原发性卵巢类癌7例临床分析

Clinical analysis of 7 cases of primary ovarian carcinoid tumours.

目的探讨原发性卵巢类癌的临床特点。方法回顾性分析北京协和医院2002-2007年收治的7例原发性卵巢类癌患者的临床病理资料。结果原发性卵巢类癌十分罕见,占同期收治卵巢癌的0.53%。患者年龄29～64岁,中位年龄35岁;孕次平均2.0次(0～5次);产次平均0.57次(0～1次)。以盆腔包块、便秘、月经紊乱及阴道不规则出血为主要临床表现。妇科检查附件区扪及实性或囊实性包块。CA125轻度升高2例,CA199升高1例。神经内分泌标志物的检测有助于诊断。病理检查证实7例患者均为临床Ⅰ期,单纯类癌3例,类癌合并畸胎瘤3例,甲状腺肿类癌2例。7例患者均行手术治疗,其中保留生育功能者4例,子宫+双附件切除3例。术后1例行BEP方案(顺铂、博莱霉素、足叶乙甙)化疗3个疗程,1例行紫杉醇单药化疗1个疗程。定期随访,除1例失访外,余无复发病例。结论原发性卵巢类癌恶性程度较低,生物学行为较好,不易远处转移,早期病例预后良好。但此肿瘤有远期复发可能,因此应长期随访。

Objectives To investigate clinical features of primary ovarian carcinoid tumours （POCTs）. Methods We retrospectively analysed the clinical and pathological data of 7 cases of POCTs in Peking Union Medical College Hospital from 2002 to 2007. Results POCTs were rare, constituting only 0. 53% of ovarian cancers. The ages ranged from 29 to 64 and the median age was 35. The average gravidity was 2.0 （ gravida 0 - 5 ） and the average parity was 0.57 （ para 0 - 1 ）. Pelvic mass , constipation, menstrual disorder and irregular vaginal bleeding were chief complaints. Physical examination showed solid or cyst-solid mass in the adnexa area. High serum levels of CA125 were found in two cases and CA199 in one case. The diagnosis was aided by immunochemical identification of neuroendocrine markers such as Syn, CgA and NSE et al. All the 7 cases confined to one ovary（ stage I ）, and among them 3 cases developed in pure form ,3 cases were associated with teratoma and the rest 2 cases were thyroid carcinomas. All the 7 patients experienced operation and four of them reserved fertility. Three patients received hysterectomy and bilateral salpingo-oophoreetomy. After surgery, one patient received 3 courses of chemotherapy consisting of Blm , VP16 and DDP. Another patient received 1 course of paclitaxel chemotherapy. All the patients remained well except one lost in the follow-up and no one revealed evidence of recurrence. Conclusions POCTs show good biological behaviour and are not easy to spread distantly. They usually grow slowly with low malignancy. The definitive treatment of these turnouts is surgery, with an excellent prognosis in the early stage. Long-term follow-up is recommended as the tumours may recur many years later.