卵巢Sertoli-Leydig细胞瘤伴异源成分伴随精神症状2例临床病理分析

<正>卵巢Sertoli-Leydig细胞瘤(sertoli leydig cell tumor, SLCT)是一种来源于卵巢性索-间质的肿瘤,临床上罕见,占所有卵巢原发性肿瘤的0.1%～0.5%,占卵巢性索间质肿瘤的1%,其中20% SLCT 含有异源性成分。因其形态多样,容易误诊。本文报道2例 SLCT 伴异源成分,并复习相关文献,分析其临床病理特征及其临床治疗、预后、遗传学等方面的特点。1 材料与方法1.1 一般资料例1,女     

卵巢低分化Sertoli-Leydig细胞瘤临床病理分析

目的 探讨卵巢Sertoli-Leydig细胞瘤(SLCT)的临床病理学特点和免疫表型。方法 回顾性分析1例卵巢SLCT的临床病理学特征及诊断思路,并复习相关文献。结果 患者为19岁女性,因间断下腹胀痛1周入院,影像学示下腹部、盆腔巨大囊实性占位(大小17.8 cm×11.2 cm),盆腔、腹壁多发强化结节,后经病理活检,镜下见肿瘤细胞形态呈肉瘤样,异型性明显,片状及巢团状分布,可见大量病理性核分裂象(>5/10HPF),伴出血及坏死,局部可见高分化的Sertoli细胞形成腺管样结构,未见异源性成分。免疫表型：肿瘤细胞表达α-inhibin、CK、Calretinin、CD99、CD10和CD56。结论 卵巢SLCT是一种罕见的妇科肿瘤,与许多妇科肿瘤有形态学上的交叉,在临床诊断工作中,需要结合临床表现,镜下形态及免疫组化综合考虑,必要时应做基因检测辅助诊断。     

妊娠合并晚期胃癌行剖宫产及剖腹探查术1例护理配合

正胃癌是最常见的恶性肿瘤之一,占我国消化道肿瘤发病率的第一位。然而妊娠期胃癌临床罕见,胃癌症状容易被妊娠相关消化系统症状掩盖,同时诊断措施受妊娠限制,导致妊娠期胃癌常延误诊断[1]。2015年12月,我院收治1例妊娠30周合并晚期胃癌肠转移、肠梗阻、卵巢转移的患者,手术行剖宫产及左侧附件切除、右卵巢部分切除、肠系膜结节活检、结肠双腔造瘘术,手术顺利完成,抢救成功,无手术并发症发生。     

妊娠合并卵巢癌2例临床病理分析

妊娠合并卵巢癌极为罕见.卵巢恶性肿瘤病死率极高,当其合并妊娠时,常因妊娠掩盖症状,而延误对卵巢恶性肿瘤的诊治,从而导致不良结局.本院自1997年以来共收治妊娠合并卵巢癌2例,现报告如下,并结合文献作一综述.     

异位妊娠合并卵巢黄体破裂漏诊后者五例报告

目的探讨异位妊娠合并卵巢黄体破裂的发病原因、临床特点、漏诊原因及其防范措施。方法对我院收治的5例异位妊娠合并卵巢黄体破裂漏诊后者的临床资料进行回顾性分析。结果 5例均因不同程度突发性下腹痛就诊,术前均仅诊断异位妊娠,急诊行剖腹探查术,经术中所见、术后病理检查及临床表现确诊异位妊娠合并卵巢黄体破裂。卵巢妊娠合并卵巢黄体破裂及阔韧带妊娠合并卵巢黄体破裂各1例,输卵管妊娠合并卵巢黄体破裂3例。5例均于术后5~7 d出院;术后4周随访,B超检查未见明显异常,血绒毛膜促性腺激素均在正常范围。结论异位妊娠合并卵巢黄体破裂极易在妊娠早期发生腹腔内大出血、休克,严重者可危及患者生命,故早发现、早诊断、早治疗极为重要。     

卵巢高分化型Sertoli-Leydig细胞瘤1例报道

卵巢Sertoli-Leydig细胞瘤(sertoli-Leydig cell tumors,SLCT),也称男性母细胞瘤,是一种罕见的性索-间质来源的肿瘤,占全部卵巢肿瘤的0.1％[1].20％的SLCT含有异源成分[2].本文报道1例高分化型SLCT并复习文献. 1 临床资料 患者女性,58岁.绝经后阴道不规则出血6年,每年4～5次,每次持续半个月至3个月,无腹痛,出血量少、色暗红.患者平素月经欠规则,1次/1～2个月,量中,无痛经.B超示子宫增大,内膜增厚1.9 cm;右侧卵巢增大3.5 cm ×2.5 cm×1.8 cm.妇科检查:宫体前位,增大,如孕40多天.实验室检查:AFP、CEA、CA125和CA199均正常.行全子宫+双附件切除术.     

良性卵巢肿瘤合并中期妊娠围术期的护理

妊娠合并卵巢良性肿瘤较常见,较非孕期危害大.妊娠合并良性肿瘤以成熟囊性畸胎瘤及浆液性囊腺瘤居多.早期妊娠时肿瘤嵌入盆腔可能引起流产,中期妊娠时易并发蒂扭转,晚期妊娠时肿瘤较大可导致胎位异常,分娩时肿瘤易发生破裂,肿瘤位置低可梗阻产道导致难产.手术最佳时机一般选择在孕16周～20周,此阶段比较安全.我院2005年1月-2008年10月收治卵巢良性肿瘤合并妊娠中期病人15例,均在硬膜外麻醉下行卵巢囊肿剥除术,手术顺利,经严密观察和精心护理,痊愈出院.现将护理介绍如下.     

妊娠合并卵巢囊肿孕期漏诊分析──附3例报告

妊娠合并卵巢囊肿孕期漏诊分析──附３例报告程银兰２４６００４安徽省安庆市第二人民医院卵巢体积虽小，但却是肿瘤极易发生的器官，因卵巢肿瘤早期无明显症状，故又不易发现，而卵巢肿瘤恶变或原发卵巢恶性肿瘤的机会并不罕见。所以，应重视已婚妇女的定期妇科检查，特...     

妊娠合并卵巢肿瘤的诊断与处理

目的:探讨妊娠合并卵巢肿瘤的诊断方式和临床处理。方法:对147例妊娠合并卵巢肿瘤的临床资料进行回顾性分析。结果:147例中57例B超发现,23例盆腔检查发现,67例剖宫产术中发现;119例手术治疗,其中10例人工流产后手术剥除,18例孕中期手术剥除,2例并发蒂扭转而急诊手术剥除,88例剖宫产的同时手术,1例平产后手术剥除;手术治疗者中5例为恶性肿瘤。结论:妊娠合并卵巢肿瘤的诊断主要靠盆腔检查,B型超声,剖宫产术中探查;孕期发现的卵巢良性肿瘤手术治疗的最佳时机为孕14~18周,剖宫产术中可同时行肿瘤剥除术;卵巢恶性肿瘤一旦确诊应立即手术、铺以化疗,手术方式视肿瘤性质、临床期别、妊娠后果及日后有无生育要求而定,继续妊娠者孕期不化疗。     

妊娠合并卵巢恶性肿瘤化疗患者的护理干预

目的探讨妊娠合并卵巢恶性肿瘤化疗患者有效的护理措施。方法回顾性分析6例妊娠合并卵巢恶性肿瘤化疗患者的临床资料。结果6例患者中稽留流产1例、中期引产1例、早产重度窒息死亡1例,余3例新生儿均体健。患者中除1例术后4个月死亡,余未见肿瘤复发。结论有效的护理干预可增加患者治疗的依从性,提高其生存率和胎儿存活率。     

卵巢实性肿块的低场MRI表现

目的探讨卵巢实性肿块的低场MRI表现。方法回顾性分析经手术、病理证实的11例卵巢实性肿块的临床、MR影像资料,并与病理结果对照分析该病的MR影像特征。结果11例卵巢实性肿块者,7例卵泡膜细胞瘤(OT)、3例纤维瘤(OF)及1例支持-间质细胞瘤(SLCT)。11例T1WI呈低或等信号,T2WI上8例低信号肿块中夹杂点状、条索状或片絮状高信号,2例OT及1例SLCT肿块呈高信号;2例OF不强化、5例OT轻度强化、2例OT及1例SLCT明显强化。MRI表现与病理结果相符。结论大多数OT、OF及SLCT在MRI上呈实性肿块,其T2WI表现较具有特征性,有助于诊断。     

妇科恶性肿瘤患者心理状态及影响因素分析与对策

目的评估妇科恶性肿瘤患者心理状态及影响因素,并制定护理对策。方法采用抑郁自评量表(SDS)和焦虑自评量表(SAS),对妇科恶性肿瘤及良性肿瘤患者各70例进行问卷调查。结果妇科恶性肿瘤组抑郁、焦虑指数均高于对照组(P<0.01)。中青年人抑郁、焦虑指数高于老年人(P<0.05),文化程度越高、化疗疗程越长(超过6个)者抑郁、焦虑指数越高(P<0.05);妇科恶性肿瘤组术后6个月内及7~12个月的患者焦虑评分均高于对照组(P<0.05),且以术后6个月内的增高程度更明显(P<0.05)。妇科恶性肿瘤组术后6个月内抑郁评分高于对照组(P<0.05)。结论妇科恶性肿瘤患者多存在抑郁、焦虑心理,了解其影响因素,为患者提供有针对性的护理,可减轻患者不良的心理状态。     

The effect of age and sex on localization, tumor stage and prognosis of colorectal carcinoma

In a retrospective study including 946 cases with colorectal cancer we analysed age, sex, distribution and stage. There was a significant higher prevalence in women and in all tumor stages women were older than men. The frequencies of Dukes C and proximal colon cancer was significantly higher in women. In older patients we found an increasing incidence of proximal cancer. Instead of tumor stage the age, sex and distribution showed no influence on the outcome.     

Large focal nodular hyperplasia of the liver treated with transcatheter arterial embolization and laparoscopic resection: A case report

Focal nodular hyperplasia (FNH) is a rare benign hepatic tumor which is frequently observed in women of reproductive age, and therapeutic intervention needs to be considered in cases wherein the tumor has a risk of rupture. The laparoscopic approach is beneficial, especially for young women, but is often challenging because the tumor is large and hemorrhagic. Herein, we report a case of large FNH in a 22-year-old woman. The patient was asymptomatic; however, the tumor was approximately 15 cm in diameter and protruded from the liver. Given the risk of rupture, we decided to perform surgical resection. Preoperative transcatheter arterial embolization led to rapid shrinkage of the tumor and control of intraoperative bleeding, which enabled us to safely perform laparoscopic liver resection. The combination of surgical resection with intravascular embolization may be a promising therapeutic option for hypervascular tumors such as FNH.     

绝经后妇女盆腔包块的超声诊断价值

目的 探讨超声在绝经后妇女盆腔包块诊断中的价值.方法 回顾性分析经手术证实的130例绝经后妇女盆腔包块的临床资料及超声声像图特点.结果 良性肿瘤94例（72.3％）,恶性肿瘤36例（27.7％）,超声对绝经后期盆腔肿物性质的诊断,其敏感性为93.9％,特异性为94.8％.良性盆腔肿物诊断符合率为97.8％,恶性为86.1％,超声误诊14例,误诊率10.7％.结论 超声诊断绝经后妇女盆腔包块,具有快速、无创、诊断率高等特点,对肿瘤良恶性的鉴别较为可靠,可作为绝经后妇女盆腔包块首选检查手段.     

The use of endovaginal ultrasound to diagnose invasion of endometrial carcinoma.

Endovaginal ultrasound was used in 30 women to characterize endometrial carcinoma with respect to myometrial invasion according to FIGO recommendations for surgical staging of endometrial cancer. The ultrasound data were correlated to macroscopic findings of the uterine specimen and to histopathology.Using endovaginal ultrasound, the sensitivity of detecting myometrial invasion of > 50% was 15/19 or 79%. However, the positive predictive value was 100%, in all cases when ultrasound suggested myometrial invasion of > 50%. This was confirmed on histopathological examination of the tumor specimen. Cervical tumor extension was correctly diagnosed in all six women in which it was present. Endovaginal ultrasound seems to be a reliable method of assessing tumor invasion and engagement of the cervix. This non-invasive method could be included as an important tool in the establishment of individualized treatment programs in women with endometrial carcinoma.     

城乡妇女乳腺癌早期检测知识的调查研究

[目的]了解乳腺癌病人疾病发现方式及乳房自查知识掌握情况,为护理人员提供正确的健康教育方式。[方法]分别对60例农村和城市乳腺癌病人进行问卷调查。[结果]农村妇女乳腺癌发现途径侧重于自我无意发现肿块占83.33%,10.00%是由于有自觉症状、疼痛、乳头溢液等,肿瘤多为Ⅱa期、Ⅱb期、缺乏掌握乳腺自我检查的知识。城市妇女自我无意发现肿块途径占56.67%,体检和自查发现肿块各占20.00%。肿瘤多为Ⅰ期、Ⅱa期。不能完全掌握乳腺自我检查的知识和技巧。[结论]医护人员应根据不同人群提供乳腺癌早期检测的知识和技能,建立符合我国国情的乳腺癌的早期检测方案。     

The care of older women with early-stage breast cancer: what is the role of surgeon gender?

BACKGROUND: Over the past decade and a half, a substantial literature has documented age-dependent variations in breast cancer care. Accumulating evidence suggests that these variations impact the health outcomes of older women with breast cancer. Surgeon gender may be an important source of age-dependent variations in care. OBJECTIVE: To examine the relationship between surgeon gender and primary tumor therapy and systemic adjuvant therapy among 303 older women with early-stage breast cancer cared for by 20 surgeons in Boston, Massachusetts. METHODS: The research design was a cross-sectional observational study. The subjects were women at least 55 years of age with newly diagnosed Stage I or II breast cancer. The main outcome measure was definitive primary tumor therapy and systemic adjuvant therapy. RESULTS: After adjustment for patient and tumor characteristics, patients of female surgeons were more likely to receive definitive treatment, with the strongest effect being observed for the receipt of both definitive primary tumor therapy and systemic adjuvant therapy (odds ratio 4.5; 95% confidence interval 2.7, 7.7). CONCLUSIONS: Women with early-stage breast cancer cared for by female surgeons are more likely to receive standard therapies. Surgeons provide the initial care, both diagnostic and therapeutic, for all women with breast cancer. Their role in breast cancer care is pivotal and has a substantial impact on the nature of breast cancer care received.     

Anti-hormones: mechanism and use in treatment of breast cancer

Breast cancer is the second-leading cause of cancer-related death in women. Recently, new drugs are being developed based on the molecular mechanisms of receptors, tumor suppressor genes, monoclonal antibodies, tumor markers and antihormone therapy. Anti-hormone therapy is used in the treatment of hormone-dependent breast tumors. Among the anti-hormone therapies, a substantial amount of research has been focused on the development of the ideal selective estrogen receptor modulator to treat metastatic breast tumors and to prevent breast cancer in high risk women.     

选择性子宫动脉栓塞术治疗子宫肌瘤的探讨

目的评价选择性子宫动脉栓塞术治疗子宫肌瘤的临床疗效及应用价值。方法19例子宫肌瘤患者均采用经右侧股动脉穿刺双侧子宫动脉超选择性插管,使用聚乙醇＋明胶海绵颗粒栓塞双侧子宫动脉,阻塞肌瘤血供。结果全部病例随访3～24个月,8例肌瘤体积缩小大于50％,9例肌瘤体积缩小20％-50％,月经量和月经周期恢复正常,1例缩小〈20％,临床症状明显改善,1例无明显变化。治疗后3个月18例患者血红蛋白升至105g/L以上。无1例严重并发症发生。结论选择性子宫动脉栓塞术治疗子宫肌瘤是一种安全、简便、创伤小、疗效高的治疗方法,具有较高的临床应用价值。