用手术与化疗和（或）放疗的综合治疗     

子宫恶性苗勒氏管混合瘤：31例临床病理免疫组化研究

恶性混合性肿瘤是女性生殖道的特殊肿瘤,由癌和肉瘤两种成分组成。根据肉瘤成分为同源性或异源性,可分为癌肉瘤和恶性中胚叶混合瘤两类,总称为恶性苗勒氏管混合瘤,较子宫内膜腺癌和平滑肌肉瘤少见,预后较差。20年内,我院共收治31例,现报道如下。     

子宫恶性中胚叶混合瘤(附11例报告)

本文报告11例子宫恶性中胚叶混合瘤的临床、病理研究。无特殊临床征象。3例死于本病,7例术后存活1年半到8年。7例肿物为息肉状。镜下2例组织类型为同质型,9例为异质型。3例生存7年以上者,瘤团周围有明显的间质反应(淋巴细胞浸润)。我们认为:肿瘤的组织类型对预后似乎无明显影响,而间质反应与预后却有重要关系。此外,手术切除配合化疗可能对预后有所裨益。     

女性生殖道苗勒氏管恶性混合瘤——附12例报道

本文报道12例女性生殖道苗勒氏管恶性混合瘤。发生在子宫者9例,其中8例为绝经期老年妇女,平均年令55岁。发生在宫颈者2例,1例为40岁的中年妇女,另1例为19岁的少女。发生在阴道者为一5岁幼女。临床主要症状为阴道流血或流黄色分泌液,子宫增大,下腹痛等。并描述其共同病理的形态变化。结合文献还着重对组织发生,命名分类,肿瘤的转移,预后和治疗进行了讨论。     

子宫肉瘤的化学治疗

子宫肉瘤是一组来源于子宫间质、结缔组织或平滑肌的恶性肿瘤，病理类型主要有子宫平滑肌肉瘤（1eiomyosarcoma，LMS）、子宫内膜间质肉瘤（endometrial stromal sarcoma，ESS）以及子宫恶性中胚叶混合瘤（malignant mullerian mixed tumor／mixed mesodermal tumor，MMT，亦称恶性苗勒管混合瘤或癌肉瘤）。子宫肉瘤临床少见，约占妇科恶性肿瘤的1％～3％，     

子宫恶性外胚叶—中胚叶混合瘤1例

患者女,26岁。阴道不规则流血性分泌物4个月,近1个月伴脓血样分泌物及烂肉样组织。检查:外阴,阴道正常,宫颈口脱出8×7×4cm大小肿物,表面不平伴出血及坏死,肿物基底伸向颈管。临床诊断:子宫粘膜下肌瘤继发感染。手术行全子宫、左附件、右卵管及部分阴道壁切除。病理诊断:子宫恶性外胚叶—中胚叶混合瘤。术后3个月患者死于肿瘤复发、肾功衰竭。     

Carcinosarcomes gynécologiques : revue générale et principes de prise en charge

Carcinosarcoma, also known as mixed mesodermal tumor or malignant mixed Mullerian tumor (MMMT) is a pathological entity combining a sarcomatous and a carcinomatous component. Found in thoracic, digestive, genitourinary, liver or skin locations, the most common location is the female genital tract. In gynecological tumors, carcinosarcoma accounts for about 2-5% of endometrial cancers, and 1% of ovarian cancers. To date, there is no consensus on the therapeutic strategy. It relies mostly on maximum cytoreductive surgery. Adjuvant therapy remains controversial, and few prospective studies investigating its interest. Retrospective studies show the benefits of adjuvant chemotherapy based on platinum in most cases. Radiation therapy has a place in the adjuvant situations of endometrial and cervical carcinosarcoma. A more detailed pathological knowledge, and the use of targeted therapies may be promising in this histological subtype whose prognosis remains very poor. The objective of this study is to present the main principles of carcinosarcoma management in female genital tracts, describing pathological and prognostic features at the same time.     

女性生殖器原发恶性黑色素瘤14例分析

目的　探讨女性生殖器原发性恶性黑色素瘤的临床特征。方法　对我院收治的 14例女性生殖器的原发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、宫颈的恶性黑色素瘤分别为 4例、9例、1例。 10例行手术切除辅以化疗和免疫疗法 ,4例单纯行化疗和免疫疗法。 14例中随访 13例。 5例生存期 <1年 ,6例 <2年 ,2例>3年 (其中一例无瘤生存 2 0年 )。结论　女性生殖器的原发性恶性黑色素瘤预后差。其治疗方法以手术为主 ,辅以化疗和免疫治疗的综合治疗。     

Rhabdomyosarcoma of the uterine cervix. Sarcoma botryoides

Twenty-one cases of sarcoma botryoides of the uterine cervix, including four previously unreported cases, are reviewed. The age of the patients ranged from 5 months to 48 years, with a peak incidence in the group aged 14 to 18 years. Eighty percent of the patients are alive, with a mean follow-up period of 68 months. Seventy-five percent of the patients had Group I disease, of whom 88% are alive. Eleven of 14 patients (79%) receiving vincristine and dactinomycin based chemotherapy are alive. There were five patients with recurrent disease (24%) of whom two (40%) are alive. The prognosis for cervical sarcoma botryoides is similar to that of other female genital tract embryonal rhabdomyosarcomas. Primary therapy should consist of vincristine and dactinomycin based chemotherapy. Surgery should be guided by the response to initial chemotherapy and should attempt to conserve the function of the bladder, rectum, vagina, and ovaries.     

Conservative treatment for girls with nonmetastatic rhabdomyosarcoma of the genital tract: A report from the Study Committee of the International Society of Pediatric Oncology.

PURPOSE: To report the results of a conservative multimodal approach in girls with nonmetastatic rhabdomyosarcoma (RMS) of the genital tract, treated in International Society of Pediatric Oncology (SIOP) Malignant Mesenchymal Tumors 84 and 89 protocols. PATIENTS AND METHODS: From 1984 to 1994, 38 girls with RMS of the genital tract (vulva, vagina, uterus) were treated in SIOP protocols. With the exception of patients with rare small tumors, which were resected at the start of the studies, all patients received initial chemotherapy (CHT) (ifosfamide, vincristine, and actinomycin D). Local treatment including surgery, brachytherapy (BT), and external-beam radiotherapy (ERT) was given only to girls who did not achieve complete remission (CR) with CHT or who subsequently relapsed. RESULTS: The primary tumor originated in the vulva or vagina in 27 girls and in the uterus in 11. The overall survival rate (+/- SE) was 91% +/- 6% at 5 years, and the event-free survival rate was 78% +/- 7%. At a median follow-up of 5 years, 30 girls were alive and in first CR and five were alive and in second CR. Four patients treated with complete resection of the tumor at diagnosis received less CHT. Thirteen patients were treated with CHT alone. In 17 patients, local treatment was necessary to achieve complete local control, for a residual mass after initial CHT (10 patients), for viable tumor on biopsy (three patients), or for local relapse (four patients). The local treatment used was radiotherapy (RT) (ERT in three patients, BT in seven), radical surgery with uterine ablation (three patients), RT and radical surgery (three patients), and conservative surgery with RT (one patient). CONCLUSION: Girls with nonmetastatic RMS of the genital tract have an excellent prognosis. We found no difference in outcome between uterine and vulvovaginal RMS. Local treatment does not seem necessary in patients who have a complete response to CHT. When a local treatment is needed, BT may be an alternative to radical surgery or ERT.     

Primary malignant melanomas of the female lower genital tract: clinicopathological characteristics and management

The female lower genital tract melanomas mainly include vulvar, vaginal and cervical melanoma. There is little clinical data on the melanomas thus making them highly lethal with their prognosis being worse than for cutaneous melanoma and other gynecological malignancies. Surgery is still the primary treatment for gynecological melanomas with wide local resection (WLE) of tumors with adequate margins being preferred for early-stage vulvar melanoma while complete resection of the primary tumor is the standard treatment for early-stage cervical and vaginal melanoma. Sentinel lymph node biopsy seems to avoid unnecessary complete regional lymphadenectomy. However, it should be chosen cautiously. Recently discovered molecular changes have provided new hopes for effective systemic treatment of female genital tract melanomas. In this review, we summarize the pathogenesis and clinicopathological characteristics of these rare melanomas with particular emphasis on new therapies and clinical management methods that may affect prognosis. The review aims to provide a viable direction for clinicians to diagnose and treat female lower genital tract melanomas.     

24例女阴恶性黑色素瘤临床病理分析

 目的　研究女阴恶性黑色素瘤的临床和病理学特征。方法　复习临床、病理学资料 ,全部病例进行随访 ,免疫组织化学方法用S P法。结果　 2 4例中发生于外阴 13例 ,阴道 7例 ,宫颈 4例。 17例获得随访 ,1年内死亡 6例 ,2年 4例 ,3～ 4年 3例 ,4例存活 5年以上。免疫组织化学染色nm2 3阳性 14例中淋巴结转移者仅 2例阳性 ,9例者淋巴结转移者中 6例 p5 3蛋白染色阳性。 结论　女阴恶性黑色素瘤恶性程度高。nm 2 3的表达与淋巴结转移呈负相关 ;p5 3表达者淋巴结转移比淋巴结阴性病例高 ,有预后意义。     

Carcinosarcome ovarien: à propos d’un cas

Ovarian carcinosarcoma, also called malignant mixed mesodermal tumor, is a rare ovarian tumor representing less than two per cent of ovarian cancers. Carcinosarcoma is an aggressive tumor, which associates some epithelial elements (carcinoma) with a stromal component (sarcoma). This tumor can be found in the female genital tractus, mostly in the uterus. It can be found even more rarely in the ovaries. The initial stage of the disease at the time of diagnosis is considered as the only prognostic factor. There is no existing consensus concerning treatment. Nevertheless, surgical treatment is paramount for the survival of patients. Response rates to chemotherapy are about 20%.     

Mitoxantrone in the treatment of advanced uterine sarcoma. A phase II trial of the Gynecologic Oncology Group

Twenty-nine evaluable patients with metastatic or recurrent leiomyosarcoma or malignant mixed mesodermal tumors of the uterus were treated with mitoxantrone 12 mg/m2 every 3 weeks. All patients had good performance status and measurable disease. Nineteen had prior chemotherapy but only five had prior doxorubicin. No complete or partial responses were seen in 12 patients with leiomyosarcoma (95% confidence interval for a response of 0-22%) or 17 patients with mixed mesodermal tumors (95% confidence interval for a response of 0-16%). The median progression-free interval for patients with leiomyosarcoma was 1.4 months and the median survival 4.1 months. The median progression-free interval for patients with mixed mesodermal was 1.4 months and median survival 4.0 months. Mitoxantrone does not appear to be very active against leiomyosarcoma or mixed mesodermal tumors as second-line therapy.     

Small cell carcinoma of the female genital tract

Small cell carcinoma (SCC) of the female genital tract is rare, constituting less than 2% of all gynecologic malignancies. It occurs most frequently in the cervix but can also occur in the endometrium, ovary, fallopian tube, vagina, and vulva. SCC of the genital tract is microscopically indistinguishable from that of the lung. Neuroendocrine differentiation is often manifested by a histologic growth pattern, argyrophilia, ultrastructural demonstration of secretory granules, and expression of neuroendocrine markers. Patients with SCC of the female genital tract may be asymptomatic but usually present with localized pain, vaginal bleeding, abdominal bloating or a mass, or symptoms of metastasis disease to the liver, bone, lung, or regional lymph nodes. Ectopic Cushing's syndrome has been reported in SCC of the vagina, and hypercalcemia and inappropriate secretion of antidiuretic hormone have been noted with SCC of the ovary. In general, these tumors have an aggressive clinical course with a propensity for extensive local invasion and distant metastases. Therapy has included surgery, radiation, and chemotherapy akin to those regimens used for SCC of the lung. Although there are no randomized clinical trials, it appears that multimodality therapy is associated with the best results and is the treatment of choice for most patients. Despite aggressive therapy, however, the prognosis for SCC of the female genital tract is poor, with only a minority of patients enjoying a prolonged survival. Indeed, the majority of patients have an early demise with extensive distant disease. We review the clinical features, evaluation, and management of SCC of the female genital tract based on a comprehensive review of the literature.     

Comprehensive treatment for sarcoma botryoides of uterine cervix

Seven cases of sarcoma botryoides of the uterine cervix are reviewed. The age of the patients ranged from 19 to 40 years, with a median age of 23 years. Four patients were diagnosed as stage Ia, two as Ib and one as II a, 6 cases were treated with surgery, chemotherapy and/or radiotherapy, and 1 with surgery only, 5 cases in this group survived more than 5 years with a mean 7.9 years of follow-up. The prognosis for cervical sarcoma botryoides is similar to that of other female genital tract embryonal rhabdomyosarcomas. Primary therapy should consist of vincristine and dactinomycin based chemotherapy. Surgery should be guided by the response to initial chemotherapy and should attempt to conserve the function of the bladder, rectum, vagina, and ovaries. Radiotherapy was used for involved surgical margins or positive nodes. The effect of radiotherapy is unclear for stage Ia cases.