特殊临床表现的卵巢成熟型畸胎瘤12例临床分析

Clinical analysis of 12 patients with specific clinical manifestations of ovarian mature teratoma

目的总结12例具有特殊表现的卵巢成熟型畸胎瘤的临床特点和处理的经验。方法于2003年2月至2013年5月间,北京协和医院共收治卵巢成熟型畸胎瘤手术患者3 688例,其中选取12例罕见临床表现的患者,进行回顾性分析。结果在12例患者中,8例出现月经改变甚至闭经,其中3例有高雄激素血症,1例表现高泌乳素血症和泌乳;3例为抗N-甲基-D-天冬氨酸（NMDA）受体脑炎综合征,主要表现为精神神经系统异常症状,其中大笑、大喊、胡言乱语等精神症状1例,发作性四肢抽搐、意识障碍等神经症状2例;另1例表现为腹痛伴发热,大便中排出油脂、毛发。12例均经手术治疗,术后病理均证实为卵巢成熟型畸胎瘤,未发生死亡及术后并发症;术后症状和体征均明显缓解甚至完全消失;术后随访14~101个月,未再出现肿瘤或症状复发。结论卵巢成熟型畸胎瘤尽管临床表现不典型,但是通过体格检查和影像学辅助检查可得到诊断,并通过手术治疗能达到满意效果。提高对本病的认识,进行妇科及盆腔影像学检查是获得早期诊断、及时治疗,并取得良好预后的关键。

Objective： To summarize the clinical characteristics and explore the diagnosis and management of 12 patients with ovarian mature teratoma. Methods： The data of twelve patients with special clinical manifestations of ovarian mature teratoma selected from 3 668 patients with ovarian mature teratoma treated in Peking Union Medical College Hospital between February 2003 and May 2013 were retrospectively reviewed. Results： In the 12 patients,8 patients had the manifestations of menstrual changes,even amenorrhea. Among 8 patients,3 patients had hyperandrogenemia and 1 patient had hyperprolactinemia and lactation. Three patients had the manifestations of neuropsychiatric symptoms, and finally diagnosed as anti-N- methyl-D-aspartate receptor encephalitis syndrome. Among 3 patients, 1 patient presented with psychiatric symptoms as laughing,shouting and talking nonsense, and another 2 patients with neurological symptoms as paroxysmal convulsion of the limbs, disturbance of consciousness. The last patient had abdominal pain and fever,abnormal stool with fat and hair. All the 12 patients were treated by operation,and the diagnosis of ovarian mature teratoma confirmed postoperative pathologic examination. No death or complication was associated with the operation. There was no recurrence during 14 to 101 months follow-up. Conclusions： Although the clinical manifestations were atypical, ovarian mature teratoma can bediagnosed by pelvic and imaging examination. Ovarian mature teratoma can be cured by surgical treatment. Early diagnosis and timely treatment are the key to obtain a favorable outcome.