22例Sertoli-Leydig细胞瘤的临床病理及预后分析

The clinical pathology and prognosis analysis of 22 SLCT cases

目的：分析Sertoli-Leydig细胞瘤的发病情况、临床表现及病理特征,并探讨合理的治疗方法。方法：回顾分析1998年1月至2012年8月在复旦大学附属妇产科医院接受诊治的22例Sertoli-Leydig细胞瘤患者的临床表现、分期、病理特点、治疗及预后情况。结果：患者的发病年龄为17～68岁,平均（40.9±18.3）岁;20例ⅠA期,2例ⅠC期。病例均发生于单侧卵巢。7例患者术前接受激素水平检测,术前睾酮（T）为0.22～5.9ng/ml,平均（2.91±2.01）ng/ml;其中1例术前T在正常范围。12例患者术后接受激素水平检测,其中10例患者的术后T为0.01～0.58ng/ml,平均（0.31±0.17）ng/ml,较术前显著下降（P〈0.05）。术前的B超检查无显著特异性。22例患者均行手术治疗,手术范围从卵巢囊肿剥除术到全面分期手术不等。化疗途径包括静脉和腹腔化疗,多采用PEB方案。22例患者的术后标本免疫组化中,Inhibin-a（＋）16例,Vimentin（＋）14例,EMA（-）18例。21例患者无病生存至末次随访日期。结论：SertoliLeydig细胞瘤作为一种发病率极低的卵巢肿瘤,术前明确诊断相对困难。对于怀疑此类疾病的患者,检测T的水平可帮助诊断。患者总体预后较好,对于未生育者可根据病情行保留生育功能的手术。

Objective： To analyze the occurrence,clinical and pathological features of Sertoli-Leydig cell tumor,and to explore its proper treatment modality. Methods： Prospectively analyzed22 cases of SLCT treated in our hospital from Jan. 1998 to Aug. 2012 on clinical manifestation,stage,pathological features,treatment and prognosis. Result： The patient age of onset range from 17 to 68,with an average of（ 40. 9±18. 3） years old. 20 cases were stageⅠAand 2 were stageⅠC. All the cases were discovered in one ovary. 7 patients received blood testosterone test before surgery,and the results ranged from 0. 22ng /ml to 5. 9ng /ml,average（ 2. 91±2. 01） ng /ml. 1 patient tested normal before surgery. The testosterone test result of 10 patients after surgery ranged from 0. 01ng /ml to0. 58ng /ml,average（ 0. 31±0. 17） ng /ml,reduced with statistical significance（ P〈0. 05）. B ultrasound test showed no specificity for this tumor. 22 patients received surgery,from ovarian cystectomy to comprehensive staging surgery. Chemotherapy pathways included intravenous and intraperitoneal injection,and the PEB regimen was mostly adopted. The immunohistochemistry test of the 22 cases showed 16 cases of Inhibin-a（ ＋）,14 Vimentin（ ＋）,and 18 EMA（-）. 21 patients were recurrencefree till the date of last follow-up. Conclusions： SLCT,as a type of ovarian tumor with extremely low incidence,is comparatively difficult to be diagnosed unequivocally before surgery. Testosterone test before surgery may help with diagnosis. Overall prognosis is generally good,and for those who haven＇t given birth,fertility sparing surgery should be considered according to individual condition.