B超辅助诊断卵巢内胚窦瘤的价值

Ｂ超辅助诊断卵巢内胚窦瘤的价值朱素琼，李里四川省肿瘤医院（６１００４１）卵巢内胚窦瘤又称卵黄囊瘤。本病恶性程度高，发展快，转移早，预后差。随着超声技术的迅速发展，卵巢内胚窦瘤的术前诊断较以往有明显提高，但系统的超声资料较少。为了提高本病的超声诊断，本...     

卵巢内胚窦瘤化疗的合理性探讨

1980～1988年收治22例卵巢内胚窦瘤,按术后残存肿瘤<1cm和>1cm分成两组,两组分别存活期各为46个月和15.5个月(P<0.01).又按术后予以联合化疗和单一化疗分成两组,两组存活期分别为28个月和10个月(P<0.05).术后首先应用腹腔联合化疗,越早越好.DDP和5—Fu联合腹腔化疗较合理,3次后每月1次VAC方案全身化疗效果较佳.少数病例在7～8个疗程后加全腹~(60)Co外照射.早期病例应行腹膜后淋巴清除术.连续测定AFP可作为治疗监护和评价预后.不宜行二次探查术.     

卵巢内胚窦瘤一例

患儿女，6岁。因食欲差、乏力1月，腹胀5天收住院。患儿于1月前出现食欲差、乏力，无发热及腹痛，近5天患儿腹胀明显，小便少，呼吸费力，精神差。起病后无发热及黄疸。既往体健，否认肝炎及结核病史。体查：T38．6℃，R30次／分，P130次／分，BP11／8kPa，发育正常，营养良好，急病容，无黄疸。心肺正常。腹壁静脉曲张，腹胀明显，肝脾未触及，全腹无压痛，未触及包块。腹部移动性浊音阴性，肠鸣音弱。下肢无浮肿，巴彬斯基征阴性。实验室检查：血常规：Hb120克／L。，WBC13.0×109／L，多核0．99，淋巴0．12。尿、便常规检查正常。血…     

卵巢内胚窦瘤5例

卵巢内胚窦瘤较少见,且多发生于儿童或青年患者,恶性度高,预后差。我院自１９８３年９月～１９９７年５月收治５例,现报道如下。５例患者年龄８～２２岁,中位年龄１６岁。按ＦＩＧＯ分期,Ⅰａ期１例,Ⅰｂ期１例,Ⅰｃ期１例,Ⅱｂ期１例,Ⅲ期１例。患者多以腹胀、腹内肿块为主诉。临床检查下腹可触及肿物。Ｂ超检查见肿瘤表面不光滑,回声极不均匀,伴腹水。化验ＡＦＰ均升高,为１３８～３７８ｎｇ／ｍｌ。患者发育差,瘦小,与实际年龄不符,月经稀少或无月经。手术中所见４例均为幼稚子宫。肿瘤发生在单侧卵巢１例,双侧４例。肿…     

卵巢内胚窦瘤临床分析

卵巢内胚窦瘤源于生殖细胞，为卵巢恶性肿瘤中预后最差的一种。现将其临床特点、治疗方法及预后进行分析。资料与方法1981年3月至1991年3月我院共收治卵巢内胚窦瘤21例，占同期收治的原发性恶性卵巢肿瘤的7．72％；占卵巢生殖细胞恶性肿瘤的29．12％。发病年龄10～14岁、10～25岁占80．95％。主要症状为下腹疼痛15例或（和）下腹肿块16例，仅1例无症状为产前检查发现。治疗前18例血清AFP高于正常，手术及化疗后均显示不同程度下降。按FIGO（1974年）分期标准：Ⅰ期7例，Ⅱ期3例，Ⅲ期6例，Ⅳ期5例。术中肿瘤双侧者1例，单侧20例，其中右…     

卵巢内胚窦瘤2例报告

卵巢内胚窦瘤又称卵黄囊瘤，是一种少见'（fi恶性程度很高的生殖细胞肿瘤。我院近20年中仅收治2例，现就其临床与病理特征结合文献讨论如下：例1：14岁，突发性下腹部持续性疼痛5天，发现下腹部一叫？块，伴有发热、恶心、B超提示"卵巢囊肿"，以"左卵巢慢脚扭转"住院行急诊手术。术中见腹内有血性液250ml左右，左卵巢肿瘤大小约16／lZcm，表面尚光滑，包膜完整，但有破裂口3处，组织呈鱼肉样，质松脆，考虑为卵巢癌自发性破裂可能，鉴于年龄小，仅予左附件切除。术后病理报告为"左卵巢内胚窦瘤件破裂出血。术后查AFP＞500ng／。l、三周后…     

原发性卵巢内胚窦瘤1例

原发性卵巢内胚窦瘤１例赵和平牛进才王荷花１病例介绍患者，女性，９岁，因腹部肿物伴腹水收住入院。Ｂ超示：卵巢实质性肿瘤。查体：患者颜面及全身肿胀、腹水、颈部增粗，颈静脉怒张。行ＣＴ检查：右腹部肿块７ｃｍ×６ｃｍ×５ｃｍ。腹水穿刺细胞学检查，可见恶性瘤细...     

Transformation of ovarian yolk sac tumor to immature teratoma following chemotherapy

The patient, a 28-year-old woman, in her ninth week of pregnancy, was operated on for stage Ia, mixed germ cell tumor (grade 3 immature teratoma + yolk sac tumor) of AFP decreased to the normal level. Eight months later, an intrapelvic mass and raised AFP were found. The extirpated recurrent tumor in the pouch of Douglas was a grade 2 immature teratoma with no yolk sac element. FAM chemotherapy was given again, and the patient is alive and well after taking oral UFT. As in testicular germ cell tumors, ovarian germ cell tumors can be converted to a more differentiated tumor following chemotherapy.     

Primary chemotherapy in strongly suspected yolk sac tumor of the ovary

We report a case of a right ovarian tumor measuring 10.8 × 10 × 8.5 cm (diagnosed as a yolk sac tumor) in a 31-year-old nulligravid woman with serum α-fetoprotein (AFP) level of 25 000 ng/ml and pleural effusion. Seven courses of primary chemotherapy (PVB; cisplatin, vinblastine, bleomycin) were given from May 16 to November 11, 1994. No surgical procedures were conducted. After the second course of PVB, the pleural effusion resolved; after the third course, the tumor disappeared, and after the fourth course, serum AFP decreased to the normal range. At the true of writing (May 11, 1998), the patient is in good health without recurrence, with an AFP level below 20 ng/ml. This paper reports, for the first time, a patient with yolk sac tumor in whom remission was achieved by primary chemotherapy alone. Received: September 3, 1997 / Accepted: June 3, 1998     

Primary yolk sac tumor of the rectum

Extragonadal germ cell tumors are well recognized in men but have rarely been reported in women. Reports have Primarily, focused on the pediatric population and have suggested a poor prognosis for extragonadal yolk sac tumors. A 23-year-old woman with a yolk sac tumor arising in the rectum is described. A review of the English-language literature (MEDLINE 1966-1998) regarding extragonadal germ cell tumors in females is provided. Treatment with, four courses of cisplntin. etopo-side, and bleomycin was followed by surgical resection of the involved area. No residual tumor was identified. She remains disease free 3.5 years later. Previous reports are limited by the small number of patients, focus on the pediatric population, and treatment before the availability. of cisplatin. Extragonadal germ cell tumors in women are extremely rare but can be successfully treated with aggressive chemotherapy and surgery similar to testis cancer.     

新辅助化疗对晚期卵巢癌患者带瘤状态、手术效果及预后的影响

目的：探讨新辅助化疗对晚期卵巢癌患者带瘤状态、手术效果及预后的影响。方法选取80例晚期卵巢癌患者,实施新辅助化疗联合减瘤术治疗的40例患者为研究组,仅实施减瘤术治疗的40例患者为对照组,比较两组临床疗效、手术效果及预后情况。结果研究组患者治疗的总有效率为87.5%（35/40）,高于对照组的65.0%（26/40）,差异有统计学意义（P﹤0.05）;研究组患者的腹腔积液量、术中出血量、总瘤灶直径、转移灶数均少于对照组,手术时间短于对照组,差异均有统计学意义（P﹤0.05）;研究组副损伤发生率低于对照组,最佳减灭率高于对照组,差异有统计学意义（P﹤0.05）;研究组患者的1年、3年生存率分别为92.5%（37/40）、57.5%（23/40）,与对照组的90.0%（36/40）、52.5%（21/40）比较,差异均无统计学意义（P﹥0.05）;研究组中位生存时间为（42±5）个月,与对照组的（37±5）个月比较,差异无统计学意义（P﹥0.05）。结论新辅助化疗能够有效改善晚期卵巢癌患者带瘤状态、手术效果,但对预后影响不大。     

Mediastinal yolk sac tumor in a woman

Primary endodermal sinus tumor (yolk sac tumor) of the mediastinum is uncommon and most patients are young and male. We report a yolk sac tumor with a mature teratoma of the anterior mediastinum in a 28-year-old woman with an intrathoracic mass. Four courses of combination chemotherapy were given and the tumor was resected. The patient's serum alpha-fetoprotein (AFP) level was elevated, to more 100 000 ng/ml. To the best of our knowledge, this is the first report of serum AFP level exceeding 100 000 ng/ml in a yolk sac tumor with a mature teratoma.     

The use of different induction and maintenance chemotherapy regimens for the treatment of advanced yolk sac tumors

Four children with yolk sac tumor were treated with an aggressive combination chemotherapy program. Three children had presacral primary tumors, one having pulmonary metastases, and one had a testicular primary tumor with pulmonary metastases. Three children were treated when they had measurable disease, and one had no measurable disease. The chemotherapy program consisted of a 6-wk induction period with vincristine (VCR), cis-diamminedichloroplatinum (DDP), and bleomycin. Maintenance therapy consisted of VCR, actinomycin D, and cyclophosphamide (cytoxan) every 3-4 wk as tolerated. Treatment was discontinued after 12 mo of complete remission. All three patients with evaluable disease had a partial response (PR) to induction therapy. Two underwent surgical exploration following induction therapy, one a laparotomy and the other a thoracotomy, and were found to have only scar tissue at the sites of presumed residual disease. The third child with measurable disease progressed to a clinical complete response (CR) during maintenance therapy. Two patients have had no evidence of disease (NED) for 42+ and 41+ mo since starting therapy (28+ and 27+ mo since completing treatment). Two patients are NED 11+ and 7+ mo since starting therapy and remain on treatment. We have encountered no significant renal or pulmonary toxicity, and there have been only two hospitalizations during maintenance therapy for fever and neutropenia. These preliminary results employing different induction and maintenance chemotherapy programs and planned second-look surgical intervention appear encouraging.     

Intrapericardial yolk sac tumor in an infant girl

This article is a report on the first known case of an intrapericardial yolk sac (endodermal sinus) tumor discovered in a 14-month-old girl. The patient presented with a systolic murmur, cardiomegaly, and manifestations of cardiac failure. At surgery a large, friable, intrapericardial mass with no evidence of extrapericardial spread was found. Histologic and immunohistochemical findings were diagnostic of yolk sac tumor. Following initial resection, chemotherapy, and a second resection 13 months after the first, the patient died 24 months after diagnosis. Tumor enlargement was associated with elevated serum alpha-fetoprotein levels.     

Case of yolk sac tumor decreasing in size and the normalizing of alph-fetoprotein level by anticancer chemotherapy

A 19-year old man was hospitalized suspected of a mediastinal tumor with superior vena caval syndrome. As the chest X-ray film and thoracic CT scan on admission revealed a huge anterior mediastinal tumor, and the value of serum alpha-fetoprotein (AFP) was high, we made a diagnosis of malignant mediastinal tumor from the germ cell. Radiation therapy was not effective, but a combination chemotherapy consisted of cis-platinum, adriamycin, and vincristine was clearly effective, decreasing the size of the tumor and normalizing the value of serum AFP. As the tumor acquired tolerance to the anticancer drugs before long, the chemotherapy became ineffective and the patient died 9 months after the initiation of the treatment. This tumor had endodermal sinus structure, Schiller-Duval body, and eosinophilic hyaline globulus which were histological characteristics of yolk sac tumor, and was confirmed to be originated from anterior mediastinum.     

Serum lactate dehydrogenase isoenzyme-1 in children with yolk sac tumor

Although in recent years the evidence of an increase in serum lactate dehydrogenase isoenzyme-1 (LDH-1) in patients with germ cell tumor (GCT) has attracted attention, there have only been a few reports concerning yolk sac tumor (YST), which is a frequent type of GCT in childhood. Serum LDH isoenzymes were determined in eight children with YST, and an increase in LDH-1 was found in seven of them, excluding one in an early stage. On the basis of the findings of serial serum LDH-1 levels during treatment and of LDH isoenzyme pattern in tumor tissues, it is presumed that the increased serum LDH-1 is derived from tumor tissues. LDH-1 seems to be useful as a tumor marker, not specific for YST but associated with the whole spectrum of GCT, for monitoring of YST.