Ovarian Teratoma with Peritoneal Gliomatosis

The case report describes the clinical and pathological features of a young girl with ovarian teratoma which showed a predominance of neural tissue. The peritoneal involvement by an admixture of mature and immature glial tissue resulted in the death of the patient despite surgery and cytotoxic chemotherapy. There was an association between this tumour and the presence of carcinoembryonic antigen and alphafetoprotein in the serum and ascitic fluid.     

未成熟型卵巢畸胎瘤的术前超声诊断分析

目的:探讨利用超声检查与肿瘤标志物测定鉴别卵巢畸胎瘤成熟与否的可能性。方法:收集卵巢成熟畸胎瘤46例,未成熟畸胎瘤16例,比较其二维超声特征、血流RI值及肿瘤标志物水平。结果:卵巢成熟与未成熟畸胎瘤的超声特征、血流阻力指数、肿瘤标志物AFP水平等指标有显著差异。结论:根据畸胎瘤的超声形态特征及AFP水平可初步鉴别畸胎瘤成熟与否。     

Recurrent High-grade Ovarian Immature Teratoma with Peritoneal Dissemination

BackgroundPeritoneal dissemination of ovarian immature teratoma in children is a rare entity and is associated with a poor prognosis. There are no guidelines on the optimal management of these patients with regard to surgery and systemic treatments.CaseThis is the case of a 16-year-old patient who experienced an early recurrence of immature teratoma with peritoneal dissemination after surgery and systemic chemotherapy failure, and was treated with an aggressive salvage cytoreductive surgery. She was still disease-free 6 months after her second surgery.Summary and ConclusionUpfront aggressive surgical management with complete cytoreductive surgery is recommended when patients present with disease recurrence and peritoneal dissemination of ovarian immature teratoma. Such cases should be managed in centers with local expertise in the treatment of peritoneal surface malignancies.     

Anti-NMDA-Receptor Encephalitis: An Adolescent with an Ovarian Teratoma

BackgroundAnti-N-methyl-D-aspartate (NMDA) receptor encephalitis has been reported to be associated with ovarian teratomas. In many patients, surgical excision has resulted in improvement.CaseA previously healthy 14-year-old girl presented with confusion which later evolved into a comatose state. Imaging revealed an adnexal mass which was surgically removed and confirmed to be a mature teratoma. Her cerebral spinal fluid was positive for antibodies to NR1/NR2 heteromers of NMDA receptors.CommentsCystic teratomas are one of the most common benign ovarian lesions in children and young women. While an association of ovarian teratomas and paraneoplastic encephalitis is published in the neurologic literature, this association needs to be clarified for the practicing gynecologist who may be asked to consult on these patients.     

抗N-甲基-D-天门冬氨酸受体脑炎合并卵巢畸胎瘤的研究进展

抗N-甲基-D-天门冬氨酸受体脑炎是近年新发现的一种自身免疫性疾病,多合并畸胎瘤等生殖细胞肿瘤,发病机制可能为抗N-甲基-D-天门冬氨酸受体抗体干扰神经信号传递所致,目前尚未完全清楚。该病临床表现呈多样性,主要分为行为认知异常、记忆障碍、语言障碍、运动障碍、自主神经功能障碍、癫痫发作、意识丧失及低通气8组症状,可呈单一表现,也可联合几组症状同时表现,其临床症状主要由抗N-甲基-D-天门冬氨酸受体抗体累及的脑部解剖结构所决定。治疗以免疫治疗合并肿瘤切除为主,预后较好。综述抗N-甲基-D-天门冬氨酸受体脑炎合并卵巢畸胎瘤的相关研究,以期提高临床医生对该病的认识。     

卵巢成熟性畸胎瘤合并腹膜胶质瘤病一例报告

腹膜胶质瘤病(gliomatosis peritonei,GP)是一种罕见的疾病,迄今仅报道100余例,典型临床表现是良性的、成熟的胶质组织广泛分布于腹膜,常与卵巢未成熟畸胎瘤(ovarian immature teratoma,OIT)同时存在。临床上必须经过彻底的切片检查,确定为成熟神经胶质组织,方可确诊。治疗多与原发肿瘤相关,但因该病罕见,尚未建立一套标准治疗方案。另因有极少部分病例有恶变可能,需长期随访观察。近年来,对于GP在发病机制、治疗及随访等方面均有新的进展,故本文就GP的研究进展进行探讨,为后续治疗提供参考。     

Spontaneous Rupture of Benign Ovarian Cystic Teratoma in a Premenarcheal Girl

BackgroundSpontaneous rupture of benign cystic ovarian teratoma is an unusual occurrence.CaseA 9-year-old girl presented with acute onset of abdominal pain. Under a radiological diagnosis of cystic ovarian teratoma, she underwent laparoscopic cystectomy, preserving as much ovarian tissue as possible. Direct observation of a defect on the tumor surface and the presence of keratinized squamous cells in the ascites were important clues for intraperitoneal rupture. Pathologically, the defect was surrounded by inflamed tissues adjacent to the gastric mucosa, suggesting that autolysis of the wall by proteolytic enzymes induced the spontaneous rupture.Summary and conclusionWe present the youngest and first premenarcheal case of spontaneous rupture of cystic ovarian teratoma. Early diagnosis and minimally invasive surgical procedure are essential to preserve future fertility.     

Ovarian Mixed Germ Cell Tumor Composed of Polyembryoma and Immature Teratoma

We report the case of a 41-year-old woman with ovarian mixed germ cell tumor which was composed of polyembryoma and immature teratoma and who had high serum levels of α-fetoprotein (AFP) and human chorionic gonadotropin (hCG). By immunohistochemical methods, AFP was found in yolk sac cells of the embryoid bodies and immature hepatoid tissues, and hCG was found in giant syncytiotrophoblastic cells. She was treated with surgery followed by cisplatin-based combination chemotherapy. She is well, and her serum levels of AFP and hCG have not been elevated for more than 4 years after the treatment.     

卵巢成熟性囊性畸胎瘤癌变临床病理及基因检测分析

目的:探讨卵巢成熟性囊性畸胎瘤(MCT)癌变的临床病理特点及基因检测情况。方法:回顾性分析2011至2013年间我院收治的12例卵巢MCT癌变患者的临床病理资料,并进行基因突变检测。结果:12例MCT癌变全部发病于一侧卵巢,4例出现下腹疼痛。4例MCT最长径大于10cm。10例于术前行血清CEA、CA125、CA199检查的患者,至少有一种肿瘤标志物升高。术前超声检查结合临床病史和血清标志物检查,有7例诊断可疑畸胎瘤癌变。12例癌变包括鳞癌5例,各型腺癌7例。巨检示鳞癌囊壁部分增厚;腺癌可见附壁乳头。免疫组化示鳞癌CK5/6、P63(+),腺癌CK20、Villin、CDX2(+)。基因检测示肠型腺癌2例均发生KRAS基因突变。11例进行全子宫切除术+双侧附件切除术,1例行单侧附件切除术+输卵管通液术。结论:结合临床病史、术前超声及血清肿瘤标志物检查可一定程度诊断卵巢MCT癌变。术中常见MCT囊壁增厚及附壁乳头。KRAS基因突变检测可能辅助判断卵巢MCT癌变。     

Surgical Approach to Pediatric Ovarian Growing Teratoma Syndrome: A Case Report

BackgroundGrowing teratoma syndrome is defined as conversion of a metastatic immature tumor to a mature tumor after adjuvant chemotherapy and remains an area of investigation because of its unclear pathogenesis. Because of its risk of malignant transformation, the primary treatment strategy for pediatric patients is surgical resection.CaseIn this report we present a case of a pediatric patient with recurrent growing teratoma syndrome who was treated with chemotherapy, debulking procedures, and cryoablation for the growing nodules throughout her abdominal cavity. The patient has had a good clinical outcome without recurrent malignant tumor.Summary and ConclusionThese masses do not always regress with chemotherapy and complete surgical excision or ablation should be attempted when possible.     

腹腔镜与开腹手术剥除卵巢良性畸胎瘤对机体免疫功能影响的比较研究

目的:评价腹腔镜手术剥除卵巢良性畸胎瘤对机体免疫功能的影响.方法:选择卵巢良性畸胎瘤行开腹手术患者32例和腹腔镜手术患者50例,检测术前、术后1天、术后4天外周血白细胞介素-6(IL-6)及T淋巴细胞亚群CD4/CD8水平.结果:腹腔镜组术前外周血IL-6水平和CD4/CD8水平与开腹手术组比较,差异无统计学意义(P>0.05);腹腔镜组术后1天和术后4天外周血IL-6水平和CD4/CD8水平分别与开腹手术组比较,差异均有统计学意义(P<0.05);同时腹腔镜组术后4天外周血IL-6和CI)4/CD8水平与术前相比,差异无统计学意义(P>0.05),而开腹手术组术后1天和术后4天与术前比较,差异均有统计学意义(P<0.05).结论:腹腔镜下卵巢良性畸胎瘤剥除术对机体的体液免疫与细胞免疫功能影响均轻微,对机体损伤小、且恢复迅速.     

卵巢畸胎瘤致自身免疫性脑炎12例临床分析

目的:探讨卵巢畸胎瘤致抗N-甲基-D-天冬氨酸(NMDA)受体脑炎患者临床特点及诊治。方法:回顾性分析2013年1月至2017年7月就诊于我院因卵巢畸胎瘤致抗NMDA受体脑炎患者12例临床资料。结果:12例患者平均发病年龄27.4±8.4岁。9例以精神症状起病,3例以癫痫起病。在疾病发展过程中,所有患者均有精神行为异常,表现为言行紊乱、情感障碍、幻听、幻视、被害妄想等。10例(83.3%)出现不同程度意识障碍和运动障碍,9例(75.0%)在病程中出现癫痫样发作,6例(50.0%)出现自主神经功能紊乱,5例(41.7%)伴随中枢性低通气,2例(16.7%)出现言语障碍,2例(16.7%)出现近记忆减退。所有患者就诊前均无明显腹胀、腹痛等症状,仅1例(8.3%)出现月经周期延长。5例患者(41.7%)出现头部影像学改变,5例(41.7%)脑脊液有核细胞数增高,8例(66.7%)部分血清肿瘤标志物异常。12例患者脑脊液中抗NMDA受体抗体的检测均为阳性,其中6例患者同时进行了血中抗NMDA受体抗体的检测,5例(83.3%)阳性,1例(16.7%)阴性。经过免疫治疗及手术治疗,11例(91.7%)预后良好,1例拒绝手术死亡。术后病理检查示8例(72.7%)为成熟性畸胎瘤,2例(18.2%)为未成熟畸胎瘤,1例(9.1%)为交界性畸胎瘤。结论:临床上对于以精神行为异常或癫痫起病的年轻女性脑炎患者,应考虑到抗NMDA受体脑炎可能。同时应积极寻找是否存在畸胎瘤,尽早手术治疗有利于预后。     

Physician and Hospital-level Variation in Hemostatic Agent Use in Benign Gynecologic Procedures

Study ObjectiveTo identify recent nationwide trends in hemostatic agent (HA) use and to explore factors associated with HA use in 3 benign gynecologic surgery contexts: isolated hysterectomy, pelvic organ prolapse repair, and anti-incontinence surgery.DesignRetrospective cohort study.SettingVizient Clinical Database.PatientsThree cohorts of female patients of ≥18 years who underwent benign isolated hysterectomy, pelvic organ prolapse repair, or anti-incontinence procedures were identified between October 2015 and December 2019.InterventionsHAs are topically applied procoagulant products used for surgical hemostasis and use during included encounters was determined by charge codes.Measurements and Main ResultsSubject-, hospital-, and surgeon-level characteristics and costs were captured. Data were initially analyzed in the aggregate and based on procedure category using the chi-square test or independent samples t tests as appropriate. A bootstrap forest model was used to identify the factors most predictive of HA use.In the final cohort of 184 070 encounters, HAs were used most frequently in hysterectomy (20.7%) and least in anti-incontinence surgery (10.9%). The use of HAs increased from 15.6% in quarter 4 2015 to 19.2% in quarter 4 2019 (p <.001). Encounters using HAs cost more than encounters without HAs ($6271.10 vs $4572.00; p <.001). A bootstrap forest model inclusive of all variables found surgeon and hospital identity cumulatively predictive of 84.9% of HA use, 65.5% and 19.4%, respectively. There was significant variation in HA use among individual surgeons, with 59.9% never using HAs. Of those who did use HAs, 72.8% used HAs more frequently than the mean provider HA use rate (19.4%) and 9.2% used HAs in every case he/she performed.ConclusionThe significant variation in HA use is driven primarily by physician and hospital identity, suggesting that use of HA in these benign gynecologic surgical contexts may be determined more by physician- and hospital-level factors than patient-level factors.