青少年卵巢混合性生殖细胞肿瘤一例并文献复习

Adolescent Mixed Ovarian Germ Cell Tumor:A Case Report and Literature Review

卵巢恶性生殖细胞肿瘤(malignant ovarian germ cell tumor,MOGCT)来源于胚胎原始生殖细胞,好发于儿童、青少年和年轻女性,多涉及保留生育功能问题。报告1例15岁的卵巢混合性生殖细胞肿瘤病例,患者运动后突发左下腹痛,经腹彩色超声示盆腔中低回声包块,经腹腔镜探查术发现左侧卵巢巨大肿物破裂,引起腹腔内大出血。行左侧附件切除术,术后查血清甲胎蛋白(alpha fetoprotein,AFP)、糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)和人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)升高。病理结果示混合性生殖细胞肿瘤,以胚胎癌为主,可见绒毛膜癌成分及少许卵黄囊瘤、畸胎瘤成分。术后第11天正电子发射体层成像(positron emission tomography,PET)/CT显示无残留病灶,行平阳霉素+依托泊苷+顺铂(BEP)方案化疗4个周期,AFP、hCG于第2个周期后降至正常。至2022年2月患者月经恢复,随访至2022年5月无复发迹象。

Malignant ovarian germ cell tumor(MOGCT)are derived from primitive germ cells of embryos and occur mostly in children,adolescents and young women,so preserving the function of reproduction must be taken into consideration.We report a case of a 15-year-old girl presented with acute left lower abdominal pain after exercise.Transabdominal color ultrasound suggested a hypoechoic mass in the pelvic cavity and a ruptured left ovarian mass which caused massive intraperitoneal hemorrhage was found via laparoscope.Unilateral salpingo-oophorectomy was admitted,and serum alpha fetoprotein(AFP),carbohydrate antigen 19-9(CA19-9)and human chorionic gonadotropin(hCG)were increased postoperatively.Pathological results revealed a mixed ovarian germ cell tumor with dominant components of embryonal carcinoma and choriocarcinoma,and a few yolk sac tumor and teratoma.On the 11th day after surgery,positron emission tomography(PET)/CT showed no residuals.Four cycles of chemotherapy with the regimen of Ping-Yangmycin+etoposide+cisplatin(BEP)were performed.Her serum AFP and hCG came normal after two cycles of chemotherapy.Menstruation was resumed by February 2022 and there was no signs of recurrence until May 2022.