卵巢成熟性畸胎瘤恶变的临床病理学分析

Clinicopathological Analysis of Malignancy of Mature Teratoma of Ovary

目的:探讨卵巢成熟性畸胎瘤恶变的临床病理特征。方法:选择2009年1月至2020年12月收治的卵巢成熟性畸胎瘤1476例,回顾性分析其中伴恶变17例的临床及病理学资料。结果:卵巢成熟性畸胎瘤恶变比例1.15%,平均年龄47.2岁(25~80岁),其中肿块最大直径9.5±4.0 cm(4.0~17.5 cm)。143例处于绝经后,其中7例(4.89%)恶变,1333例为绝经前患者,有10例(0.75%)恶变,绝经后恶变比例高于绝经前(P<0.05)。术前6例血清肿瘤标志物升高,2例术前影像学确诊为畸胎瘤恶变。病理检查恶变成分为鳞癌11例,腺癌3例,类癌3例。随访时长13~116个月,其中2例复发,4例死亡,其余患者均无病存活。结论:卵巢成熟性畸胎瘤恶变可发生于任何年龄,但绝经后畸胎瘤恶变比例高,以鳞癌最常见。术前影像学及血清肿瘤标志物诊断价值有限,准确的诊断依赖于病理检查。

Objective:To investigate the clinicopathological characteristics of malignant transformation of mature teratoma of ovary.Methods:From January 2009 to December 2020,1476 cases of mature teratoma of ovary in our hospital were retrospectively analyzed,including 17 cases with malignant transformation.The clinical and pathological data were extracted and analyzed.Results:The average age of mature teratoma of ovary was 47.2 years old(23 to 80 years old),the maximum diameter of the tumor was 9.5± 4.0 cm(4.0 to 17.5 cm),143 cases were postmenopausal,7 cases(4.89%)were malignant,and 1333 cases were premenopausal,10 cases(0.75%)were malignant.The proportion of malignant changes after menopause was higher than that before menopause(P<0.05).6 cases had elevated serum tumor markers before surgery,and 2 cases were diagnosed as teratoma malignant by preoperative imaging.There were 11 cases of squamous cell carcinoma,3 cases of adenocarcinoma and 3 cases of carcinoid carcinoma.Follow-up ranged from 13 months to 116 months,of which 2 patients relapsed and 4 died.All the other patients survived without disease.Conclusions:Malignant transformation of mature teratoma of ovary can occur at any age,but the proportion of malignant degeneration is high after menopause,and squamous cell carcinoma is the most common.The diagnostic value of preoperative imaging and serum tumor markers is limited,and the accurate diagnosis depends on pathological examination.