卵巢泡膜细胞瘤74例临床分析

目的：探讨卵巢泡膜细胞瘤的临床特征、治疗和预后。方法：回顾性分析了我院1958－1998年诊治的74例卵巢良、恶性泡膜细胞瘤患者的临床和病理资料。结果：74例中,恶性泡膜细胞瘤8例;良性泡膜细胞瘤66例,其中9例伴细胞生长活跃。临床症状有腹部包块者42例（56．8％）,其次为月经不调、阴道不规则出血、闭经、腹痛、不孕等;22例合并腹水,其中1例同时伴有胸水;39例合并雌激素刺激相关疾病,包括子宫内膜癌和内膜不典型增生各1例,子宫肌瘤、内膜复合性增生、内膜息肉等。66例良性泡膜细胞瘤中,15例行CA125检查,9例增高;9例伴细胞生长活跃的患者中,肿瘤侵犯周围组织和术后复发各1例,经手术和放射治疗（放疗）,至今已无瘤生存11年和27年。8例恶性泡膜细胞瘤中,4例因放弃或进行不规范治疗者均在2年内死亡;另4例（I、Ⅱb期各1例,复发2例）经积极手术后行放疗或化学药物治疗（化疗),除1例死于放射性肠瘘外,2例无癌生存10年以上,1例无癌生存2年。结论：良性泡膜细胞瘤预后好,但应警惕伴细胞生长活跃者。恶性泡膜细胞瘤预后差,但积极手术后行放疗或化疗,可明显延长生存时间。

Clinical analysis of 74 cases with ovarian thecoma

OBJECTIVE: To study the clinical pathologic characteristics, treatment and prognostic factors of ovarian thecoma. METHODS: From 1958 approximately 1998, a total of 74 patients with benign and malignant thecoma were retrospectively analyzed. RESULTS: The reviewed diagnosis were 8 patients with malignant thecoma, 66 patients were benign thecoma. Nine of 66 patients with benign thecoma appeared cell proliferative activity. The mean age was 52 years. The most frequent symptoms were abdominal-pelvic masses (56.8%), metromenorrhagia and abnormal vaginal bleeding, other symptoms were abdominal pain, infertility followed. Twenty-two of 66 patients had ascites, only 1 patient with ascites and hydrothorax simultaneously. Thirty-nine patients with diseases which associate with excessive estrogenic stimulation, including 1 endometrial adenocarcinoma and 1 endometrial dysplasia and other diseases such as: myoma; endometrial hyperplasia and polyp. Fifteen patients with benign thecoma were evaluated blood serum CA(125), the CA(125) were elevated in 9 of 15 patients. In 2 of 9 patients with cell proliferative activity, the tumors invaded adjacent tissues or relapsed, after received operation and pelvic radiotherapy, they are alive 11 years and 27 years respectively. Among 8 patients with malignant thecoma, 4 patients without postoperation therapy or with non-standard chemotherapy died in 2 years postoperation, the other 4 patients received operation, postoperational radiotherapy or (and) chemotherapy, 1 of 4 patients died of irradiation intestinal fistule 4 years later; two patients are alive without disease more than 10 years, another one for 2 years. CONCLUSIONS: Theca cell tumor of ovary have good prognosis, but we should pay attention to thecomas with proliferative activity. The prognosis of malignant thecomas is poor, postoperative systemic chemotherapy or radiotherapy to the patients with malignant thecomas can improve their survival.