染色体正常性腺母细胞瘤1例

<正>一、病例摘要患者女,32岁,因“卵巢无性细胞瘤术后3年,发现盆腔包块1月余”于2020年6月22日收入院。患者7年前出现月经稀发,量少,外院诊断为卵巢早衰,3年前因“右卵巢无性细胞瘤”于外院行保留生育功能分期手术,病理结果回报：符合卵巢无性细胞瘤。术后患者无月经来潮,未行放化疗,定期复查彩超和肿瘤标志物,均未见明显异常。入院18天前行彩超提示：子宫小,约3.3 cm×2.8 cm×2.2 cm,左卵巢低回声包块大小约3.3 cm×2.0 cm×1.7 cm,边界清楚,内回声不均,可及血流信号,阻力指数：0.55。     

姐妹同患染色体核型异常及卵巢无性细胞瘤

姐妹同患染色体核型异常及卵巢无性细胞瘤李东红杨梦庚患者（妹），１８岁，１９９３年７月因右侧卵巢肿物于外院行开腹探查术。术中见右侧卵巢呈卵圆形，约１２ｃｍ×１３ｃｍ×１６ｃｍ，包膜完整，与周围无粘连；子宫约２．０ｃｍ×２．０ｃｍ×１．５ｃｍ，左侧卵巢肉...     

妊娠合并卵巢幼年型颗粒细胞瘤一例报告及文献复习

目的:分析妊娠合并卵巢幼年型颗粒细胞瘤(juvenile granulosa cell tumor,JGCT)的临床特点、诊断要点、治疗及预后,提高鉴别诊断水平。方法:回顾性分析1例妊娠合并JGCT病例资料,复习相关文献。结果:患者27岁,因停经39~(+3)周,间断右下腹疼痛3 d入院。彩色超声提示右下腹部一8.5 cm×6.1 cm囊实混合回声。查糖类癌抗原125(CA125)32.3 U/m L,CA19-9为19.1 U/m L,诊断为先兆临产,盆腔包块(性质待排),行剖宫产术+剖腹探查术,探查见右侧卵巢一囊性肿物,已破溃,行右侧卵巢肿物切除术,术后病理诊断为卵巢JGCT。行二次手术,给予右侧卵巢输卵管切除术+左侧卵巢活检术+盆腔淋巴结取样术+部分大网膜切除术+阑尾切除术+盆腔粘连松解术。术后予顺铂+长春新碱+博莱霉素(PVB方案)化疗3个疗程,随访8个月,肿瘤无复发。结论:JGCT是一种罕见的恶性肿瘤,发生于妊娠期者更为罕见,确诊需依赖病理及免疫组化检查。     

妊娠合并卵巢幼年型颗粒细胞瘤一例报告及文献复习

目的：分析妊娠合并卵巢幼年型颗粒细胞瘤（juvenile granulosa cell tumor,JGCT）的临床特点、诊断要点、治疗及预后,提高鉴别诊断水平。方法：回顾性分析 1 例妊娠合并JGCT病例资料,复习相关文献。结果：患者27岁,因停经39+3周,间断右下腹疼痛3 d入院。彩色超声提示右下腹部一8.5 cm×6.1 cm囊实混合回声。查糖类癌抗原125（CA125） 32.3 U/mL, CA19-9为19.1 U/mL,诊断为先兆临产,盆腔包块（性质待排）,行剖宫产术+剖腹探查术,探查见右侧卵巢一囊性肿物,已破溃,行右侧卵巢肿物切除术,术后病理诊断为卵巢JGCT。行二次手术,给予右侧卵巢输卵管切除术+左侧卵巢活检术+盆腔淋巴结取样术+部分大网膜切除术+阑尾切除术+盆腔粘连松解术。术后予顺铂+长春新碱+博莱霉素（PVB方案）化疗3个疗程,随访8个月,肿瘤无复发。结论：JGCT是一种罕见的恶性肿瘤,发生于妊娠期者更为罕见,确诊需依赖病理及免疫组化检查。     

卵巢癌腹腔化疗并发腹腔大出血1例报道

正1病例报告患者,38岁,因右侧卵巢高分化黏液腺癌肿瘤细胞减灭术后拟行第3次化疗,于2018年10月22日入我院。患者平素月经规律,既往身体良好,无特殊病史。2017年9月15日因体检发现左侧附件区占位,直径约20 cm,肿瘤糖类抗原125(CA125) 300 U/ml。在外院行开腹左侧附件切除术+右侧卵巢活检术,术后病理检查示:双侧卵巢交界性黏液性囊腺瘤伴上皮内癌变。术后未补充化疗,于当地医院规律随访。2018年7月10日患者因腹痛3天前来我院就诊,B超检查示:右侧附件     

卵巢恶性生殖细胞瘤近期治疗结果:附34例病例研究分析

对泰国一个医院中罕见的卵巢恶性生殖细胞瘤(mOGCT)患者存活率和手术治疗结果进行回顾性研究。选择1990～1996年病理诊断为卵巢恶性生殖细胞瘤(mOGCT)的34例妇女。手术治疗原则:初次手术为子宫全切术—双侧输卵管卵巢切除术(TAH.BSO)的非保守术或单侧输卵管卵巢切除(USO)的保守术(用于年轻妇女保留生育功能),晚期病例配合细胞减灭术。并行结肠下网膜切除术、腹腔液细胞学检查、对可疑部位进行活检。 纯无性细胞瘤(DgS)IA期单行USO,IB～Ⅱ期行TAH.BSO后化疗3～4疗程,ⅡC～Ⅳ期晚期病例术后化疗4～6疗程。化疗无效者进一步给予     

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。     

原发性卵巢类癌术后妊娠1例

患者,女,29岁,已婚,未孕.因左下腹包块20天,外院术后5天来我院就诊.5天前患者在外院接受手术治疗,术中探查见左侧卵巢肿瘤,约9cm×8cm×7cm大,表面光滑,与周围组织无粘连,子宫前位,正常大,左侧输卵管及右侧附件未见明显异常,无腹水,剥除左侧卵巢肿瘤,冰冻切片病理报告为左卵巢浆液性囊腺瘤,局部旱低级别上皮内瘤变改变,卵巢畸胎瘤,遂行左侧附件切除术,术后石蜡病理诊断左卵巢子宫内膜样高分化腺癌,合并囊性成熟性畸胎瘤,未送腹腔冲洗液细胞学检查,大网膜及对侧卵巢未送活检.     

早期非上皮性卵巢恶性肿瘤腹腔镜手术的临床分析

目的:探讨早期非上皮性卵巢恶性肿瘤(MNEOT)腹腔镜手术的可行性及临床疗效。方法:回顾分析2010年1月~2014年5月在我科行腹腔镜手术的45例早期MNEOT患者的临床资料,包括颗粒细胞瘤15例,无性细胞瘤13例,未成熟畸胎瘤12例,卵黄囊瘤3例,睾丸母细胞瘤2例。17例行腹腔镜全面分期手术,28例(62.2%)行保留生育功能手术。结果:手术均顺利完成,无中转开腹和术中并发症。术后24h内均可下床活动,术后肛门排气时间(4±2)d。除IA期及拒绝化疗者外,30例术后辅助化疗,术后与开始化疗间隔(7±2)d。随访时间(27±11)月,1例IC期复发,行二次手术及化疗。无死亡。结论:腹腔镜手术治疗早期MNETO是安全、有效的。     

卵巢自体移植一例

患者女,38岁。因月经显著增多,于1980年10月在某医院行子宫全切除及左侧卵巢肿瘤切除术。术后病理诊断为左卵巢交界性子宫内膜瘤及囊性腺纤维瘤。术后一个月转来我院要求作预防性右侧卵巢摘除。入院后检查,未发现异常,复查组织切片证实原病理诊断正确。为保持卵巢内分泌功能和及时发现卵巢恶性病变,规定将右侧卵巢带血管蒂游离移植至腹部皮下。     

Ovarian dysgerminoma metastatic to the breast.

A 16-year-old girl underwent a right salpingo-oophorectomy for a pure dysgerminoma limited to the right ovary. One month later, she developed a right pelvic mass along with abdominal lymphadenopathies, peritoneal carcinomatosis, left breast mass, and left axillary node. Cytology of the breast mass was suggestive of a pure dysgerminoma. Breast metastases of epithelial ovarian carcinoma are uncommon. In the literature, this is the first case of a breast metastasis of an ovarian dysgerminoma.     

Ovarian dysgerminoma associated with Pseudo-Meigs' syndrome and functioning ovarian stroma: a case report

BACKGROUND: We present the first case of an ovarian dysgerminoma complicated by pseudo-Meigs' syndrome. Furthermore, this is the fourth reported case of ovarian dysgerminoma with functioning ovarian stroma resulting elevated androgen levels preoperatively. CASE: A 25-year-old white female was referred to our department for abdominal swelling and a rapidly enlarging abdominal mass. Chest X-ray showed massive right pleural effusion. Abdominopelvic CT scan showed a left adnexal solid mass and ascites. Preoperative abnormally elevated hormone levels were as follows: free testosterone 7.7 pg/mL, androstenodione 13.6 ng/mL, and cortisol 29.4 microg/dL. Left salpingo-oophorectomy and wedge resection of the right ovary were performed. Final histopathological investigation of the left ovary was dysgerminoma associated with stromal luteinization. CONCLUSION: Dysgerminoma should be considered in the differential diagnosis in a young patient with a pelvic mass, ascites, and pleural effusion and preoperative counseling should be directed accordingly. In addition, dysgerminomas may be accompanied by ovarian stromal luteinization and steroid hormone production, which occasionally result in chemical or clinical hyperandrogenism.     

A large pelvic mass in an adolescent patient with granulomatous nephritis: case report and discussion of treatment challenges

BACKGROUND: An adolescent patient with granulomatous nephritis presents with a large, solid pelvic mass. Pertinent differential diagnosis for this solid ovarian mass as well as discussion regarding treatment challenges for this patient is delineated. CASE: A 15-year-old female presented to her primary care doctor with fatigue and syncope. Initial laboratory workup revealed a hemoglobin of 7.9 g/dL, an elevated creatinine of 3.5 mmol/L, and an elevated ionized calcium of 13.1 mg/dL. Renal biopsy revealed diffuse non-caseating granulomatous nephritis with rare acid-fast bacilli. Renal ultrasound first noted a pelvic mass. Pelvic ultrasound revealed a 15.0 x 8.4 x 12.2 cm mass, characterized as mostly solid with diffuse spaces, in the location of the right ovary. CA-125 and the lactate dehydrogenase (LDH) tumor markers were elevated. The patient underwent a left salpingo-oophorectomy and pelvic staging. Intra-operative frozen section revealed a dysgerminoma. Final pathology report revealed extensive non-caseating granulomatous inflammation within the ovarian tumor. Special stains showed no evidence of acid-fast organisms. CONCLUSION: Dysgerminoma is the most likely solid ovarian tumor in a patient of this age. In light of her initial renal biopsy with acid-fast bacilli, pelvic tuberculosis needs to be considered. Due to its extreme rarity, sarcoidosis of her genital tract should be lower on the differential, yet this patient presented with pathology consistent with non-caseating granulomas suggesting this diagnosis. Once ovarian dysgerminoma was diagnosed, the possibility that this patient's renal findings may represent paraneoplastic syndrome also becomes important for her treatment.     

Androgenic adult granulosa cell tumor in a 13-year-old prepubertal patient: a case report and review of the literature.

We report the clinicopathologic findings of an unusual case of adult granulosa cell tumor with androgenic manifestation in a 13-year-old prepubertal girl. The patient had never had a menstrual period and presented with a 1 year history of hirsutism. Physical examination was only remarkable for an increase in facial and abdominal hair, both with a male pattern of distribution. A pelvic ultrasound demonstrated a 6.0 cm right adnexal cyst. Plasma testosterone and 17-hydroxyprogesterone levels were elevated. The patient initially was treated with monophasic oral contraceptive pills for 3 months and owing to lack of response, she underwent an exploratory laparotomy in which a left ovarian tumor, 7.0 cm in greatest dimension, and a 6.5 cm right paratubal cyst were found. A wedge biopsy of the left ovary and subsequent left oophorectomy with right salpingectomy were performed. No gross evidence of disease outside the ovary was noted. Microscopic examination of the left ovarian tumor revealed the typical features of an adult granulosa cell tumor. No tumor was seen outside the ovary. Six days after surgery, plasma testosterone and 17-hydroxyprogesterone levels were in the normal range. Nine months postoperatively, the patient shows no evidence of disease. To our knowledge, this represents the first case of a prepubertal patient with an adult granulosa cell tumor with androgenic manifestations reported in the English literature.     

Case of peptide-YY-producing strumal carcinoid of the ovary: A case report and review

Ovarian carcinoid is a rare tumor accounting for approximately 0.1% of all ovarian malignancies. We describe a case of peptide-YY-producing strumal carcinoid of the ovary associated with severe constipation. A 48-year-old woman was found to have a pelvic mass on ultrasonography when she visited her primary doctor for a health check-up. She was thus referred to our department. Magnetic resonance imaging revealed a solid right ovarian tumor 60?×?50?mm in size. The patient underwent a right adnexectomy and was histopathologically diagnosed as having strumal carcinoid of the ovary. On immunohistochemical examination, the tumor cells were positive for peptide YY. The patient's constipation resolved rapidly after surgery. Based on her clinical course, her constipation was considered to have been caused by the strumal carcinoid of the ovary. The clinical course of this case supports the previously recognized correlation between peptide-YY-producing ovarian carcinoid and constipation.     

Ovarian dysgerminoma. Report of a case with successive pregnancies

The case of a young woman is described who gave birth to two children following the removal of an ovarian dysgerminoma and currently enjoys good health eight years after the operation. The tumour was a pure dysgerminoma, with a diameter of 12 cm, which affected the left ovary. Surgical treatment alone was used.     

卵巢原发性弥漫大B细胞淋巴瘤一例并文献复习

卵巢弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma,DLBCL）是一种临床少见的发生于卵巢的恶性肿瘤,其发病机制尚不清晰,临床表现及辅助检查无明显特异性,术前诊断困难,确诊只能依靠组织病理结果及免疫组织化学结果,极易与卵巢其他恶性肿瘤相混淆,错过最佳治疗时机会延误病情。报道我院收治的1例卵巢DLBCL病例,患者以腹胀为主诉就诊,无其他不适,影像学检查不典型,入院初步诊断为盆腔肿物,通过行剖腹探查术得以明确诊断,给予手术及化学药物治疗。回顾性分析该患者的临床资料,复习相关文献,旨在加深临床医生对该病的认识,切实提高临床诊治能力。     

"Can laparoscopy really complete full surgical staging?" A case of early recurrence and malignant transformation of borderline ovarian tumor

Ovarian borderline tumor (BOT) with noninvasive implants traditionally is considered to be non-aggressive. Recurrences are delayed and transformations to high-grade carcinoma are rarely documented. We report on a patient with BOT with early recurrence and high-grade carcinoma transformation in a short interval after complete laparoscopic staging. A 27-year-old unmarried woman presented with a 26 cm in size ruptured left ovarian mass. Laparoscopic left salpingo-oophorectomy with right ovarian biopsies, multiple peritoneal biopsies, omental biopsy and washing cytology were performed. FIGO Stage I ovarian serous borderline tumor with microinvasion was confirmed. About ten months later, a 15 cm in size left BOT recurred and was resected by laparoscopic cystectomy including staging surgery. Seven months after the second surgery, we found a pelvic mass by sonogram and elevated CA125. A third diagnostic laparoscopy revealed invasive serous carcinoma with multiple peritoneal implants. In spite of radical surgery and adjuvant chemotherapy, the patient died of a progressive metastatic liver tumor. A case of early recurrence with malignant transformation of BOT is presented together with a brief review.     

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.     

Ovarian stone. A case report

BACKGROUND: To our knowledge, ovarian calcification and ossification involving the whole ovary with images that mimic stone formations have not been reported before. CASE REPORT: A 42-year-old woman presented with severe abdominal pain. Plain abdominal radiography showed a well-defined, calcified mass, 4 x 5 cm, located in the pelvis. Physical examination showed a right adnexal mass accompanied by severe pain and tenderness while lifting. Transvaginal ultrasound showed an ill-defined mass with acoustic comet tail. Computed tomography demonstrated a well-defined mass on the right adnexa, 4 x 5 cm, with an extensively calcified shell. Surgical exploration revealed an enlarged, ovoid, pale brown ovary, which looked exactly like an ovary made of stone. The pathologic findings were compatible with a benign chocolate cyst with extensive calcification and ossification. The pelvic pain resolved completely after the surgery. CONCLUSION: Though the cause of this unique case remains unknown, torsion with subsequent infarction of an ovarian endometrioma was suggested. Complete excision was the treatment of choice.