原发性卵巢平滑肌瘤4例临床病理分析

Clinicopathologic characteristics of four cases of primary ovarian leiomyoma

目的探讨原发性卵巢平滑肌瘤的临床病理特点。方法将北京协和医院妇产科自1984—2006年收治的4例原发性卵巢平滑肌瘤患者的临床病理资料进行回顾性分析。结果4例患者平均44.8岁(28～75岁),主要就诊原因分别为急性腹痛(1例),绝经后出血(1例),查体发现盆腔包块(2例)。囊肿均为单侧性,直径平均6.4cm(4.1～9.2cm)。1例患者血清CA125升高(129.1kU/L)。2例未生育患者进行了腹腔镜下肿瘤剔除术,2例已完成生育的患者进行了全子宫和附件切除术,无一例合并子宫平滑肌瘤,1例绝经后出血患者合并子宫内膜息肉。病理结合免疫组织化学染色最终明确诊断。平均随诊时间44.5个月(13～117个月),全部治愈,1例患者已完成足月妊娠分娩。结论原发性卵巢平滑肌瘤临床罕见,组织学上容易和其它梭形细胞肿瘤混淆,免疫组织化学染色可以协助诊断。手术完整切除肿瘤疗效满意,对于没有完成生育的年轻患者,可以尝试保守性手术。

Objectives To study clinical characteristics of primary ovarian leiomyoma. Methods Four patients with primary, ovarian leiomyoma were admitted to Peking Union Medical College Hospital from 1984 to 2006,whose clinical and histopathologie features were evaluated. Results The mean age was 44, 8 years, （ranged from 28 to 75 years）, One was postmenopausal woman and the other three were all premenopausal women, The clinical manifestation was acute abdominal pain （1/4）, postmenopausal bleeding（1/4） and palpable adnexal mass（2/4） respectively, The ovarian cysts were all unilateral, The average size was 6.4cm（ranged from 4. 1 to 9.2cm）, Serum CA125 was measured in 3 patients and elevated in one patient （129, I kU/L）, Tumor removal was performed in two childbearing patients by laparoscopy, Total abdominal hysterectomy and salpingo - oophorectomy was performed in two patients who have finished their ehildbearings, No uterine leiomyomas were detected during the operations. Multiple endometrial polyps were presented in a postmenopausal patient. Diagnosis was based on histopathnlogie features and immunohistochemical staining, Follow-up （ mean 44. 5 months,ranged from 13 to 117months）was available in all patients; no evidence of recurrence was identified, One patient has finished a normal term pregnancy, Conclusions Primary ovarian leiomyoma is rare and usually misdiagnosed with other spindle cell tumors. Immunohistoehemical staining can assist the diagnosis. The＂ prognosis is good after ovarieetomy. Tumor enuclation should be tried in childbearing young patients.