原发性卵巢非霍奇金淋巴瘤1例及文献复习

目的:探讨原发性卵巢非霍奇金淋巴瘤(NHL)的诊断、治疗及预后。方法:复习1例原发性卵巢非霍奇金淋巴瘤完整的临床资料。结果:该例患者为原发弥漫大B细胞型,手术方式分期为ⅣA期,目前症状达到部分缓解。结论:原发性卵巢NHL与其他原发性卵巢恶性肿瘤表现相似,临床表现缺乏特异性,术前诊断十分困难,妇产科医生如在手术台上遇到类似病例,应果断行肿瘤细胞减灭术,尽可能行盆腔淋巴结清扫术+腹主动脉旁淋巴结清扫术+大网膜切除术+阑尾切除术,对于肿瘤局限于单侧的年轻患者可行保留生育功能的手术,术后到血液科辅以化疗等综合治疗,可以延长患者的生存期。     

原发生卵巢恶性淋巴瘤四例临床分析

恶性淋巴瘤晚期可侵犯卵巢,但原发性卵巢恶性淋巴瘤很少见,临床上常误诊为卵巢其他恶性肿瘤,延缓诊治,我院１９９０年１月－１９９８年１１月共收治４例,现结合有关文献,对其临床表现,诊断及治疗分析,报道如下。     

卵巢恶性肿瘤PET-CT检查58例临床分析

目的:探讨正电子发射断层-计算机(辅助)体层成像(PET-CT)在卵巢恶性肿瘤术后化疗疗效评价、复发监测和预后判断中的价值.方法:对2004年2月至2007年4月北京大学人民医院治疗的58例卵巢恶性肿瘤患者进行18F-氟代脱氧葡萄糖(18F-FDG)PET-CT分析,并将PET-CT结果与同期B超、CT、肿瘤标志物及病理检查结果进行对照研究.结果:58例患者共进行75例次PET-CT检查,发现复发病灶位于阴道断端、膀胱壁层表面、直肠表面、大网膜残端、升结肠旁等常见转移部位及肝、脾被膜周围、纵隔内淋巴结、膈肌下、腹主动脉旁淋巴结等隐匿部位.PET-CT用于监测卵巢恶性肿瘤的灵敏度为100%,特异度为82.8%,阳性预测值为75%,阴性预测值为100%,准确性为88.6%.20例PET-CT阳性患者同时进行二次肿瘤细胞减灭术或二次手术,结果与病理诊断符合率60%;68例次PET-CT检查与B超检查同期进行,符合率77.94%;19例次与CT同期检查,符合率为78.95%;75例次同时进行肿瘤标志物检查,符合率为74.67%;50例次PET-CT检查在患者随访期间进行,与B超、CT和肿瘤标志物检查的符合率为74%.结论:PET-CT作为无创性检查方法,较CT和B超检查能早期诊断卵巢恶性肿瘤的复发.故可进行病情监测,指导临床治疗.     

临床综合评分法对卵巢子宫内膜异位囊肿的诊断价值

为寻求简便、易行、无创伤性的卵巢子宫内膜异位囊肿诊断方法，本研究对因附件包块住院行腹腔镜检查及治疗患者在症状、体征、B超、CA，笛四方面进行临床综合评分，对卵巢子宫内膜异位囊肿及其他疾病做出初步诊断，并与腹腔镜结果进行对照，旨在探讨并拟定术前对卵巢子宫内膜异位囊肿的临床诊断及分型标准。     

阴道超声结合彩色多普勒超声诊断卵巢恶性肿瘤的价值

目的探讨经阴道超声及彩色多普勒超声准确诊断卵巢恶性肿瘤的价值,鉴别卵巢良恶性肿瘤.方法47例有盆腔肿块的患者,术前应用阴道超声对肿块进行评分同时加用彩色多普勒超声检查获得PI和RI值.术后对照病理诊断了解诊断符合率.结果阴道超声对盆腔肿块评分B超积分＞9的19例患者中,病理检查证实为恶性肿瘤17例,诊断符合率为89.5%.B超积分≤9的28例患者中,病理检查证实为良性肿瘤26例,诊断符合率为92.9%.彩色多普勒超声测定肿块周边血流PI＜1.0的例数19例,病理检查证实为恶性肿瘤18例,诊断符合率为94.7%.RI＜0.5的例数19例,病理检查证实为恶性肿瘤19例,诊断符合率为100%.超声评分和血流PI、RI值综合估计肿块良恶性程度B超积分＞9和PI＜1.0、RI＜0.5共18例,病理检查均为恶性肿瘤,诊断符合率为100%.B超积分≤9和PI≥1.0、RI≥0.5共27例,病理检查证实为良性肿瘤26例,诊断符合率96.3%.结论B超积分＞9和PI＜1.0、RI＜0.5是卵巢恶性肿瘤较特异的超声表现,是鉴别卵巢良恶性肿瘤较好的手段.     

同时性双原发性妇科恶性肿瘤23例临床分析

目的探讨同时性双原发性妇科恶性肿瘤的临床病理特征、诊治方法及预后。方法本研究为回顾性研究。收集2010年1月1日—2020年12月31日11年间在首都医科大学附属北京妇产医院进行初次治疗的妇科恶性肿瘤患者共8 987例, 其中明确诊断为同时性双原发性妇科恶性肿瘤患者共23例, 查阅23例患者的电子病历并记录其年龄、临床表现、肿瘤分期、肿瘤类型、治疗方法和预后等临床病理资料;23例患者均随访至2021年12月31日或死亡时间, 记录复发及死亡情况。结果 (1)2010—2020年11年间收治的妇科恶性肿瘤患者呈增多趋势。8 987例妇科恶性肿瘤患者中, 子宫颈癌3 474例、子宫内膜癌3 484例、卵巢恶性肿瘤1 329例、输卵管癌171例、子宫肉瘤182例、阴道癌42例、外阴癌192例、滋养细胞肿瘤110例、其他妇科恶性肿瘤3例, 排名前3位的依次为子宫内膜癌、子宫颈癌和卵巢恶性肿瘤。(2)8 987例妇科恶性肿瘤患者中, 同时性双原发性妇科恶性肿瘤患者23例, 占所有妇科恶性肿瘤的0.26%(23/8 987)。其中, 子宫颈癌合并子宫内膜癌3例, 子宫颈癌合并卵巢恶性肿瘤3例, 子...     

卵巢良性肿块伴腹水和血清CA125升高的临床分析--附三例报告

目的 探讨卵巢良性肿瘤伴腹水和血清CA125升高的临床特征。方法 对我院收治的3例患者进行临床分析并复习相关文献。结果 3例患者术前均误诊为卵巢癌而手术治疗,并均于手术中确诊;术前均无恶性肿瘤的诊断证据,如病理学和(或)细胞学阳性发现,也无特征性的超声表现。该类疾病以盆腔结核性肿块、卵巢子宫内膜异位囊肿和卵巢纤维瘤最常见,其他的有卵巢泡膜纤维瘤、腺纤维瘤、卵巢甲状腺肿、卵巢泡膜细胞瘤、卵巢良性Brenner瘤、卵巢成熟畸胎瘤、卵巢水肿和卵巢纤维瘤样变。结论 盆腔肿块伴腹水和血清CA125升高,并不能立即诊断卵巢癌。病理学和细胞学检查是惟一确诊的方法;对可疑病例腹腔镜检查是简便、可靠的方法。     

卵巢子宫内膜异位症与卵巢恶性肿瘤的相关性分析

目的卵巢子宫内膜异位症（EM）是常见的妇科良性疾病,具有潜在的恶变可能。本研究通过对卵巢EM恶变、合并EM及未合并EM的卵巢恶性肿瘤病例的分析,了解卵巢EM恶变与卵巢恶性肿瘤的关系。方法 回顾性分析新疆医科大学第一附属医院2003年1月至2010年12月经病理确诊的原发性卵巢恶性肿瘤患者共362例,根据卵巢EM恶变诊断标准及病理结果,将EM恶变的17例患者分为A组,其他仅合并卵巢EM的卵巢恶性肿瘤16例患者分为B组,未合并卵巢EM的卵巢恶性肿瘤329例为C组,从卵巢恶性肿瘤的临床病理资料对三组进行对照分析。同期在本院经手术确诊的卵巢EM患者共1 946例。结果A、B组临床症状多以腹痛为主,其次为盆腔包块;从临床分期来看,A、B组以Ⅱ期居多,分别占70.6%、56.5%,C组以Ⅲ期为多,占47.7%;从组织类型来看,A、B组多为透明细胞癌（分别为70.6%、56.2%）,而C组则以浆液性腺癌（50.2%）为主。三组在一般特征、临床分期及病理组织分类的分布差异均有统计学意义。结论卵巢EM恶变的临床症状以腹痛为多,其次为盆腔包块,肿块直径超过9 cm,且CA125水平多在200 U/ml以上;卵巢EM恶变及卵巢恶性肿瘤合并EM病例中早期患者比例较高,具有年轻化（尤其是卵巢内异症恶变患者）的特点,且多为卵巢透明细胞癌和子宫内膜样癌;卵巢EM恶变的诊断与组织病灶程度、临床分期可能有关,卵巢EM病灶恶变可能来源于透明细胞癌和子宫内膜样癌,因此卵巢EM可被认为是卵巢恶性肿瘤的危险因素。     

恶性肿瘤特异性生长因子在卵巢肿瘤中的临床应用价值

目的探讨血清恶性肿瘤特异性生长因子(TSGF)在卵巢恶性肿瘤的诊断及疗效监测中的临床应用价值。方法使用TSGF快速诊断试剂盒,对170例患者的196份血清进行检测,其中69例为卵巢恶性肿瘤,18例卵巢交界性肿瘤,42例卵巢良性肿瘤,41例盆腔良性病变;同时取20例正常妇女血清标本作为对照。所有标本同时检测CA125。结果卵巢恶性肿瘤组血清TSGF阳性率明显高于其他各组(P<0.01)。晚期肿瘤的血清TSGF诊断敏感性高于早期(P<0.05)。卵巢高分化恶性肿瘤及交界性肿瘤血清TSGF敏感性明显低于中、低分化组(P<0.01)。TSGF诊断卵巢恶性肿瘤的敏感性和特异性分别为78.3％和48.2％,CA125为73.9％和55.4％,二者差异无显著性(P>0.05)。TSGF+CA125联合检测诊断卵巢恶性肿瘤的敏感性为87.0％,较TSGF、CA125单项检测敏感性明显提高(P<0.05),治疗前后血清TSGF水平下降不明显(P>0.05)。TSGF对卵巢恶性肿瘤的疗效监测价值似乎不大。结论 TSGF测定诊断卵巢恶性肿瘤的敏感性和特异性分别为78.3％和48.2％,其水平与细胞分化、临床分期有关。TSGF和CA125联合检测可明显提高卵巢恶性肿瘤的检出率,但TSGF对卵巢恶性肿瘤的疗效监测似无明显临床价值。     

54例卵巢恶性肿瘤的超声诊断

卵巢癌的发现仍以临床检查为主,加强临床诊断实属必要。本文通过54例卵巢恶性肿瘤的超声检查,探讨临床与超声结合能否提高卵巢恶性肿瘤的诊断准确性及超声检查对卵巢癌诊断和处理的应用价值,以进一步明确卵巢恶性肿瘤的声学特点及扫查内容,明确盆腔肿块的超声诊断要点。     

原发性女性生殖系统恶性淋巴瘤一例报告及文献复习

恶性淋巴瘤是一种临床少见的免疫性肿瘤,原发于女性生殖系统的恶性淋巴瘤以非霍奇金淋巴瘤多见,这其中以弥漫性大B细胞淋巴瘤最为常见,伯基特淋巴瘤非常罕见。由于其临床表现不典型,缺乏有效辅助检查手段,术前诊断困难,极易与女性生殖系统其他良恶性肿瘤相混淆。且该病恶性程度高,侵袭性强,易转移,预后极差,故临床医生必须给予足够重视。现对1例伯基特淋巴瘤患者资料进行回顾分析,并复习相关文献,进一步探讨其起源、临床表现、诊断及治疗,以加深临床医生对此病的认识,并提高诊治能力。     

Malignant mixed müllerian tumor of the ovary and false negative punctures

Malignant mixed müllerian tumour (MMMT) of the ovary is a rare and aggressive tumour with a poor prognosis. We present a case of a 57-year-old woman with a large pelvic mass, omental cake, ascites and pleural effusions, clinically highly suspect of an ovarian neoplasm. Paracentesis and ultrasound-guided biopsy of the ovary were negative for malignant disease. Therefore a CT-guided true cut biopsy was performed. The latter gave a histopathologic diagnosis of an endometrioid adenocarcinoma of the ovary. However after cytoreductive surgery anatomopathologic examination revealed a malignant mixed müllerian tumour of the ovary with heterologous differentiation. Apparently only one of the two components was found in the puncture. Adjuvant chemotherapy, active against the sarcomatous and the carcinomatous component, was given. At present the patient is well and disease free 35 months after the initial diagnosis. Cytological examination of ascites may be negative in the presence of malignant disease. If a tumour consists of two components, puncture can miss one, which may lead to undertreatment. Punctures should be discouraged as a diagnostic tool in patients in whom an ovarian malignancy is suspected.     

儿童卵巢无性细胞瘤一例并文献复习

儿童卵巢无性细胞瘤在临床较少见,结合病史及辅助检查综合考虑,手术在儿童卵巢无性细胞瘤中是首选方法。随着综合治疗模式的发展,需要考虑手术治疗后对于儿童生育力的保护及卵巢恶性肿瘤的管理。报告1例12岁儿童卵巢无性细胞瘤病例,患者因下腹胀痛首次就诊于延安大学附属医院儿科,发现盆腔包块后就诊于妇科,肛门指诊示盆腔偏右侧可触及约7.0 cm×6.0 cm包块,质中,边界尚清,活动可,相关肿瘤标志物（甲胎蛋白、糖类抗原125）略升高,剖腹探查行术中冰冻病理所示考虑左侧卵巢良性病变,右侧卵巢恶性病变,故行右侧附件切除术+左侧卵巢囊肿剥除术,术后给予辅助化疗同时给予戈舍瑞林去势保护卵巢功能治疗。现已随访11个月,患者月经规律,无特殊不适。通过回顾性分析儿童卵巢无性细胞瘤诊治过程及特点,以期提高临床医师对该病诊断、治疗及管理的认识。     

原发性子宫和阴道非霍奇金淋巴瘤

目的探讨原发性子宫和阴道非霍奇金淋巴瘤临床病理特点及治疗。方法回顾性分析1996年8月～2003年9月北京协和医院和江西省妇幼保健院收治的10例原发性子宫和阴道非霍奇金淋巴瘤患者的临床表现、病理特征和治疗结果。结果10例原发性子宫和阴道非霍奇金淋巴瘤患者平均发病年龄为43．5岁，分期均为IEa，发生部位：子宫颈8例、子宫底部和阴道壁各1例。临床表现为阴道分泌物增多和血性分泌物，4例患者有明确占位病变。组织病理均为B细胞淋巴瘤(CD20 )。4例为粘膜相关淋巴瘤(MALT)，4例弥漫大B细胞淋巴瘤(DLBCL)。手术治疗6例，手术方式为全子宫、双附件切除及盆腔淋巴结清扫术，其中手术 化疗5例，手术 化疗 放疗1例，单纯化疗3例，化疗 放疗1例。化疗多为CHOP方案。死亡1例，存活9例，最长生存期已84个月。结论原发性子宫和阴道非霍奇金淋巴瘤极为少见，临床表现无特异，组织病理B细胞淋巴瘤为主，根治性手术切除和联合化疗是有效的治疗方法，宫颈和阴道淋巴瘤预后较好。     

Primary malignant melanoma in ovarian cystic teratoma

BACKGROUND: Malignant degeneration of benign cystic teratoma of the ovary is rare. Occurrence of melanoma in an ovarian cystic primary teratoma in the absence of a demonstrable extraovarian primary is even rarer. We describe here one such case. CASE: A 42-year-old nulliparous woman underwent laparotomy for a cyst in the right ovary. Histopathological examination of the specimen revealed malignant cystic teratoma with the presence of a melanoma component. There was no evidence of extraovarian primary melanoma on clinical examination. Two years later, she presented with lung metastasis and underwent left pneumonectomy. Histopathology confirmed metastatic melanoma. Postoperatively, she received combination chemotherapy using cisplatin and dacarbazine. She is on regular follow-up and continues to be disease-free, 18 months after treatment. CONCLUSION: Primary malignant melanoma in cystic teratoma of the ovary is extremely rare. We could find only 19 such cases on review of the literature. Clinical presentation is similar to that of primary epithelial ovarian cancer. Surgery remains the mainstay of treatment. Use of cisplatin and dacarbazine may be considered in a patient with metastatic disease.     

Chronic diffuse intravascular coagulation (DIC) in nonmetastatic ovarian cancer: Report of a case and review of the literature

A patient with a dramatic clinical picture of cerebral artery occlusion, peripheral artery occlusion, and pulmonary embolism was diagnosed as suffering from disseminated intravascular coagulation (DIC) according to the typical laboratory findings of hypofibrinogenemia, hypoprothrombinemia, relative thrombocytopenia, and reduction of other clotting factors. Increased fibrinogen split products (FSP) were found on several occasions later in the disease. Heparin was effective in controlling the syndrome which recurred when treatment was stopped. The cause of the syndrome was an ovarian tumor. The patient died of acute myocardial infarction. The postmortem examination confirmed the diagnosis of DIC, the primary disease being a mucinous cystadenocarcinoma of the right ovary, and revealed that the terminal myocardial infarction was also the result of DIC. The surprise was that the tumor was solitary and without metastases. The literature dealing with chronic DIC in cancer is reviewed, and its diagnosis, frequency, and association with metastases is assessed.     

Non-Hodgkin's B-cell lymphoma of the ovary: A case report and review of the literature

ObjectiveTo report a case and review published cases of non-Hodgkin's lymphoma of the ovary.Case reportA 30-year-old female presented with abdominal fullness. Abdominal CT revealed bilateral huge ovarian masses with moderate amount of ascites. Explore laparotomy was performed and the frozen section of right ovarian mass reported to be malignant lymphoma. The final diagnosis was Ann Arbor stage IV diffuse large B cell lymphoma. The patient received six cycles of chemotherapy with RCHOP regimen. She achieved complete remission after the treatment, and there's no evidence of recurrence after 12 months follow up.ConclusionOvarian lymphoma is a rare condition. It could present with findings mimicking ovarian cancer. Chemotherapy is the main treatment option and cytoreductive surgery should be avoided.     

Malignant epithelioid ovarian schwannoma: a case report

Abstract.   LászlóÁ, Ivaskevics K, Sápi Z. Malignant epithelioid ovarian schwannoma: a case report. Int J Gynecol Cancer 2006; 16(Suppl. 1): 360–362.
There are only a few cases reported in the literature about schwannoma originating from the ovary. The patient was registered to the hospital due to a painless solid tumor in her left axillary region. Histologic examination of the excised tumor showed reticulum cell sarcoma. Two years later, oophorectomy was performed due to a unilateral ovarian tumor. The results of the histologic examination with different staining were particularly the same as those found in the axillary tumor, finally diagnosed as a malignant epithelioid schwannoma of the ovary. Our case report may be of interest for three reasons: 1) malignant schwannoma of the ovary is a very rare tumor, 2) the epithelioid type of the tumor may cause a differential diagnostic problem, and 3) clinical appearance of the metastasis was quite unusual, also resulting in difficulties in the appropriate diagnosis.     

A sarcomatous-type peritoneal malign mixed mullerian tumor implant in association with ovarian adenocarcinoma: a case report

A rare case of a patient with a histopathological diagnosis of a sarcomatous-type peritoneal malign mixed müllerian tumor implant in association with ovarian adenocarcinoma is reported. A 52-year-old patient was referred to our clinic for an adnexal mass. At pelvic examination, an irregular, fixed, approximately 7-8 cm in size mass was detected in the right adnexal area. At transvaginal ultrasonographic examination, it was observed that there was an 80 x 70 mm sized, irregularly contoured, semisolid mass with hyperechogenous areas inside originating from the ovary in the right adnexal area. At laboratory examination tumor marker CA-125 was 280.4 U/ml (< 35), CA-15-3 was 146.5 U/ml (< 25), whereas other markers were within normal range. The patient was operated on for a right adnexal mass. A staging laparatomy procedure was applied. Postoperative histopathological diagnosis was reported as malignant mixed mullerian tumor of the ovary, with the ovarian component as poorly differentiated adenocarcinoma, and the metastatic foci over serosal surfaces as a sarcomatous component. Postoperatively six courses of adjuvant and consolidation chemotherapy were administered to the patient. Further studies are needed to set a consensus about evaluation of treatment and prognosis for this kind of pathology.     

Preoperative irradiation in stage III carcinoma of the ovary.

A series of 456 patients with malignant epithelial tumours of the ovary clinical stage III is presented. Of these, 96 were initially inoperable, and 49 had a clinical diagnosis of inoperable disease at the first examination. After 3000 rads external highvoltage irradiation it was found possible to remove the primary tumour, the uterus and the omentum in 36 (38%) of the previously inoperable patients. Of the 49 patients who had only a clinical diagnosis of inoperability, only four were inoperable at laparotomy performed three weeks after completion of 3000 rads external radiotherapy. The five year survival rate for the whole series was 16%.