库肯勃(Krukenberg)瘤的诊断与治疗(附18例分析)

目的探讨Krukenlerg瘤的临床特点、治疗方法.方法回顾性分析我院1988-2000年收治的18例Krukenberg瘤临床资料.结果Krukenberg瘤在年轻女性中多见,多为双侧性(16/18),原发灶多为低分化腺癌或粘液腺癌,临床分期多为中晚期(Ⅲ期、Ⅳ期胃癌12例,DukesC、D期大肠癌5例)恶性度高,易漏诊,预后极差.结论确诊为卵巢恶性肿瘤时应首先排除转移性可能,先发现卵巢转移肿瘤者,应常规行胃肠道检查以寻找原发灶.女性胃肠癌患者应注意有无卵巢转移.有卵巢转移者应同时切除原发灶、子宫及双侧附件.无卵巢转移者是否行预防性卵巢切除术应遵循个体化原则.     

综合治疗库肯勃氏瘤22例疗效分析

目的：探讨影响库肯勃氏瘤预后的主要因素。方法：所有病例均行手术切除,其中８ 例行全子宫＋ 双附件切除术;１０ 例行双附件切除术;３ 例行单附件切除术;１ 例行单侧附件切除＋ 对侧卵巢活检术,术后化疗,２ 个月后行次全子宫切除术。采用 Ｍ Ｆ Ａ（ Ｍ Ｍ Ｃ＋ ５ Ｆ Ｕ ＋ Ａｒａｃ） 方案并同时口服安瘤乳。结果：２２ 例均在术后２ ～１９ 个月死亡,平均生存１３ 个月零１２ 天。结论：早期诊断,并尽可能将原发灶、全子宫、双附件一并切除,术后辅加多途径、多疗程化疗,可提高生存率。     

二维超声及彩色多普勒对库肯勃瘤的诊断价值

目的分析库肯勃瘤的二维及彩色多普勒超声表现,旨在探讨对其诊断价值.方法回顾分析40例经术后病理证实为库肯勃瘤的病人,观察肿瘤的形态、大小、内部回声、被膜、与周围组织的关系,有无腹水,内部及周边血流.结果库肯勃瘤具有较为特殊的声像图特点,本组40例患者中26例超声诊断为库肯勃瘤,定性诊断符合率65%.结论二维超声及彩色多普勒对诊断库肯勃瘤有重要的诊断价值.     

库肯勃氏瘤的超声诊断

库肯勃氏瘤(Krukenberg tumor)是卵巢上皮性转移瘤,多来自胃肠道。病理学将此类肿瘤限定于具有以下两个特征:(1)肿瘤细胞是含有印戎细胞的粘液细胞,(2)间质伴有肉瘤样增生。此病发病率有逐年增高的趋势,既往超声     

双途径化疗对大肠源性库肯勃氏瘤术后患者的疗效观察

胃肠道癌转移至卵巢的肿瘤则称为库肯勃氏瘤[1],临床上较少见。2001年1月至2003年12月,我们对17例大肠源性库肯勃氏瘤患者采用FOLFOX方案(L-OHP CF/5-Fu)静脉化疗及腹腔双途径化疗,取得较好的近期疗效,现总结如下。1临床资料1.1一般资料1993年3月～2003年12月,我科共收治大肠源     

综合治疗库肯勃氏瘤22例疗效分析

目的：探讨影响库肯勃氏瘤预后的主要因素。方法：所有病例均行手术切除,其中８例行全子宫＋双附件切除术;１０例行双附件切除术;３例行单附件切除术;１例行单 会件切除＋对侧卵巢活检术,术后化疗,２个月后行次全子宫切除术。采用ＭＦＡ方案并同时口服安瘤乳。     

源于胃的库肯勃瘤伴甲胎蛋白增高症1例

1病例资料患者,蔡某某,女,41岁。2009年1月因＂全腹胀痛＂就诊,1月13日B超：双侧附件区实质占位,子宫偏大伴异常结构,腹腔积液,建议进一步检查。2月13日腹部CT提示：下腹、盆腔巨大占位伴后腹膜多枚淋巴结肿大,考虑卵巢转移性癌,肝脾肿大伴少量腹水。胃镜提示：粘膜慢性炎伴活动及糜烂,部分腺体呈息肉样增生。     

源于胃的库肯勃瘤伴甲胎蛋白增高症1例

1 病例资料 患者,蔡某某,女,41岁.2009年1月因"全腹胀痛"就诊,1月13日B超:双侧附件区实质占位,子宫偏大伴异常结构,腹腔积液,建议进一步枪查.2月13日腹部CT提示:下腹、盆腔巨大占位伴后腹膜多枚淋巴结肿大,考虑卵巢转移性癌,肝脾肿大伴少量腹水.胃镜提示:粘膜慢性炎伴活动及糜烂,部分腺体呈息肉样增生.     

早孕合并卵巢库肯勃瘤一例报告

1病例报告 患者43岁,因停经54d,恶心呕吐15d,右下腹疼痛20d,以妊娠合并卵巢蒂扭转于2005年5月4日入院。以往月经规律,孕3产2流1,末次月经2005年3月16日,食欲减退,全身乏力。入院查体：体温37．5℃．脉搏21次／min,血压100／60mmHg,消耗体质,精神不振,神志清晰,中度贫血貌,心肺正常,肝脾未触及。全腹压痛反跳痛,未扪及明显包块,移动性浊音（-）。     

库肯勃氏瘤预后相关因素分析

目的分析库肯勃氏瘤的临床病理特征、治疗方式及预后相关性。方法对56例库肯勃氏瘤的预后因素进行回顾性分析,应用COX风险比例模型分析预后相关因素,采用Kaplan-Meier法评估相关因素对患者生存期的影响。结果 56例患者平均生存期为11.2个月,转移部位(P=0.01)及手术方式(P=0.03)影响患者总生存时间;单纯卵巢转移者较合并其它部位转移者总生存期长(12.8 Vs 5.8月),原发肿瘤与卵巢转移性肿瘤同时切除者较单纯切除卵巢转移病灶者总生存期长(14.2 Vs 7.9月)。结论库肯勃氏瘤多发于年轻、绝经前女性患者。外科及妇科联合手术治疗可延长患者生存期。     

The diagnosis and outcome of Krukenberg tumors

BackgroundAccurate diagnostic tools are crucial to distinguish patients with Krukenberg tumors from those with ovarian cancers before decision on initial management. To address this unmet need, we aimed to evaluate the diagnostic utility of clinical, biochemical, and radiographic factors in this patient population.MethodsPatients with Krukenberg tumors or primary ovarian cancers were retrospectively identified from institutional cancer registry. Kaplan-Meier method and Cox proportional hazards models were used for survival analysis. Logistic regression evaluated clinical, biochemical, and radiographic factors; residual deep neural network model evaluated features in computed tomography images as predictors to distinguish Krukenberg tumors from ovarian cancers. Model performance was summarized as accuracy and area under the receiver operating characteristic curve (AUC).ResultsThis study included 214 patients with Krukenberg tumors with median age of 52 years. Among 104 (48.6%) patients with colorectal cancer, those who received palliative surgery had significantly higher median overall survival (48.1 versus 30.6 months, P=0.015) and progression-free survival (22.2 versus 6.7 months, P<0.001) than those with medical management only. The accuracy of radiology reports to make either diagnosis of Krukenberg tumors or primary ovarian cancers was 60.7%. In contrast, multivariable logistic regression model with age [odds ratio (OR) 2.98, P<0.001], carbohydrate antigen 125 (OR 1.57, P=0.004), and carcinoembryonic antigen (OR 0.03, P=0.031) had 87.5% [95% confidence interval (CI): 75.0–100.0%] accuracy with AUC 0.96 (95% CI: 0.87–1.00). The neural network model had 62.8% (95% CI: 51.8–74.5%) accuracy with AUC of 0.61 (95% CI: 0.53–0.72).ConclusionsWe developed a diagnostic model with clinical and biochemical features to distinguish Krukenberg tumors from primary ovarian cancers with promising accuracy.     

Surgical treatment for patients with different origins of Krukenberg tumors: Outcomes and prognostic factors

Aims

We sought to investigate survival impacts of metastasectomy in women with Krukenberg tumors of the ovary and survival benefits in different origins (gastric caner, colorectal cancer, or others).

Methods

All patients diagnosed with Krukenberg tumors of the ovary who underwent surgical treatment at a single institution between 1997 and 2003 were retrospectively evaluated. Survival analyses and comparisons were performed using Kaplan–Meier method and log-rank test.

Results

A total of 54 patients with Krukenberg tumors of the ovary were identified. The estimated 5-year survival was 12.1%. The median survival in patients with microscopic residual disease after metastasectomy was 29.6 months, compared to 10 months in those with visible residual disease (P < 0.01). The median survival among patients with Krukenberg tumors of gastric origin, colon and rectum origin, and other origins were 13 months, 29.6 months, and 48.2 months, respectively (P = 0.03). There was a significant difference in survival between patients with metastatic disease confined to the ovaries and those with extensive metastases, with an estimated median survival of 30.7 months and 10 months, respectively (P = 0.02). Multivariate analysis suggested that the origin of ovarian metastatic carcinoma (P < 0.01), residual disease after metastasectomy (P < 0.01), and KPS (Karnofsky performance status) (P = 0.03) were independent prognostic factors of survival.

Conclusions

Patients with Krukenberg tumors from colorectal cancer experience a better prognosis than those from gastric cancer and benefit more from metastasectomy. And metastasectomy significantly lengthens overall survival in patients with primary colorectal or breast cancer, higher KPS score, and those with optimal metastasectomy.     

阑尾原发性腺癌晚期形成Krukenberg瘤的临床分析

目的:探讨阑尾原发性腺癌晚期形成Krukenberg瘤的临床特点、诊断及治疗。方法:分析1例表现为Krukenberg瘤的阑尾原发性腺癌患者的临床资料,并复习相关文献。结果:阑尾原发性腺癌晚期转移形成Krukenberg瘤的病例较为罕见,并且缺乏特异性临床表现,极易漏诊、误诊,术前或术中即明确诊断者极少见,绝大多数是通过术后组织病理学诊断而最终确诊。右半结肠切除术是阑尾原发性腺癌的首选治疗方式,术后辅以化疗等综合治疗。结论:以Krukenberg瘤为首发表现的病例在寻找原发癌灶时应考虑到原发性阑尾恶性肿瘤的可能。术中对阑尾的仔细探查是必要的,若发现阑尾形态异常改变除了及时行阑尾切除,术中还应对其进行冰冻病理检查以提高术中确诊率,指导手术治疗。     

Primary adenocarcinoma of the appendix with bilateral Krukenberg ovarian tumors

An unusual case of a 22-year-old white female with known chronic ulcerative colitis presented with a several-day history of lower abdominal pain and a pelvic mass. Laparotomy revealed a primary carcinoma of the appendix with Krukenberg metastasis to both ovaries. Pathologically this tumor appeared to arise from an appendix which showed no evidence of chronic ulcerative colitis and therefore could not be associated with the above-mentioned entity.     

Surgical management and outcome of metachronous Krukenberg tumors from gastric cancer

BACKGROUND AND OBJECTIVES: The question of whether resection should be performed in Krukenberg tumors from gastric cancer has yet to be adequately examined. Despite some reports on the surgical treatment of Krukenberg tumors, the outcomes after resection are not well characterized. PATIENTS AND METHODS: Using a gastric cancer database, a total of 34 patients who underwent a resection of metastatic ovarian tumors after curative surgery for gastric cancer were identified. A prospective database of these patients was reviewed for the presentation, clinical features, and outcomes after resection. RESULTS: The median age of 34 patients was 44 years (range, 24-66). The majority of patients was in the premenopausal state and had bilateral ovarian involvement. The most common presenting symptom was an abdominal mass (35.3%). Tumor size ranged from 3.5 to 20 cm with 61.8% measuring larger than 10 cm. In 17 patients who had metastatic disease confined to the pelvis, a complete gross resection (R0) was achieved. In the other 17 with the disease beyond the pelvis gross residual tumors remained after the resection (R1). The median survival of all patients was 11 months (95% confidence interval [CI] 8-14), and that of the patients rendered R0 was 18 months (95% CI, 14-22), in comparison with 9 months (95% CI, 3-15) for those with R1 resection (P = 0.0001; log-rank test). The median progression free survival was also significantly longer for the patients with R0 resection than those with R1 resection (8 months, 95% CI, 5-11 vs. 5 months, 95% CI, 4-6, P = 0.0103). Multivariate analysis identified R0 resection as the only significant factor predictive of survival. CONCLUSIONS: In the management of Krukenberg tumors after gastric cancer, a metastasectomy may significantly improve the overall and progression free survival if it could render a complete gross resection. To define the patient group that benefits most from resection, the extent of disease and resectability must be carefully evaluated before surgery.     

26例甲状腺Hurthle细胞肿瘤的外科诊治分析

目的探讨甲状腺嗜酸细胞肿瘤的诊断和外科治疗。方法回顾性分析我院1990至2008年收治的26例甲状腺嗜酸细胞肿瘤。结果本组行单侧甲状腺次全切除12例,单侧甲状腺腺叶切除9例,单侧甲状腺腺叶切除及峡部切除2例,甲状腺全切除术2例,甲状腺全切除加患侧改良颈部淋巴结清扫1例。术后病理：甲状腺嗜酸细胞腺瘤23例,嗜酸细胞癌3例,伴颈部淋巴结转移1例;切除标本中合并结节性甲状腺肿2例、甲状腺滤泡型腺瘤2例及桥本甲状腺炎4例。23例患者获得随访,随访时间9个月至14年,中位随访时间6年,未发现肿瘤复发或转移。结论选择适宜的外科手术方式和术后长期密切随访对甲状腺嗜酸细胞肿瘤的诊治非常重要。     

A curious discourse of Krukenberg tumor: a case report

Krukenberg tumor is usually but not always a bilateral involvement of ovaries from metastatic deposit from adenocarcinoma of stomach and rarely from other gastrointestinal (GI) and non GI organs. The route of metastatsis of this rare condition is still not proven. It is still uncertain whether surgical resection of ovarian metastases and/or primary tumor could improve the outcome. We report even a rare presentation of this rare disease entity.     

３４例Ｋｒｕｋｅｎｂｅｒｇ瘤的临床病理分析

目的　分析Ｋｒｕｋｅｎｂｅｒｇ瘤患者的临床病理特点及治疗,寻找预后相关因素。方法　回顾性分析３４例确诊为Ｋｒｕｋｅｎｂｅｒｇ瘤且有完整生存资料者的临床病理特征,对生存相关参数进行单因素及多因素分析。结果　年龄１４～７３岁,中位年龄４１岁;原发瘤包括胃癌２０例（５８.８％）,结肠癌６例（１７.７％）,直肠癌７例（２０.６％）,不明者１例（２.９％）;单侧卵巢转移１２例（３５.３％）;双侧卵巢转移２２例（６４.７％）;全组患者生存时间为０～５５个月,中位生存１１０个月。单因素分析显示,年龄≤５０岁者预后较差（Ｐ＝０.０１１）,化疗≥４周期者生存期较长（Ｐ＝０.００６）;多因素分析显示仅年龄与预后相关（Ｐ＝０.００５）。结论　Ｋｒｕｋｅｎｂｅｒｇ瘤患者预后差,目前尚未发现有效化疗方案,绝经后女性、经积极手术治疗并完成≥４周期化疗者预后相对较好。     

FOLFIRI方案治疗胃癌异时性卵巢转移的疗效

目的:观察FOLFIRI方案治疗胃癌异时性卵巢转移患者的近期疗效和安全性。方法:FOLFIRI方案治疗转移性胃癌30例,具体为:伊立替康180mg/m2,静脉滴注,第1天;亚叶酸钙200mg/m2,静脉滴注,第1、2天;5-FU 400mg/m2,静脉推注,第1、2天;5-FU 2 400mg/m2,输液泵持续泵入44~48小时。2周为一周期。3周后评价疗效。结果:30例均可评价疗效,完全缓解0例,部分缓解6例,稳定8例,疾病进展16例,总有效率为20%,疾病控制率为46.7%。主要毒副反应为血液学毒性和消化道症状,其中恶心、呕吐、转氨酶升高、口腔黏膜炎为I-II度。Ⅲ-Ⅳ度分别为白细胞减少,发生率20%;中性粒细胞减少,发生率23.3%;血小板减少,发生率为10%;腹泻,发生率为16.7%。结论:FOLFIRI方案治疗胃癌异时性卵巢转移有较好的疗效,毒性小,耐受性好。     

库肯勃瘤中CD44v6﹑VEGF﹑MMP-2﹑MMP-9的表达及相关性研究

目的:探讨CD44v6、VEGF、MMP-2、MMP-9在库肯勃瘤及卵巢原发上皮癌中的表达及相关性。方法:应用免疫组化SP法检测CD44v6、VEGF、MMP-2、MMP-9在20例正常卵巢组织、38例库肯勃瘤、45例卵巢原发上皮癌中的表达情况。结果:CD44v6、VEGF在卵巢原发上皮癌和库肯勃瘤组织中的表达显著高于正常卵巢组织(P<0.05);MMP-2﹑MMP-9在正常卵巢组织中表达缺如;CD44v6、VEGF、MMP-2、MMP-9在库肯勃中阳性表达率明显高于卵巢原发上皮癌(P<0.05)。CD44v6、VEGF、MMP-2、MMP-9在卵巢原发上皮性癌、库肯勃瘤中,任意两指标阳性表达均有正相关性(P<0.05)。结论:CD44v6、VEGF、MMP-2、MMP-9均参与卵巢癌、胃癌、库肯勃瘤的发生、发展及演进过程,并可为卵巢上皮癌、胃癌及库肯勃瘤的鉴别诊断提供一定依据。