卵巢Sertoli-Leydig细胞瘤13例临床诊治分析

目的：提高对卵巢Sertoli-Leydig细胞瘤（Sertoli-Leydig cell tumor,SLCT）的认识及治疗水平。方法：回顾性分析2014年6月—2021年7月首都医科大学附属北京妇产医院收治的经手术、病理确诊的13例卵巢SLCT患者的病例资料,分析其临床特点、诊断、治疗及预后。结果：13例患者发病年龄为13~72岁,中位年龄31岁。8例患者（61.5%）血清睾酮水平升高并出现雄激素过多的临床表现,3例（23.1%）患者表现为异常子宫出血,另2例（15.4%）无明显临床症状。影像学主要表现为附件区囊实性或实性肿物。13例患者均行手术治疗,术后均经组织学病理及免疫组织化学检查确诊为卵巢SLCT,其中ⅠA期11例,ⅠC期2例。4例在病理诊断明确、前次手术间隔1~2个月后行二次手术,行患侧附件切除及盆腹腔多点活检。2例ⅠC期患者术后行博来霉素+依托泊苷+顺铂（BEP）方案化疗。13例患者术后中位随访时间为33个月,均未见复发。结论：女性有异常内分泌症状、附件区囊实性或实性肿物,应考虑卵巢SLCT的可能性;治疗以手术为主,术中和术后病理明确SLCT诊断,酌情联合化疗;建议术后多学科联合随访。

A Clinical Analysis of 13 Cases of Ovarian Sertoli-Leydig Cell Tumor

Objective: To improve the diagnosis and treatment of ovarian Sertoli-Leydig cell tumor (SLCT). Methods: Thirteen cases of ovarian SLCT admitted between June 2014 and July 2021 were analyzed retrospectively, including their clinical characteristics, diagnosis, treatment and prognosis. Results: The median age of onset was 31 years (13-72 years) in 13 patients. Eight patients (61.5%) had the androgenic manifestations (due to the elevated levels of testosterone), 3 patients (23.1%) presented with abnormal uterine bleeding, and the other two patients (15.4%) had no obvious clinical symptoms. Imaging mainly showed cystic-solid tumors or solid tumors. All 13 patients underwent surgery, and diagnosed with ovarian SLCT by histopathology and immunohistochemistry. Eleven patients were at stage ⅠA, and 2 patients at stage ⅠC. Four patients underwent the complementary surgery to resect the affected adnexa and perform the multi-point pelvic and abdominal biopsy after 1-2 months of the initial operation and histopathological diagnosis. Two patients with SLCT at stage ⅠC underwent postoperative chemotherapy with the bleomycin + etoposide + cisplatin (BEP) regimen. The median follow-up time after surgery was 33 months. None of the 13 patients had a recurrence. Conclusions: Ovarian SLCT should be considered when women had abnormal endocrine symptoms and ovarian cystic-solid or solid masses. Surgery is main treatment for SLCT patient, and operative and postoperative histopathology will confirm the diagnosis of ovarian SLCT. Postoperative chemotherapy can be accordingly considered, and the postoperative multidisciplinary follow-up has been suggested.