卵巢粒层细胞瘤临床病理特点及相关因素分析  

Clinical and Pathological Analysis on Ovarian Granolosa Cell Tumors

作　　者：游小林[1] 尹如铁[1] 李克敏[1] 王丹青[1] 李雷[2] 杨开选[2] 

机构地区：[1]四川大学华西第二医院妇产科,成都610041 [2]四川大学华西第二医院病理科,成都610041

出　　处：《四川大学学报（医学版）》2010年第3期467-470,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探讨成人型和幼年型粒层细胞瘤的发病率及其不同临床病理特征,对卵巢粒层细胞瘤的诊治提供一定参考意见。方法回顾性分析2001年4月至2009年9月我院收治的42例粒层细胞瘤病例,分析成人型及幼年型粒层细胞瘤患者的临床病理特征、治疗方法及随访结果。结果 42例中4例为2001年以前初发,2001年后复发的患者。38例初诊患者(成人型29例,幼年型9例)占我院同期卵巢恶性肿瘤患者的3.13%。成人型中位发病年龄为53岁,幼年型25岁,差异有统计学意义(z=-2.990,P=0.003)。临床最常见的症状和体征分别为腹痛腹胀(44.7%)、阴道不规则流血或月经紊乱(42.1%)及盆腹腔包块(76.3%);最常见的合并症是宫内膜单纯性或复杂性增生(52.6%);其次为子宫肌瘤(21.1%)。38例初诊患者Ⅰ期占73.7%,Ⅱ期23.7%,Ⅲ期2.6%。根据患者年龄、分期、病情等行单侧附件切除或肿瘤剥除者10例,子宫加双附件切除者20例,肿瘤细胞减灭术者8例。42例患者随访7～175月,失访14例,随访中无患者死亡。免疫组化检测结果示抑制素、钙视网膜蛋白、波形蛋白阳性有助于诊断该病。结论卵巢粒层细胞瘤为低度恶性肿瘤的功能性肿瘤,发病率低,多为单侧发病。与上皮性卵巢癌相比,粒层细胞瘤腹水征较少,但也可出现急腹症。粒层细胞瘤较易早期发现,预后较好,但易远期复发,应坚持长期随访监测。Objective To identify different clinical and pathological features for adult and juvenile granulosa cell tumors.Methods The clinical records of 42 patients with granulosa cell tumors of ovary,including pathological features,treatments and follow up results between April 2001 and September 2009 were reviewed.Results ① There were 38 newly diagnosed cases after 2001,and 4 cases were relapsed cases diagnosed before 2001.The 38 cases accounted for 3.13% of ovarian cancer cases treated in our hospital.② Twenty nine of the 38 cases（76.3%） were Adult Type,while the other 9（23.7%） were Juvenile Type.The median onset age were 53 and 25 years old for the Adult Type and Juvenile Type,respectively,which shows significant difference（z=-2.990,P=0.003）.③ The most common symptoms and signs were abdominal pain（44.7%）,vaginal bleeding（42.1%）,and abdominal mass（76.3%）.The most common complications were endometrial hyperplasia（52.6%） and hysteromyoma（21.1%）.④ Stage Ⅰ,Ⅱ and Ⅲ comprised 73.7%,23.7% and 2.6% of the 38 cases,respectively.Ten patients ng the underwent conservative unilateral oophorectomy or ovarian enucleation.Twenty patients underwent total abdominal hysterectomy plus bilateral salpingo-oophorectomy.Eight patients underwent cytoreductive surgery.The 42 patients had been followed up for 7 to 175 months,with 14 patients lost of contact.No death was recorded.Inhibin,calretinin,and vimentin were demonstrated to be useful for the diagnosis of granulose cell tumors.Conclusion With low incidence rate,ovarian granulosa cell tumor is a low-grade malignant and functional tumor.Most are unilateral diseases.Most Adult-type granulosa cell tumors occur in middle aged and elderly people,while most juvenile granulosa cell tumors occur in adolescents and children.Acute abdomen symptom may occur but ascites are less likely to occur in patients with granular cell tumors than those with epithelial ovarian cancers.Ovarian granulosa cell tumors are usually detected early,but easily relapse.Long-te

关 键 词：卵巢肿瘤 成人型卵巢粒层细胞瘤 幼年型卵巢粒层细胞瘤 

分 类 号：R737.31[医药卫生—肿瘤]