卵巢卵泡膜细胞瘤32例临床分析

Clinical analysis on 32 cases of ovarian thecoma

目的回顾性分析32例卵巢卵泡膜细胞瘤的临床病理资料,以提高卵巢卵泡膜细胞瘤的术前诊断率。方法分析2008年至2014年在西安交通大学第一附属医院妇产科手术治疗,病理诊断的卵巢卵泡膜细胞瘤病例32例。收集患者一般临床资料、影像学资料和血清标志物、术中情况、手术方式和术后病理资料。结果 32例患者发病年龄28~76岁,中位年龄55岁。症状表现多样,查体发现12例、盆腔可扪及包块9例、腹痛5例、绝经后阴道出血者3例、腹胀2例、月经紊乱1例。缺乏特异性血清标志物,12例检测血清糖类抗原125(CA125),其中9例大于35.00IU/m L,最高值498.10IU/m L。超声影像学辅助诊断意义不大,显示包块低回声者10例、高回声者2例、混合型包块13例、囊性5例、2例漏诊。术后病理结果单纯性卵泡膜细胞瘤19例,混合性卵泡膜细胞瘤13例,包括10例卵泡膜纤维瘤(细胞生长活跃3例,合并中分化子宫内膜样腺癌1例)和3例粒层卵泡膜细胞瘤(其中1例为低度恶性)1例。合并子宫内膜癌者给予PT方案化疗4疗程,低度恶性颗粒卵泡膜细胞瘤给予PEB方案化疗4疗程,随访2~6年所有患者均无复发。结论卵泡膜细胞瘤好发于生育期和围绝经期女性,分泌雌激素可能出现绝经后阴道出血或月经紊乱,部分可合并胸腹水及CA125升高。临床表现多样,缺乏特异性术前辅助诊断,确诊往往需要术后病理,绝大多数卵泡膜细胞瘤完整切除后不易复发,但应警惕合并子宫内膜癌和低度恶性颗粒卵泡膜细胞瘤。

Objective To retrospectively analyze clinical and pathological data of 32 cases of ovarian thecoma so as to improve its preoperative diagnostic rate. Methods Thirty-two cases of ovarian thecoma operated in gynecology and obstetrics department in the First Affiliated Hospital of Xi＇an Jiaotong University and confirmed by pathologic diagnosis from 2008 to 2014 were retrospectively analyzed.General clinical data,imaging data,serum markers,intraoperative conditions,operation methods and postoperative pathological data were collected. Results Onset age of 32 patients ranged 28-76 years old,with median age of 55 years old. Symptoms were various. Twelve cases were found through physical examination,pelvic palpable masses were found in 9 cases,abdominal pain was experienced in 5 cases,postmenopausal vaginal bleeding in 3 cases,abdominal distension in 2 cases and menstrual disorders in 1 case. Specific serum markers were absent. Serum CA125 was detected in 12 cases,and that of 9 cases was more than 35. 00 IU/m L. The highest value was 498. 10 IU/m L.Diagnostic value of ultrasonography was not significant. Ultrasound examination showed hypoechoic mass in 10 cases,hyperechoic mass in2 cases,mixed-type mass in 13 cases,and cystic mass in 5 cases,and 2 cases were missed diagnosed. Postoperative pathological examination found 19 cases of simple ovarian thecoma,13 cases of mixed type of ovarian thecoma,including 10 cases of thecofibroma（ 3 cases with active cell growth and 1 case with moderately differentiated endometrioid adenocarcinoma）,3 cases of granulosa theca cell tumor（ 1 case with low grade malignancy）. Cases associated with endometrial cancer were given PT chemotherapy for 4 courses,and cases of low grade malignant granulosa theca cell tumor were treated with PEB chemotherapy for 4 courses. All cases did not have recurrence in 2-6 years of follow-up. Conclusion Ovarian thecoma is usually found in women in reproductive period and perimenopausal period. Secretion of estrogen may cause postmenopausal vaginal bleeding or menstrual disorders. Some cases could be complicated with ascites and pleural effusion and increase of CA125. Its clinical manifestations are various and specific preoperative auxiliary diagnosis is absent. Its detection needs postoperative pathological examination. Most of theca cell tumor is not likely to recur after being removed completely,but combination of endometrial cancer and low malignant granulosa theca cell tumor should arouse alarm.