卵巢透明细胞癌及其合并子宫内膜异位症的临床及病理分析

The Clinicopathologic Analysis of Ovarian Clear Cell Carcinomas and Their Concomitant Endometriosis

目的探讨35例卵巢透明细胞癌患者及其合并子宫内膜异位症的临床、病理特征及预后情况。方法对临床病理及随访资料完整的35例卵巢透明细胞癌患者的病理蜡块进行重新切片、阅片,确诊18例来源于子宫内膜异位症恶变(EM组),17例原发卵巢透明细胞癌(NEM组)。随机选择同期40例原发卵巢浆液性囊腺癌为对照组。对比分析3组患者的一般特征、临床表现、辅助检查、病理特点、治疗及预后情况。结果EM组患者中位年龄为48岁,较NEM组(51岁)年轻3岁(P<0.001),较对照组(54岁)年轻6岁(P<0.001)。EM组患者主要临床表现为盆腔包块(66.7%)、下腹胀痛(33.3%)及绝经后阴道流血(11.1%)。原发OCCC患者主要临床表现为盆腔包块(58.8%)、未绝经的阴道不规则流血(23.5%)及下腹胀痛(17.6%),其中EM组38.9%盆腔包块持续半年以上,与NEM组及对照组比较差别有显著性意义(P<0.05)。EM组患者5年生存率为72.2%,高于NEM组的47.1%。结论EM组患者较年轻,早期病例多见,5年生存率虽高于NEM组,但无明显的差别。研究表明二者的分子机制可能是不同的,但治疗上无差别,是否改变治疗方法有待于进一步研究。

Objective To approach the clinicopathologic features and prognosis of 35 patients with ovarian clear cell carcinoma, and as well as those with pelvic endometriosis simultaneously. Methods Through slicing successively and examining the paraffin blocks of 35 patients, which have completely clinicopathologic and follow up data, 18 cases were from malignant transformation of ovarian endometriosis （EM group） , and the other 17 cases without pelvic endometriosis （NEM group）. 40 cases homeochronous ovarian serous cystadenocarcinoma were randomly selected with control group. To analysis comparatively their common features, clinic symptoms and signs, auxiliary examination, pathological characteristics, treatment and prognosis. Resuits The median age of EM group is 48 years, which is younger 3 years than NEM group which is 51 years （ P 〈 0. 001 ）, and it is also younger 8 years than control group which is 56 years （ P 〈 0. 001 ）. The mainly symptoms of the patients in EM group are pelvic mass （66.7%）, abdominal distention （33.3%） and postmenopausal vaginal bleeding （ 11.1% ） ; The mainly symptoms of the patients in NEM group are pelvic mass （58.8%）, irregular vaginal bleeding before menopause （23.5%） and abdominal distention （ 17.6% ）. The duration of pelvic mass is more than half a year in 38.9% of patients in EM group, and there are significant differences compared with NEM group and control group （ P 〈 0. 05 ）. The 5 - year survival in EM and NEM group is 72. 2% and 47.1%, respectively, both of them are higher than that of control group which is 35.0%. Conclusion In EM group, the years of patients are more younger, and the early - stage cases are common. The 5 - year survival of patients in EM group is 72.2% and it is 47. 1% in NEM group. There is no differece between them. Although the prognosis in EM group is better than that of NEM group, there is no significant difference between them. It is indicated that their molecular mechanisms are probably different, but their therapies are identical. However. whether they will be changed still require confirmation by further studies.