卵巢癌合并卵巢脓肿一例

卵巢癌是常见的妇科恶性肿瘤,其早期病变因症状及体征不明显且起病隐匿,故缺乏有效的筛查手段。卵巢癌合并卵巢脓肿或者卵巢脓肿恶变为卵巢癌在临床上发病率极低,确诊需要依赖临床实验室、病理及免疫组织化学等相关检查,治疗以手术为主,辅以化学治疗联合或不联合靶向治疗,临床疗效欠佳。该文结合病历资料及相关文献进行回顾性分析,对1例卵巢腺癌合并卵巢脓肿的临床特点及其诊治方法进行总结报道,以期引起临床医师的重视,提高对这类疾病的认识,为该类疾病的诊断和治疗提供支持。     

Association of ovarian response with picoAMH in women undergoing controlled ovarian hyperstimulation

ObjectiveOur study aims to evaluate the diagnostic performance of a high-sensitivity picoAnti-Müllerian Hormone (picoAMH) for predicting ovarian response in women undergoing controlled ovarian hyperstimulation and occurrence of ovarian hyperstimulation syndrome.MethodsRetrospective cohort study at a single academic fertility center including all patients with picoAMH ELISA who underwent controlled ovarian hyperstimulation. The primary outcome was the number of oocytes retrieved, and secondary outcomes included cycle cancellation and ovarian hyperstimulation syndrome. Patients were grouped into poor, normal, and hyper-responders based on number of oocytes retrieved.ResultsThe mean AMH and antral follicle count (AFC) were significantly different between normal response vs. hyper response group (p < 0.0001). Only serum AMH and not AFC was significantly increased in patients diagnosed with ovarian hyperstimulation syndrome (OHSS). For prediction of OHSS, receiver operating characteristic (ROC) analysis revealed that AMH (area under the ROC curve [AUC] = 0.85) was significantly better than the AFC (AUC = 0.64). The serum AMH cut-off at sensitivity of 80% for predicting OHSS among hyper responders from ROC curve was 3.67 ng/ml. Serum AMH measured by picoAMH ELISA showed superior correlation to number of oocytes retrieved when compared to AFC in the age group over 40 years old (r² = 0.74 and r² = 0.4, respectively)ConclusionThis study shows great utility of picoAMH ELISA for predicting ovarian response to controlled ovarian hyperstimulation (COH). Diagnostic performance of picoAMH for prediction of OHSS is superior to the AFC in our cohort.     

Two cases of pregnant women with ovarian endometrioma mimicking a malignant ovarian tumor

The detection of an ovarian mass during pregnancy is often a diagnostic challenge. We describe 2 cases of ovarian endometrioma during pregnancy with marked mural nodules on the cyst wall. The sonographic and MR imaging findings mimicked ovarian cancer. Surgical intervention may still be inevitable to exclude the possibility of malignancy.     

The contribution of sonographic evaluation of ovarian size in patients with polycystic ovarian disease

The ovarian size of 44 patients with clinical and endocrinologic findings suggesting polycystic ovarian disease (PCOD) was studied by ultrasound examination. Reproducibility of the ovarian parameters (transverse, longitudinal, and anteroposterior diameters, and volume) was also evaluated. The endocrine status of each patient was evaluated by assay of blood levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, 17 beta-estradiol (17 beta E2), and serum prolactin (PRL). Ovarian size was also investigated in 40 women with normal cycles, following the same ultrasound procedure. The mean ovarian volume of the normal controls was statistically different from the mean of patients with PCOD. Only 34 per cent of the patients affected by PCOD were above the second standard deviation of normal ovarian size. A correlation between endocrinologic findings and ovarian size was observed in women whose ovarian size fell within normal limits; these women had higher, though not statistically different, values of LH and testosterone and lower values of 17 beta E2 and PRL compared with patients with enlarged ovaries. Responsiveness to treatment was more easily observed in patients with ovarian enlargement.     

腹腔镜卵巢打孔联合药物治疗难治性 多囊卵巢综合征临床分析

目的探讨腹腔镜卵巢打孔术(LOD)结合来曲唑(LE)对难治性多囊卵巢综合征(PCOS)不孕的治疗效果。方法将72例患者随机分成研究组和对照组各36例,所有患者进行LOD。手术前后分别测血黄体生成激素(LH)、卵泡刺激素(FSH)、睾酮(T)及雌二醇(E2)水平,术后第9天起监测患者卵泡发育和排卵共3个周期,并记录妊娠数和流产数。结果两组患者术后LH和T水平与术前相比均有显著性下降(P<0.05),两组E2水平术后均较术前降低,但研究组治疗后降低更为显著(P<0.05)。3个治疗周期内研究组排卵率明显高于对照组(P<0.05)。结论 LOD后结合氯米芬(CC)能明显改善难治性PCOS患者的排卵和受孕机会。     

Sialyl salivary-type amylase associated with ovarian cancer

BACKGROUND: There have been many reports describing hyperamylasemia, with a salivary-type amylase phenotype, in patients with malignant tumors and/or multiple myelomas. In contrast, we have discovered and characterized a sialyl salivary-type amylase from multiple myeloma and/or lung cancer cells. This paper reports the first association of sialyl salivary-type amylase with ovarian cancer, discovered and characterized using sera from retrospective studies. METHODS: Based on strictly retrospective observation of amylase zymograms, three samples of patients' sera with abnormally fast-migrating isoamylases were detected. Sialyl salivary-type amylase was determined by neuraminidase treatment and reaction with anti-salivary monoclonal antibody, and the extra elution peak of amylase was detected by size-exclusion HPLC analysis. RESULTS: Sialyl salivary-type amylase was detected in the sera of three female patients with ovarian cancer. The ratio of S3 to S2 sub-band in isoamylase electrophoresis, was slightly over 1.00 in two cases and below 1.00 in the other. These cases were not recognized in routine isoamylase electrophoretic analyses, because the abnormal patterns were weak. CONCLUSION: Sialyl salivary-type amylase was characterized for the first time in the sera of patients with ovarian cancer.     

Fertility-sparing treatment of patients with ovarian cancer

Ovarian malignancies in reproductive age women often provide the physician and patient with a management dilemma. Many investigators have proposed conservative management in early-stage disease. This article provides evidence supporting fertility-sparing management in young women with early ovarian malignancies.     

多囊卵巢综合征超排卵前腹腔镜治疗临床价值分析

目的探讨多囊卵巢综合征(polycystic ovarian syndrome，PCOS)不孕症患者超排卵前腹腔镜手术对其超排卵结果的影响。方法对符合PCOS标准的接受体外受精-胚胎移植(IVF-ET）的69例不孕症患者的资料进行回顾性分析，超排卵前行腹腔镜手术20例，未行腹腔镜手术49例，观察两组促排卵药物用量，用药天数，所取卵子数目，卵巢过度刺激综合征(ovarian hyperstimulation Syndrome，OHSS)发生情况，以及手术组前后FSH、LH、T、E2的变化。结果腹腔镜手术组促排卵药物用量、用药天数明显多于未手术组，重度OHSS发生率显著降低，手术组术后LH、T浓度均较术前明显降低。结论PCOS患者超排卵前腹腔镜手术治疗可降低OHSS风险。降低取消移植比例，为超排卵困难的PCOS患者提供了新的治疗途径。     

Symptom concerns of women with ovarian cancer

This study describes the symptom experience of women with ovarian cancer. A body of data consisting of 21,806 letters, cards, and e-mails written by ovarian cancer patients was donated to the City of Hope investigators by the founder and editor of Conversations!: The International Newsletter for Those Fighting Ovarian Cancer. Using ethnographic qualitative research procedures, meaningful comments in the data were bracketed and coded within physical, psychological, social, and spiritual domains according to the City of Hope QOL–Ovarian Cancer instrument. Six hundred seventy-seven (677) comments were identified as pertaining to pre- and post-diagnostic symptomatology. Findings, based on major themes derived from the analysis, included distress over delayed diagnoses given the presence of pre-diagnosis symptoms. Frequently described post-diagnosis symptoms included pain, fatigue, gastrointestinal effects, and menstrual and fertility changes. Women demonstrated resourcefulness and optimism by sharing innovative ideas for coping with varied symptoms. Significant attention was dedicated to complementary and alternative therapies, both for symptom management and with curative intent. Findings demonstrate the need to improve diagnostic tests, symptom management, and patient education.     

Cystic ovarian teratoma with intracystic floating globules

Ovarian cystic teratomas are cystic fatty tumors that are often found in patients of reproductive age, and the diagnosis can be easily made radiologically. We present a case of postmenopausal ovarian cystic teratoma with an unusual radiologic appearance of intracystic floating globules.     

Fertility-sparing treatment of patients with ovarian cancer

The variety of malignant neoplasms produced by the ovary are legion. Each must be considered individually in the young woman with early disease who wishes to preserve her childbearing capability. The risks of conservative surgery are often low, and the patient can be so advised. Careful monitoring of this group of patients is essential regardless of the approach.     

Coping simultaneously with 2 stressors: immigrants with ovarian cancer

The dual adjustment to being a cancer patient and an immigrant involves major changes in life and might be a severe experience. This study set out to describe the experience of women who have come to Israel from the former Soviet Union and are coping with ovarian cancer. It focused on illness narratives as presented by 8 patients with cancer at stage III. Our findings indicated that the dual process might have different implications according to the meaning attributed by the patient to the illness situation. Viewing the illness as one more burden among other difficulties, such as language barrier, was a prism through which patients experienced their vulnerability in coping with the illness. Alongside a helplessness pattern, we found indications of interviewees' perceiving advantages in their status as immigrant cancer patients, by dealing with that problem alongside other difficulties. They showed a "fighting spirit" in coping with the illness. Immigration can have a moderating effect on patients' experiences, and the 2 stressors do not necessarily accumulate. Our findings indicate that patients' meaning to the illness experience was a "litmus test," which indicated the way patients would describe their coping stages. This may have potential as a clinical marker of psychological vulnerability.     

The immunotherapy of patients with ovarian cancer

Ovarian cancer is a leading cause of cancer mortality. Chemotherapy is effective in reducing tumor burden in a majority of patients, however, only approximately 20% of advanced disease patients will ultimately survive tumor free, and further treatment options are needed. Continuing advances in immunology make immunotherapy a promising area for future research. The design of immunotherapy strategies for ovarian cancer requires an understanding of the immune microenvironment of the peritoneal cavity, which is frequently involved with ovarian cancer metastases and is the site of its most devastating effects. Immunotherapy approaches for ovarian cancer include locoregional and systemic cytokine therapies, prophylactic and therapeutic vaccines, and adoptive immunotherapy strategies. This review will summarize previous clinical trials as well as future directions for research. Further progress in T-cell specific immune responses will require the identification of specific ovarian cancer antigens that are processed and presented on the surface of tumor cells in the context of specific HLA molecules. In addition, a more detailed understanding of functional relations between the peritoneal microenvironment and the metastatic process is required.     

Sonographic monitoring of ovarian volume during LHRH analogue therapy in women with polycystic ovarian syndrome

Polycystic ovarian disease is characterized by menstrual disorders, infertility, obesity, and large ovaries. Large ovaries with multiple cysts are the direct cause of the high incidence of ovarian hyperstimulation during ovulation induction. Lately, gonadotropin-releasing hormone (GnRH) analogues have been employed to decrease ovarian steroidogenesis and thus reduce the incidence of ovarian hyperstimulation. In this study the ovarian size was ultrasonographically assessed during chronic GnRH analogue treatment, revealing a significant reduction in ovarian volume. This decrease in volume results in a reduced incidence of hyperstimulation, and we think the ultrasonic scanning can be effectively used to assess the success of GnRH treatment.     

Morphology of erythrocytes of patients with ovarian cancer

AIM of the STUDY: To investigate the morphology of erythrocytes in the peripheral blood of patients with ovarian cancer stage II and III. MATERIALS and METHODS: The patient group consisted of 17 women (age 53 +/- 16 years) diagnosed with stage II or II ovarian cancer. The control group comprised 20 healthy women (age 20 +/- 2 years). Seventeen samples of peripheral venous blood were collected from the cancer patients and 20 from the healthy women. These were then prepared for observation by scanning electron microscopy. RESULTS: The percentages of knizocytes and echinocytes were higher in the blood of patients than in that of the healthy controls. For knizocytes, the values for the mean +/- SD and the range were 2.45 +/- 3.72 and 0-15.7 vs. 0.66 +/- 0.57, 0.1-2.5, with p < 0.01. For echinocytes, these values were 1.94 +/- 1.04 and 0.5-3.6 vs. 1.03 +/- 0.71, 0.1-2.6 and p < 0.01. Acanthocytes were present only in small numbers and were not evaluated. CONCLUSION: The proportion of erythrocytes with abnormal morphology in the blood of cancer patients before cancer therapy was significantly elevated as compared to that healthy controls.