胃癌卵巢转移临床病理特点及误诊原因分析

Clinico- pathological characteristics of gastric cancer with ovarian metastasis and the reasons for its misdiagnosis

目的探讨胃癌卵巢转移患者的临床病理特点及误诊原因。方法对1990年1月至2004年6月发生的52例胃癌卵巢转移患者的临床资料、病理结果及误诊原因进行回顾性分析。结果胃癌卵巢转移患者平均年龄(40.15±1.28)(22￣64)岁,常以卵巢转移灶为首发表现。B超检查以混合性包块或实质性包块为主要表现,多伴有腹腔积液,双侧卵巢转移瘤占76.9%。血清C A125升高,平均(99.85±14.23)U/m L,但显著低于同期原发性卵巢癌(P<0.05)。术前诊断准确率低(46.1%)。结论胃癌卵巢转移与原发性恶性肿瘤无可靠的鉴别诊断标准,卵巢转移瘤超声、C T等影像检查技术无特异性,术前诊断需行多方面的综合分析。

Objective To investigate the clinical and pathological features of gastric cancer with ovarian metastasis and to analyze the reasons for its misdiagnosis. Methods There were 52 cases of gastric cancer with ovarian metastasis who had pathologic diagnoses from Jan. 1990 to Jun. 2004, whose clinical datum, pathological classification and the reasons for misdiagnosis were reviewed retrospectively and analyzed. Results The average age of the patients was 40.15±1.28 ( the ages ranging from 22 to 64 ). These patients's first symptoms and signs often were a metastatic ovary cancer. The main ultrasonographic findings were either a complex type of mass with both solid and cystic characteristics or only solid one, most of which accompany hydroperitonia, and among them metastatic ovary tumors on both sides reached 76.9 %. The serum CA125 levels increased, amounting to ( 99.85±14.23)U/mL on the average. It was greatly lower than a primary ovarian cancer(P<0.05). The rate of preoperatively accurate diagnosis was very low(46.1 %). Conclusions As diagnostic imaging techniques of US and CT findings are not specific, there are no reliable diagnostic criteria to differentiate a gastric cancer with ovarian metastasis from a primary malignant tumor. But we can try to make a differential diagnosis basing on the multivariate statistical analyses.