复发性卵巢成人型颗粒细胞瘤12例

Characteristics and treatment results of 12 cases of recurrence adult-type granulosa cell tumor of ovary

目的探讨复发性卵巢成人型颗粒细胞瘤(AGCT)的临床特点及预后影响因素。方法回顾性分析我院诊治的12例复发性AGCT患者的临床资料。结果12例患者确诊复发距离初次治疗的中位间隔时间为96月(9~228月),近期复发(<10年)7例,远期复发(≥10年)5例。5例远期复发患者80.0%为Ⅰ期肿瘤,80.0%患者的核分裂象≤5个/10 HPF。7例近期复发患者中晚期(Ⅱ~Ⅲ期)占71.4%,85.7%患者的核分裂象>5个/10 HPF,2例≥10个/10 HPF。盆腔复发9例,合并腹腔复发6例,合并腹腔及肝脏转移3例,合并阴道右侧顶端包块1例;腹膜后转移3例。复发后11例接受再次手术治疗,接受再次手术患者9例复发后接受辅助化疗,2例术后无治疗。结论AGCT是一种低度恶性、晚期复发、多部位复发的肿瘤。无进展生存期越长的患者,复发后预后越好。晚期、病理结果核分裂象及异型性高的患者更容易复发。淋巴结肿大患者应积极行淋巴结清扫术,最大限度的减瘤手术结合术后辅助化疗可以改善复发性AGCT患者的预后。

Objective To investigate the clinical characteristics and prognostic factors of recurrent adult granulosa cell tumor(AGCT).Methods The clinical data of 12 patients with recurrent AGCT in our hospital were retrospectively analyzed.Results The median time to relapse after primary treatment was 96 months(range,9-228 months),among early recurrence were in 7 patients(<10 years),which late recurrence appeared in 5 patients(≥10 years)。80%of late recurrence tumors had stage I and 80.0%had mitotic rates of less than or equal to 5/10 HPF;71.4 ofthe early recurrence tumors had middle or late stage and 85.7%had mitotic rates of over 5/10 HPF(2 had greater than or equal to 10/10 HPF)。Of the 12 patients,9 cases of pelvic recurrence,6 cases of abdominal recurrence,3 cases of abdominal and liver metastasis,and 1 case of right vaginal apical mass.Retroperitoneal metastasis in 3 cases.11 patients received reoperation after recurrence,9 patients received adjuvant chemotherapy after recurrence,with 2 patients received no treatment.Conclusions AGCT is a kind of tumor with low grade malignancy,late recurrence and multiple site recurrence.The longer the PFS,the better the prognosis after recurrence.Patients with advanced stage,pathological findings and high mitotic figures and atypia are more likely to recurrence.Lymphadenectasis patients should be actively performed lymphadenectasis,the maximum degree of tumor reduction surgery combined with postoperative adjuvant chemotherapy can improve the prognosis of patients with recurrent AGCT.