卵巢支持莱狄细胞瘤11例临床分析

目的探讨卵巢支持莱狄细胞瘤的临床特征、治疗和预后。方法 回顾性分析了我院1962—2002年治疗的11例卵巢支持莱狄细胞瘤患者的临床和病理资料。结果11例患者中,病理分化程度:高分化7例,中分化3例,低分化1例。临床分期:Ⅰ a期9例,Ⅱc期及Ⅲc期各1例。临床症状:腹部包块8例;去女性化及男性化表现共6例,其中3例行血清睾酮水平测定,均不同程度升高;月经增多、绝经后阴道出血等女性化表现者5例,其中1例同时具有女性化及男性化表现。合并症:5例合并与雌激素相关的疾病,包括子宫肌瘤、子宫内膜增生等,2例患者先后患乳腺癌。治疗:11例患者均行手术治疗,其中5例肿瘤分化不良或Ⅱ～Ⅲ期者,术后行系统性巩固化疗。随诊:随诊时间为6个月至34年,中位数随诊时间为7年,无一例死于本病。3例患者保留生育功能,均于术后1—3个月恢复月经,其中1例已生育。结论卵巢支持莱狄细胞瘤预后良好。早期、高分化者,可单纯手术治疗。分化不良或晚期肿瘤患者,术后应予巩固化疗。有生育要求者,可保留生育功能。     

卵巢支持-间质细胞肿瘤13例临床分析

目的探讨卵巢支持-间质细胞肿瘤的临床表现,治疗及预后。方法回顾性分析复旦大学附属妇产科医院1997年1月至2006年10月经手术病理检查证实为卵巢支持-间质细胞肿瘤的13例患者的临床资料。结果13例患者中5例表现为月经稀发或闭经,4例表现为绝经后阴道出血,4例为检查发现盆腔肿块。5例未育者中4例行患侧附件切除术,1例因患者家属要求行患侧肿瘤剥出术。5例行全子宫 双侧附件切除术。3例行全子宫 双侧附件 大网膜切除 盆腔淋巴结清扫术。13例患者,除1例于2005年(1998年手术)失访外,其余12例患者均健在,且无复发及转移。结论卵巢支持-间质细胞肿瘤治疗以手术为主。根据患者的年龄,生育要求,临床分期,分化程度以及肿瘤有无破裂来确定手术范围。高分化支持-间质细胞肿瘤预后好。     

卵巢恶性肿瘤患者保留生育功能手术的指征及处理原则

年轻的卵巢恶性肿瘤患者施行保留生育功能手术应限于早期且组织学类型较好者,如高、中分化上皮性肿瘤而非透明细胞瘤。术后一般不影响预后,且妊娠结局良好。而对中、晚期患者一般不推荐施行保留生育功能手术。卵巢交界性肿瘤患者年龄相对较轻,而且在诊断时多为Ⅰ期肿瘤,施行保留生育功能手术后妊娠成功率甚高。对卵巢交界性肿瘤患者甚至可行卵巢囊肿剥除术,其并不影响预后。生殖细胞肿瘤患者行保留生育功能手术的文献报道多为无性细胞瘤,手术成功率较高。而对晚期或其他类型生殖细胞肿瘤患者也有尝试保留生育功能手术,但这仅为个案报道,通常并不推荐施行保留生育功能手术,除非患者及家属有强烈意愿。对于施行保留生育功能手术的卵巢恶性肿瘤患者,由于具体情况不同,手术应因人而异行个体化治疗。     

年轻子宫内膜癌Ⅰ期患者保留卵巢功能探讨

目的:探讨年轻子宫内膜癌Ⅰ期患者保留卵巢的安全性.方法:对1995年1月至2004年12月在我院行手术治疗的41例≤40岁子宫内膜癌工期患者的临床资料进行回顾性分析并进行随访,了解保留卵巢患者的预后及卵巢功能.结果:41例患者中,保留卵巢者12例,切除卵巢者29例.所有患者中,ⅠA期25例(60.98%),子宫内膜样腺癌38例(92.68%),G1 27例(65.85%).12例保留卵巢患者中,9例(75%)为ⅠA期,3例(25%)为ⅠB期,且病理类型均为子宫内膜样腺癌.随访时间18～124个月.41例患者均健在,未发现复发及转移.12例保留卵巢患者中随访满10年1例,满5年2例,满3年5例.保留卵巢患者与切除卵巢患者相比,前者Kuppermann评分低,性生活质量高,差异有统计学意义(P<0.05).11例患者回访测定激素水平,5例保留卵巢患者,卵巢功能均正常;6例切除卵巢患者,雌激素水平均低落,两者间差异有统计学意义(P<0.05).结论:保留卵巢能提高年轻子宫内膜癌患者的生活质量.年轻子宫内膜样腺癌Ⅰ期患者高危因素少,在进行彻底手术病理分期,确定无肿瘤家族史、无卵巢隐性转移及卵巢转移高危因素后,可以选择保留卵巢,并应对保留卵巢患者严密随访.     

子宫内膜癌患者保留生理功能的治疗

子宫内膜癌是妇科常见恶性肿瘤之一,约75%的患者为早期病例,对于Ⅰ期子宫内膜癌的首选治疗方法为筋膜外全子宫切除、双附件切除及盆腔、腹主动脉旁淋巴结取样和（或）清扫术,术后5年存活率达83%～93%,预后较好.但标准的手术治疗使年轻的子宫内膜癌患者失去了生育机会及卵巢内分泌功能,严重影响患者的生存质量.因此,子宫内膜癌患者保留生理功能的治疗,包括保留年轻子宫内膜癌患者的生育功能或卵巢内分泌功能,以及对手术治疗后的子宫内膜癌患者进行激素替代治疗,成为近年较为关注的问题.     

子宫内膜癌卵巢转移危险因素及保留卵巢的可行性探讨

目的:探讨子宫内膜癌卵巢转移的高危因素及术中保留卵巢的可行性。方法:回顾性分析1999年1月至2003年12月在四川大学华西第二医院首诊并行手术治疗的388例子宫内膜癌患者的临床病理资料。结果:26例(6.7%)发生卵巢转移,其中15例(57.7%)为隐性转移。多因素分析预测子宫内膜癌卵巢转移的独立危险因素,按危险强度排列为盆腔淋巴结转移、宫颈侵犯、肌层浸润深度、病理分级;卵巢大小、腹腔内转移是卵巢隐性转移的独立危险因素。结论:子宫内膜癌患者保留卵巢应审慎,应警惕隐性卵巢转移发生的可能。     

卵巢Sertoli-Leydig细胞瘤17例临床病理分析

目的探讨卵巢Sertoli-Leydig细胞瘤(SLCT)的临床病理学特征、诊断及预后。方法回顾性分析2009年2月至2017年2月17例卵巢SLCTs的临床表现、病理学特征、免疫组化结果、治疗及预后。结果 17例患者平均年龄为(46.9±14.4)岁,均发生于单侧卵巢。肿瘤最大径1~18.6 cm,平均最大径为(5.6±4.9)cm。切面呈淡黄色、鱼肉状,实性或囊实性,偶见出血及坏死。镜下肿瘤由不同比例的Sertoli细胞和Leydig细胞组成,根据Sertoli细胞呈腺管状分化程度及原始性腺间质的数量将肿瘤分成高、中、低分化,其中高分化者3例,中分化5例,低分化者9例。免疫组化显示,CK、Vimentin、α-inhibin、Calretinin、CD99、WT-1及Melan A呈阳性表达,而EMA、Cg A及Syn均呈阴性。根据患者年龄、生育状况、病理组织学分级不同而实施范围不同的手术方式,其中7例中-低分化者术后实施辅助化疗。随访1~83个月,中位随访时间为8个月,所有患者均无瘤存活。结论 SLCTs是少见的卵巢性索-间质肿瘤,术后病理对肿瘤诊断及提示预后有重要意义,大部分患者规范化治疗后预后良好。     

早期成人型卵巢颗粒细胞瘤复发相关因素分析北大核心CSCD

目的探讨国际妇产科联盟(FIGO)(2014版)Ⅰ期成人型卵巢颗粒细胞瘤复发的相关高危因素。方法回顾性分析首都医科大学附属北京朝阳医院及中国医学科学院北京协和医院1995年1月至2010年1月收治的FIGOⅠ期成人型卵巢颗粒细胞瘤。分析患者临床及病理相关因素与肿瘤复发的关系。结果研究共纳入18例FIGOⅠ期成人型卵巢颗粒细胞瘤患者,患者中位年龄为43岁(31~69岁)。初始治疗中7例行单纯肿瘤剥除/单侧附件切除术,8例行子宫双附件切除术,3例行卵巢肿瘤全面分期术。患者术后5年和10年总生存率分别为94.4%和83.3%。共6例患者复发,中位复发时间为76个月。肿瘤直径>10cm、术中瘤体破裂是患者近期复发(<5年)的高危因素。低分化、术中瘤体破裂、高核分裂象(≥4/10HPF)是患者远期复发(≥5年)的高危因素。结论早期成人型卵巢颗粒细胞瘤整体预后好,高核分裂象、术中瘤体破裂可能是早期卵巢颗粒细胞瘤复发的潜在高危因素。     

年轻子宫内膜癌患者保留卵巢的风险评估

目的:探讨年轻子宫内膜癌患者合并卵巢恶性病变的高危因素,从而对年轻早期内膜癌患者保留卵巢的安全性进行评估。方法:回顾2005年11月～2009年12月在我院行手术治疗的238例≤45岁子宫内膜癌患者的临床病理资料,分析子宫内膜癌患者发生卵巢恶性病变的高危因素,并随访了37例保留单侧或双侧附件的患者。结果:13例(5.5%)患者合并卵巢恶性肿瘤,其中8例(3.4%)为子宫内膜癌卵巢转移,5例(2.1%)为原发双癌。多因素分析子宫内膜癌卵巢转移的危险因素,按危险强度排列为组织学类型、宫颈受累、血清CA125水平及卵巢包块大小;而原发双癌的危险因素仅为卵巢包块大小。对37例保留单侧或双侧附件的患者进行定期随访,平均随访时间28.7±12.4个月(6～57个月),期间未发现复发病例。结论:5.5%的子宫内膜癌患者合并卵巢恶性肿瘤,保留其卵巢具有很大风险,对有强烈愿望保留卵巢的年轻患者必须进行充分的术前及术中评估,全面的医患沟通及术后随访亦必不可少。     

保留生育功能的妇科恶性肿瘤患者生育后再处理

妇科恶性肿瘤保留生育功能患者产后再处理问题争议较多。早期宫颈癌产后不增加复发风险，可随访。子宫内膜癌产后多存在癌复发高危因素，主张补充手术。卵巢上皮性癌预后差，多建议产后补充手术，而交界性上皮肿瘤及生殖细胞肿瘤产后可密切随访。     

Alpha-fetoprotein and Sertoli-Leydig cell tumor

Gard GB, Mulvany N, Quinn MA. Alpha-fetoprotein and Sertoli-Leydig cell tumor. Int J Gynecol Cancer 1998; 8 : 499–503.
The association between a Sertoli-Leydig cell tumor and a raised serum alpha-fetoprotein (AFP) is an uncommon occurrence which has only been previously described in 20 patients. We report a 17-year-old patient who presented with a pelvic mass and a raised serum AFP. At laparotomy she had a FIGO stage IA moderately differentiated Sertoli-Leydig cell tumor which required no further treatment. We have reviewed the literature relating to AFP production by Sertoli-Leydig cell tumors. When serum AFP is raised at diagnosis it appears to be a reliable tumor marker, hence a baseline level should be documented on all patients with Sertoli-Leydig cell tumor.     

Sertoli-Leydig cell tumor

Sertoli-Leydig cell tumors belong to the group of sex-cord stromal tumors of the ovary. They account for less than 0,5% of all ovarian neoplasms. The majority of these tumors are benign, and almost all are localised unilaterally. Herewith, we describe an ovarian Sertoli-Leydig cell tumor in an 11-year-old girl. Serum levels of estradiol and progesterone were mildly elevated, while testosterone and androstendion levels were raised to around three- and sevenfold upper normal limit respectively on presentation. A left salpingo-oophorectomy was performed. Microscopically, the tumor was intermediately differentiated. At 6 months follow-up, there was neither clinical nor sonographical evidence of recurrence, and almost all sex hormone levels had returned to within normal range. Treatment of this pathological entity has to be individualized according to patient age, stage of tumor and degree of differentiation. Received: 15 May 2000 / Accepted: 26 July 2000     

A case of Sertoli–Leydig cell tumor in a postmenopausal woman

Sertoli-Leydig cell tumor belongs to the group of sex cord-stromal tumors of the ovary. These neoplasms account for less than 0.5% of all ovarian tumors and are more often encountered in young women between the ages of 20 and 30 years who usually become virilized. We described an unusual case of Sertoli-Leydig cell tumor in a postmenopausal women who presented with a solid right pelvic mass, a large amount of ascites, and laboratory tests revealing an elevated CA125, all suggesting a pelvic malignancy. Although five similar cases of postmenopausal women with Sertoli-Leydig cell tumor of ovary have been reported in the literature, we believe that this is an useful addition to the literature.     

Expression profile of ovarian tumors: distinct signature of Sertoli–Leydig cell tumor

Epithelial ovarian tumors are the most common subtype of ovarian cancer. In this study, we reveal distinct expression signatures of previously uncharacterized ovarian carcinoma subtypes, including endometrioid component of mixed ovarian tumor and Sertoli-Leydig tumor. Both subtypes were compared to the most common and well-characterized ovarian epithelial carcinoma of the serous type. These comparisons were performed by complementaryDNA (cDNA) microarrays allowing high-fidelity measurements of the expression levels of 39,360 human individual cDNA species representing both known and unknown human genes. Functional analysis of differentially expressed genes in Sertoli-Leydig tumor revealed an upregulation in sonic hedgehog pathway, deregulation of several metabolic pathways especially in amino acid metabolism and overexpression of genes associated with protein synthesis, including ribosomal genes.     

Laparoscopic management of Sertoli-Leydig cell tumors of the ovary. A report of two cases

BACKGROUND: Sertoli-Leydig cell tumor is a rare ovarian tumor with an incidence of < .5% of all ovarian tumors. Laparotomy is the standard approach to these cases. CASES: Sertoli-Leydig cell tumors were diagnosed in two young, nulliparous, infertile women. Both presented with secondary amenorrhea. Virilization was found in one. Their testosterone levels were high, and sonography revealed a solid, echogenic mass in the fornix. Laparoscopic removal was performed. Both women achieved normal menstruation one month after the operation, and one became pregnant and gave birth to a healthy infant. CONCLUSION: There are very few case reports of laparoscopic removal of such tumors. Laparoscopic surgery, which is minimally invasive and cosmetically acceptable and has a speedy recovery, should be the approach of choice for these patients.     

Production of inhibin A and inhibin B in human ovarian sex cord stromal tumors

OBJECTIVE: Our purpose was to examine the cellular localization of inhibin subunits and messenger ribonucleic acid expressions for the inhibin subunits and the serum levels of inhibin A and inhibin B in human ovarian sex cord stromal tumors. STUDY DESIGN: We examined the immunohistochemical localization of the inhibin subunits and the expression of the corresponding messenger ribonucleic acids by Northern blot analysis in a granulosa cell tumor and a Sertoli-Leydig cell tumor. We also measured serum concentrations of dimeric inhibin A and inhibin B by two-site enzyme-linked immunosorbent assay. RESULTS: Immunostaining specific for the inhibin α, βA, and βB subunits was observed in the granulosa cell tumor. In the Sertoli-Leydig cell tumor we observed immunostaining specific for the α subunit in Leydig tumor cells and that specific for the βA subunit in Sertoli tumor cells and that specific for the βB subunit in both tumor cells. Northern blot analysis revealed the presence of messenger ribonucleic acids for the α, βA, and βB subunits in the granulosa cell tumor and the Sertoli-Leydig cell tumor. The serum levels of dimeric inhibin A and inhibin B in patients were elevated preoperatively and decreased progressively after surgery. CONCLUSION: Our results suggest that inhibin A and inhibin B are produced by the human sex cord stromal tumors and that inhibins might be the useful markers of the tumors.(Am J Obstet Gynecol 1997;177:7)     

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。     

An ovarian Sertoli-Leydig cell tumor with heterologous mucinous gland and NSE-immunoreactive-cell

Summary A rare case of ovarian Sertoli-Leydig cell tumor with heterologous mucinous glands and tiny carcinoid-like foci in a 33-year-old female is reported. In addition to these heterologous elements, peculiar cells, which were oval, eosinophilic and neuron-specific enolase (NSE)-positive, were also observed and had not been described previously. These NSE-immunoreactive cells were different from argentaffin cells observed in mucinous glands and carcinoid-like foci, and seemed to play a significant role in the appearance of the heterologous mucinous gland. The nature of this peculiar NSE-immunoreactive cell is discussed.     

Case report: an identical twin with Sertoli-Leydig cell tumor

Our report details the workup and management of a 43-year-old woman with an identical twin who presented with 2 years of virilization and secondary amenorrhea. Serum total testosterone was elevated. An MRI did not identify adnexal or adrenal pathology. Subsequent ovarian vein sampling demonstrated unilateral testosterone elevation. The patient underwent laparoscopic unilateral oophorectomy resulting in the diagnosis of Sertoli-Leydig cell tumor (SLCT). Although SLCT is a rare sex-cord ovarian tumor, it is associated with endometrial hyperplasia and malignancy. Our goals are to review the workup of androgen-secreting tumors and discuss the clinical importance of the DICER1 mutation in the context of SLCT. In this case, an identical twin underwent DICER1 testing which was one of the essential steps in her clinical management.     

Ovarian Sertoli-Leydig cell tumor: success with salvage therapy

A case of metastatic ovarian Sertoli-Leydig cell tumor is presented. The patient achieved a complete pathologic response with four courses of cisplatin, vinblastine and bleomycin chemotherapy. Recurrence of the tumor was detected with elevated serum alpha-fetoprotein. After surgical debulking, the recurrence was treated with intra-arterial cisplatin and intravenous etoposide with pelvic radiation therapy followed by intravenous doxorubicin and cyclophosphamide. The patient is alive and disease free 75 months after initial diagnosis, 4 years after salvage therapy.