妊娠合并卵巢幼年型颗粒细胞瘤一例报告及文献复习

Juvenile Granulose Cell Tumor during Pregnancy:A Case Report and Literature Review

目的:分析妊娠合并卵巢幼年型颗粒细胞瘤(juvenile granulosa cell tumor,JGCT)的临床特点、诊断要点、治疗及预后,提高鉴别诊断水平。方法:回顾性分析1例妊娠合并JGCT病例资料,复习相关文献。结果:患者27岁,因停经39^(+3)周,间断右下腹疼痛3 d入院。彩色超声提示右下腹部一8.5 cm×6.1 cm囊实混合回声。查糖类癌抗原125(CA125)32.3 U/m L,CA19-9为19.1 U/m L,诊断为先兆临产,盆腔包块(性质待排),行剖宫产术+剖腹探查术,探查见右侧卵巢一囊性肿物,已破溃,行右侧卵巢肿物切除术,术后病理诊断为卵巢JGCT。行二次手术,给予右侧卵巢输卵管切除术+左侧卵巢活检术+盆腔淋巴结取样术+部分大网膜切除术+阑尾切除术+盆腔粘连松解术。术后予顺铂+长春新碱+博莱霉素(PVB方案)化疗3个疗程,随访8个月,肿瘤无复发。结论:JGCT是一种罕见的恶性肿瘤,发生于妊娠期者更为罕见,确诊需依赖病理及免疫组化检查。

Objective：To analyze clinical features,diagnosed key points, treatment and prognosis of juvenile granulose cell tumor（JGCT） during pregnancy in order to improve the level of differential diagnosis. Methods：To analyze retrospectively clinical data of 1 patient with JGCT occurred of pregnancy and review relevant literatures. Results：A 27-year-old female patient was admitted for menolipsis after 39^（＋3） weeks, intermittent right lower abdomen pain 3 days. Ultrasonography suggested that there was a mixed echogenic mass in the right lower abdominal containing solid and cystic components. The cancer antigen-125（CA125） was 32.3 U/m L, CA19-9 was 19.1 U/m L. Preoperative diagnosis was threatened labor and pelvic mass（uncertain quality）. Cesarean delivery and exploratory laparotomy were carried out. A cystic mass ruptured was founded in the right ovary. Resection of the right ovarian mass was performed. And the postoperative pathological diagnosis was ovarian JGCT.The second laparotomy was given： resection of the right ovary and fallopian tube,a wedge biopsy of the left ovary,pelvic lymph node biopsy, part of the large net excision and appendectomy. The patient received postoperative chemotherapy with cisplatinum, vincristine and Blenmyc（PVB） for 3 courses. And the tumor had no recurrence for eight monthes. Conclusions：JGCT is rare, especially in pregnancy. Diagnosis can be confirmed by pathological examination and immunohistochemical staining.