卵巢无性细胞瘤25例分析

报道我院１９７１年～１９９３年收治的卵巢无性细胞瘤２５例，分析表明：该肿瘤多见于３３岁以下的青年妇女，发病率占卵巢肿瘤的０．６８％，占卵巢恶性肿瘤的６．５１％。其治疗应根据肿瘤临床分期、病理组织学特征、年龄和生育要求决定手术范围及术后放疗或化疗。     

卵巢无性细胞瘤118例分析

自１９７０年１月至１９９１年１２月本院妇科收治卵巢无性细胞瘤１１８例，其中Ｉ期７５例，Ⅱ期２３例，Ⅲ期２０例，５年生存率为８７．２％，本组病例均经手术治疗，术后放疗９０例，化疗２８例，５例患者生育１胎，通过对卵巢无性细胞瘤的诊断，治疗和保留生育功能问题的讨论，认为Ｉｂ以上者都可考虑全子宫，双附件，网膜及腹膜后淋巴结清除术，术后辅以化疗或放疗以收到良好的疗效。     

卵巢无性细胞瘤60例临床回顾分析

我院自１９５９年５月至１９９２年１０月收治了纯型卵巢无性细胞瘤６０例。中位年龄２１岁。主要症状为腹部包块、腹痛、腹胀。Ｉ期患者３２例，Ⅱ期２例，Ⅲ期５例，复发或未控２１例。除１例仅行手术外，其余均接受手术加放射治疗和（或）化疗。９例死于本病，５年存活率达８５．１７％。辅助治疗采用放射治疗或化疗，两者的５年存活率差异无显著性，但对一些年轻且要求生育或晚期患者，术后采用化疗做为辅助治疗可能是更好的选择     

卵巢颗粒细胞瘤26例临床病理分析

目的:对卵巢颗粒细胞瘤(GCT)的临床病理特点及预后进行探讨.方法:回顾性分析26例GCT患者的临床表现、病理特征、免疫组化结果及预后情况.结果:①临床分期及分型:FIGO分期ⅠA期15例(57.8％),ⅠC期5例(19.2％),ⅡB期3例(11.5％),ⅡC期1例(3.8％),ⅢB期2例(7.7％).高分化18例,中分化5例,低分化3例.成年型GCT 23例,幼年型GCT 3例.②肿瘤特征:肿瘤大体上多为表面光滑,分叶状、实性或囊实性肿块,仅1例呈囊性.肿瘤细胞由小圆形、多边形或梭形细胞构成,核呈石榴子样,可见或多或少的纵形核沟及Call-Exner小体.③免疫组化表达:抑制素α(α-inhibin)表达阳性率94.1％ (16/17),CD99表达阳性率92.3％ (12/13),波形蛋白(Vimentin)表达阳性率94.7％( 18/19).④治疗及随访:1例放弃治疗死亡,其余25例均行手术治疗,联合化疗5例.随访1～6年,ⅢB期2例为中～低分化,肿瘤直径＞ 10 cm,已死亡,其余均存活.结论:GCT是低度恶性的卵巢肿瘤,核沟是常见的组织学特征,Call-Exner小体是最常见的排列方式.免疫组化中α-inhibin、CD99和Vimentin是诊断GCT比较有意义的抗体.临床分期、组织学分级等因素均影响预后.     

卵巢无性细胞瘤伴少量合体滋养叶细胞和腺样卵黄囊细胞一例及文献复习

无性细胞瘤（dysgerminoma）是卵巢比较少见的肿瘤,占原发卵巢肿瘤的1％,其中3％～5％出现合体滋养叶细胞分化,少部分出现卵黄囊成分。腺型卵黄囊是卵黄囊瘤中比较少见的形态,易引起误诊。在此报道一例卵巢无性细胞瘤伴少量合体滋养叶细胞及腺样卵黄囊细胞,并结合文献分析其临床病理特征。     

卵巢幼年型颗粒细胞瘤四例临床分析

目的 探讨卵巢幼年型颗粒细胞瘤的诊断,治疗和预后。方法 回顾性分析自1983年至2002年间北京协和医院收治的4例卵巢幼年型颗粒细胞瘤的临床资料。结果 卵巢幼年型颗粒细胞瘤的发生率极低,主要发生在青少年及儿童,临床表现为盆腔实性包块伴胸腹水,4例患者雌二醇水平均在正常范围,手术病理分期为Ⅰ期。确诊主要依据病理检查,所有患者接受手术 化学药物治疗（化疗）。其中,2例呈高核分裂相的患者病情很快恶化,分别于发病后10和14个月死亡;2例低分裂相的患者现无瘤生存分别为32和25个月。结论 卵巢幼年型颗粒细胞瘤的诊断主要依据病理检查,核分裂相高者预后不良,治疗以手术为主,辅以化疗可能改善预后。     

卵巢无性细胞瘤伴对侧卵巢环小管性索瘤一例

患者25岁,因原发性闭经,无明显诱因下腹痛1个月,B超示盆腔占位性病变,于2003年11月10日收入院。身体检查:一般状态良好,肝脾未触及,腹软,压痛(+),下腹可触及边界不清肿物。妇科检查:外阴发育欠佳,无阴毛分布,阴道畅,宫颈光滑,略小,子宫触诊不满意;盆腔内可触及边界不清的包块,约15cm×15cm,中等硬,压痛(+),以右下腹为重,双侧附件触诊不满意。B超示盆腔占位(右侧卵巢肿物不除外);血清CA125水平为439kU/L。初步诊断:盆腔肿物;原发性闭经;子宫发育不良。于2003年11月13日行剖腹探查术,术中见腹腔内草黄色腹水约1000ml,右侧卵巢肿瘤18cm×12c…     

卵巢囊性颗粒细胞瘤临床病理观察

目的探讨卵巢囊性颗粒细胞瘤的临床病理学特征、诊断以及相关的鉴别诊断。方法复习2例卵巢囊性颗粒细胞瘤临床资料,观察组织病理学表现、进行免疫组化染色,同时复习相关文献。结果2例女性分别为28岁和60岁,肿瘤为囊性,大小分别为12 cm×11.5 cm和6.5 cm×4 cm,囊内壁由单层和/或多层颗粒细胞构成,囊壁中可见实性片状排列的颗粒细胞。免疫组化标记inhibin,CD99,Vimentin阳性。结论卵巢囊性颗粒细胞瘤较少见,在囊内壁中的成片颗粒细胞中找到Call-exner小体或微滤泡结构是诊断的关键,免疫组化染色对诊断具有帮助。     

卵巢颗粒细胞瘤72例临床分析

目的 探讨卵巢颗粒细胞瘤的临床特点及预后相关因素。方法 总结７２例卵巢颗粒细胞瘤患者的临床资料,比较不同期别、不同原发肿瘤大小的卵巢颗粒细胞瘤患者应用不同方法治疗后的５年及１０年存活率。结果 卵巢颗粒细胞瘤患者的５年及１０年存活率随临床分期的增加而降低,但与原发肿瘤的大小无明显相关关系。Ｉ期病人应用不同治疗方法对存活率也无明显影响。结论 临床分期是影响卵巢颗粒细胞瘤患者预后的主要因素,Ｉ期患者术后     

卵巢成年型粒层细胞瘤的临床病理特点分析

目的 探讨卵巢成年型粒层细胞瘤的临床病理特点。方法 收集无锡市妇幼保健院的19例卵巢成年型粒层细胞瘤的病例资料,分析卵巢成年型粒层细胞瘤的临床病理特点。结果 肿瘤发病年龄29～77岁,直径2～17 cm;主诉阴道出血或月经紊乱10例,腹胀1例,9例无明显临床症状;FIGO分期均为Ⅰ期,形态结构多样;EMA、CgA、Syn均为阴性,Calretinin阳性率为94.7%,a-抑制素阳性率为89.5%;子宫内膜病变率为54.5%,均无复发转移。结论 卵巢成年型粒层细胞瘤较为罕见,易伴发子宫内膜病变,组织形态多样,需与多种疾病鉴别诊断。     

Recurrent ovarian dysgerminoma after laparoscopy

Abstract.   Prado S, Yazigi R, Garrido J, Gonzalez M, Torres R, Oddo D. Recurrent ovarian dysgerminoma after laparoscopy. Int J Gynecol Cancer 2006; 16(Suppl. 1): 397–399.
To our knowledge, recurrent dysgerminoma at the site of tumor removal by laparoscopy in a patient with stage IA disease has not been previously reported. A woman with ovarian dysgerminoma treated by laparoscopy and tumor removed through the cul-de-sac recurred the 17 months later at the site of tumor removal. She was successfully treated with etoposide, bleomycin, and cisplatin chemotherapy with complete response. This case illustrates the potential for surgical site implant of an ovarian dysgerminoma; surgeons should follow strict guidelines when performing laparoscopic procedures for ovarian malignancies in order to prevent this type of incident.     

卵巢癌新辅助化疗前病理证据获取方法

新辅助化疗对于晚期卵巢癌患者的治疗具有明显优势,而化疗前获得足够的病理证据就显得尤为重要。目前,经腹壁细针穿刺活检、经阴道细针穿刺活检、淋巴结穿刺活检、胸腹水细胞学穿刺检查、腹腔镜探查取活检及开腹探查取活检等为临床使用的几种方法,文章就上述方法的选择及其优弊进行阐述。     

妊娠合并卵巢肿瘤及瘤样病变58例临床分析

目的探讨妊娠合并卵巢肿瘤及瘤样病变患者的临床特征和处理对策。方法回顾性分析2009年1月至2010年12月福建省妇幼保健院收治的58例经手术病理诊断的妊娠合并卵巢肿瘤及瘤样病变患者的临床资料。结果 58例妊娠合并卵巢肿瘤及瘤样病变患者占同期妊娠的0.24%(58/23756),其中卵巢良性肿瘤及瘤样病变56例(96.6%),卵巢恶性肿瘤2例(3.4%)。妊娠前首次发现者5例(8.6%);孕早期发现者22例(37.9%),孕中期发现者18例(31.0%),孕晚期发现者13例(22.4%);孕早、中期均为超声检查发现,孕晚期均为剖宫产术中发现。56例卵巢良性肿瘤及瘤样病变患者中,50例(89.3%)行卵巢囊肿切除术,6例(10.7%)行附件切除术,随访8～18个月未见复发。2例妊娠合并卵巢恶性肿瘤患者中,1例卵巢浆液性囊腺癌行肿瘤细胞减灭术,术后辅助化疗8个疗程,随访12个月无瘤生存;1例卵巢肿瘤切除术后病理诊断卵巢幼年性颗粒细胞瘤,拒绝再次手术及化疗,术后2个月死亡。58例患者中,妊娠合并卵巢肿瘤蒂扭转行急诊手术8例,发生率为13.8%。58例患者的病理类型为成熟畸胎瘤24例(41.4%),浆液性囊腺瘤22例(37.9%),黄体囊肿10例(17.2%),颗粒细胞瘤1例(1.7%),浆液性乳头状囊腺癌1例(1.7%)。结论超声检查可以诊断和监测妊娠期卵巢肿瘤及瘤样病变,而剖宫产术中常规行双侧附件探查亦很重要。妊娠合并卵巢肿瘤蒂扭转患者以成熟畸胎瘤为最多见。     

卵巢男性母细胞瘤13例临床分析

目的 了解卵巢男性母细胞瘤的临床病理特征。方法 复习全部病历及病理资料,并进行随访。结果 13例卵巢男性母细胞瘤中,10例中分化型,3例低分化型。随访12例,随访率为92.3％,其中1例合并妊娠,2例死亡。2例育龄妇女,治疗后生育孩子。结论正确合理治疗是提高生存率及生育的根本保证。男性母细胞瘤分化好预后较好,合并妊娠预后最差。     

儿童及青少年卵巢肿瘤67例临床分析

目的 分析儿童及青少年卵巢肿瘤的临床特点、诊治及预后。方法 对1990年1月～2006年1月间年龄19岁以下经手术病理证实的卵巢肿瘤患者67例进行回顾性总结，其中年龄12岁以下者7例，为儿童组，13～19岁者60例，为青少年组。结果良性肿瘤占大多数（79．10％），恶性12例（17．91％）。交界性肿瘤2例（2．99％）。生殖细胞肿瘤最多，占50．75％（34／67），其中88．24％为畸胎瘤。上皮细胞肿瘤占28．35％。儿童组中恶性比例为42．86％，青少年组中恶性及交界性肿瘤比例为18．33％（11／60）。B超及肿瘤标志物对诊断卵巢肿瘤及判断良恶性有一定帮助。所有患者均手术治疗，恶性者大部分辅以化疗。生殖细胞恶性肿瘤均行保留生育功能的手术方式。初治失败者预后差。结论 对儿童及青少年应开展定期体检，必要时行B超等影像学检查。对恶性生殖细胞肿瘤应尽量行保留生育功能的手术，术后辅以放化疗。     

An ovarian dysgerminoma in Down syndrome. Hypothesis about the association

Abstract.   Satgé D, Honoré L, Sasco AJ, Vekemans M, Chompret A, Réthoré M-O. An ovarian dysgerminoma in Down syndrome. Hypothesis about the association. Int J Gynecol Cancer 2006; 16(Suppl. 1): 375–379.
An 11-year-old girl with Down syndrome (DS) was operated for a stage I right ovary dysgerminoma. She is in good health 33 years later. Some data in the literature suggest that ovarian cancers could be slightly overrepresented in DS. Despite the rarity of ovarian dysgerminoma, our case is the fifth reported in DS. This case is the second one associated with a family history suggesting the possibility of a familial predisposition to cancer. A hypothesis explaining the development of dysgerminoma in DS is proposed.     

Clinical characteristics of preterm ovarian hyperstimulation syndrome: seven cases from China and 14 cases from the literature

Preterm ovarian hyperstimulation syndrome (POHS) is a rare condition with only a few reported cases. The objective of this study is to investigate the clinical characteristics of 21 POHS cases (seven from China and 14 from the literature). Suspected patients (n?=?7) were referred for further confirmation and data on demographics, family history, clinical manifestations (edema developed in the vulva, the hypogastric site and the upper leg), serum and sonographic assessments (ovarian cyst/cysts, gonadotropins, and estradiol levels), the natural course of patients were documented. We did not observe substantial differences in clinical manifestations among POHS patients from China relative to that from the literature. Preterm female newborns developed edema in the vulva, the hypogastric site and the upper leg at 30–39⁺⁶ weeks of post-conception age (PCA) as the major clinical manifestations. The characteristic also included high gonadotropins and estradiol, and ovarian cysts. This condition can self-resolve. Clinical manifestations of POHS patients from China are similar to those from the literature. The pathognomonic signs of POHS include vulvar, hypogastric, and upper leg edema developed at 30–39⁺⁶ PCA along with high gonadotropins and E2 values and the presence of ovarian cysts in preterm female newborns and the syndrome can self-resolve.     

原发性卵巢类癌7例临床分析

目的探讨原发性卵巢类癌的临床特点。方法回顾性分析北京协和医院2002-2007年收治的7例原发性卵巢类癌患者的临床病理资料。结果原发性卵巢类癌十分罕见,占同期收治卵巢癌的0.53%。患者年龄29～64岁,中位年龄35岁;孕次平均2.0次(0～5次);产次平均0.57次(0～1次)。以盆腔包块、便秘、月经紊乱及阴道不规则出血为主要临床表现。妇科检查附件区扪及实性或囊实性包块。CA125轻度升高2例,CA199升高1例。神经内分泌标志物的检测有助于诊断。病理检查证实7例患者均为临床Ⅰ期,单纯类癌3例,类癌合并畸胎瘤3例,甲状腺肿类癌2例。7例患者均行手术治疗,其中保留生育功能者4例,子宫 双附件切除3例。术后1例行BEP方案(顺铂、博莱霉素、足叶乙甙)化疗3个疗程,1例行紫杉醇单药化疗1个疗程。定期随访,除1例失访外,余无复发病例。结论原发性卵巢类癌恶性程度较低,生物学行为较好,不易远处转移,早期病例预后良好。但此肿瘤有远期复发可能,因此应长期随访。     

Pregnancy in a woman with a Y chromosome after removal of an ovarian dysgerminoma

BACKGROUND: It appears to be a general belief that pregnancy might be impossible in women with the XY karyotype. Therefore, it is recommended that patients with dysgerminoma of the ovary associated with the XY karyotype should undergo a bilateral salpingo-oophorectomy. CASE: We report an extremely rare case of a true hermaphrodite with a 20% 46,XX/80% 46,XY karyotype who became pregnant after removal of an ovarian dysgerminoma. The patient had a completely normal female phenotype. A dysgerminoma with ovotestis was found in the right ovary. Two courses of chemotherapy following a right salpingo-oophorectomy were carried out. Nine months later she became pregnant and delivered a healthy male infant. CONCLUSION: A unilateral salpingo-oophorectomy followed by combination chemotherapy can be the treatment of choice for any woman who wishes to preserve her capacity for conception at the time of operation for dysgerminoma of the ovary.     

Chemotherapeutic treatment of a pregnant patient with ovarian dysgerminoma

Background Diagnosis of malignant ovarian tumours during pregnancy is uncommon. This report presents a case of a pregnant woman with ovarian dysgerminoma. Case report At 24 weeks gestation, a 33-year-old patient was diagnosed with unilateral ovarian dysgerminoma. Because the tumour was considered to be at an advanced stage (FIGO III), she received three cycles of paclitaxel and carboplatin. At 36 weeks gestation, she underwent a caesarean section, abdominal hysterectomy, bilateral salpingovarectomy, omentectomy, and lymphadenectomy. After surgery, she received three additional cycles of chemotherapy in an adjuvant setting. At birth, the infant was responsive to stimuli, and 20 months after delivery, the infant exhibited normal development. Conclusion This case report illustrates the difficulties arising from diagnosis of malignancy during pregnancy. Although combined treatment with paclitaxel and carboplatin is not considered a first-line therapy for ovarian dysgerminoma, in this case report it elicited an excellent response, and there were no adverse effects on the foetus.