卵巢透明细胞癌与子宫内膜异位症——附45例临床病理分析

目的　探讨伴子宫内膜异位症或其他恶性上皮性肿瘤的卵巢透明细胞癌临床病理特点及预后。方法　随访并回顾性分析 45例原发性卵巢透明细胞癌患者 ,对病理学特征和临床特征的相关性作统计学分析。结果　以腹痛、腹胀、盆腔肿块为主要症状者占 73.3%。术前拟诊为卵巢内膜样囊肿或子宫内膜异位症者占44 .4%。根据FIGO分期 ,Ⅰ期 2 6例、Ⅱ期 6例、Ⅲ期 12例、Ⅳ期 1例。术后病理证实 ,伴子宫内膜异位症 2 8例 ,占 6 2 .2 % ;不伴子宫内膜异位症 17例 ,占 37.8%。Ⅰ期 2 6例中伴子宫内膜异位症 19例 ;不伴子宫内膜异位症 7例。 45例中单纯卵巢透明细胞癌 19例 ,占 42 .2 % ;混合型卵巢透明细胞癌 2 6例 ,占 5 7.8% ;其中 2 0例(76 .9% )合并卵巢宫内膜样癌 ,5例 (13.2 % )合并浆液性囊腺癌 ,1例 (3% )合并黏液性囊腺癌。结论　伴子宫内膜异位症的卵巢透明细胞癌 ,因自觉症状明显 ,就诊早 ,容易被发现 ,故Ⅰ期病例较多。因这类患者术前常被误诊为子宫内膜异位症 ,所以对临床诊断为卵巢内膜样囊肿或子宫内膜异位症的患者必须严密随访 ,不宜一味保守治疗 ,也不宜采用穿刺抽囊液方法 ,以免遗漏可能早期发现的卵巢透明细胞癌。单纯和混合型 ,伴与不伴子宫内膜异位症的卵巢透明细胞癌 ,预后差异无显著性 (P >0 .0

Clear cell ovarian carcinoma with endometriosis-A clinicopathologic analysis of 45 cases

Objective To study the clinicopathological features of clear cell ovarian carcinoma with endometriosis and other malignant epithelial tumors. Methods Primary lesions from 45 patients with clear cell ovarian carcinoma were reviewed. Correlation between pathological finding and clinical features was evaluated statistically.Results Abdominal pain, abdominal distention and pelvic mass were the most common findings (33 in 45, 73.3%). 20 patients were diagnosed as ovarian endometrioid cyst or endometriosis preoperatively (44.4%). According to the criteria suggested by FIGO, 26 cases were of stage I, 6 of stage II, 12 of stage III and 1 of stage IV. 28 cases were found with endometriosis (62.2%), 17 without (37.8%); in 26 cases of stage I, 19 with endometriosis and 7 without ( P < 0.05). Of the 45 cases, 19 (42.22%) were simple clear cell ovarian carcinoma while 26 (57.78%) were mixed: 20 (76.9%) with endometrioid ovarian cystadenocarcinoma, 5 (13.2%) with serous cystadenocarcinoma and 1 (3%) with mucinous cystadenocarcinoma. Conclusion Most of the tumors of stage I were detected early because of presence of endometriosis, thus intensive follow up should be performed in those who are clinically diagnosed as endometrioid ovarian cyst or endometriosis. There is no difference in prognosis between the simple and the mixed clear cell ovarian carcinoma, and also between the clear cell ovarian carcinoma with or without endometriosis.