卵巢Sertoli-Leydig细胞瘤13例临床诊治分析

A Clinical Analysis of 13 Cases of Ovarian Sertoli-Leydig Cell Tumor

目的:提高对卵巢Sertoli-Leydig细胞瘤(Sertoli-Leydig cell tumor,SLCT)的认识及治疗水平。方法:回顾性分析2014年6月—2021年7月首都医科大学附属北京妇产医院收治的经手术、病理确诊的13例卵巢SLCT患者的病例资料,分析其临床特点、诊断、治疗及预后。结果:13例患者发病年龄为13~72岁,中位年龄31岁。8例患者(61.5%)血清睾酮水平升高并出现雄激素过多的临床表现,3例(23.1%)患者表现为异常子宫出血,另2例(15.4%)无明显临床症状。影像学主要表现为附件区囊实性或实性肿物。13例患者均行手术治疗,术后均经组织学病理及免疫组织化学检查确诊为卵巢SLCT,其中ⅠA期11例,ⅠC期2例。4例在病理诊断明确、前次手术间隔1~2个月后行二次手术,行患侧附件切除及盆腹腔多点活检。2例ⅠC期患者术后行博来霉素+依托泊苷+顺铂(BEP)方案化疗。13例患者术后中位随访时间为33个月,均未见复发。结论:女性有异常内分泌症状、附件区囊实性或实性肿物,应考虑卵巢SLCT的可能性;治疗以手术为主,术中和术后病理明确SLCT诊断,酌情联合化疗;建议术后多学科联合随访。

Objective:To improve the diagnosis and treatment of ovarian Sertoli-Leydig cell tumor(SLCT).Methods:Thirteen cases of ovarian SLCT admitted between June 2014 and July 2021 were analyzed retrospectively,including their clinical characteristics,diagnosis,treatment and prognosis.Results:The median age of onset was 31 years(13-72 years)in 13 patients.Eight patients(61.5%)had the androgenic manifestations(due to the elevated levels of testosterone),3 patients(23.1%)presented with abnormal uterine bleeding,and the other two patients(15.4%)had no obvious clinical symptoms.Imaging mainly showed cystic-solid tumors or solid tumors.All 13 patients underwent surgery,and diagnosed with ovarian SLCT by histopathology and immunohistochemistry.Eleven patients were at stageⅠA,and 2 patients at stageⅠC.Four patients underwent the complementary surgery to resect the affected adnexa and perform the multi-point pelvic and abdominal biopsy after 1-2 months of the initial operation and histopathological diagnosis.Two patients with SLCT at stageⅠC underwent postoperative chemotherapy with the bleomycin+etoposide+cisplatin(BEP)regimen.The median follow-up time after surgery was 33 months.None of the 13 patients had a recurrence.Conclusions:Ovarian SLCT should be considered when women had abnormal endocrine symptoms and ovarian cystic-solid or solid masses.Surgery is main treatment for SLCT patient,and operative and postoperative histopathology will confirm the diagnosis of ovarian SLCT.Postoperative chemotherapy can be accordingly considered,and the postoperative multidisciplinary follow-up has been suggested.