原发性卵巢恶性苗勒管混合瘤10例临床和病理分析  

Clinicalpathologic Analysis of 10 Cases of Malignant Mixed Mullerian Tumors of the Ovary

作　　者：李艺[1] 杜海燕[1,2] 杨柳[3] 郭红燕[3] 崔恒[1] 

机构地区：[1]北京大学人民医院,北京100044 [2]重庆市丰都市中医院 [3]北京大学第三医院,北京100191

出　　处：《实用妇产科杂志》2012年第6期437-441,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:分析原发性卵巢恶性苗勒管混合瘤(OMMMT)的临床和病理特点,以期提高诊治水平。方法:回顾性分析收集的10例OMMMT患者临床和病理资料,对其年龄、临床症状、血清CA125水平、手术分期、残留病灶、病理结果、化疗方案、化疗反应率、药物不良反应和生存情况进行分析。结果:OMMMT患者平均年龄60.1岁,主要临床表现是腹胀、腹痛和腹部包块。血清CA125均升高。Ⅱ期1例,Ⅲ期8例,Ⅳ期1例。所有患者首先接受肿瘤细胞减灭术,5例无肉眼残留,3例残余病灶<2cm,2例残留病灶>2cm。病理检查上皮癌成分有子宫内膜样腺癌、浆液性腺癌和透明细胞癌;肉瘤成分同源性7例,异源性2例,同源性和异源性同时存在1例。所有患者术后均接受了以铂类为基础的联合化疗。7例采用紫杉醇+卡铂/顺铂方案化疗,完全缓解率是71.4%(5/7),总反应率是85.7%(6/7),仅2例出现Ⅲ度以上骨髓抑制;1例采用异环磷酰胺+多柔比星+顺铂方案化疗,获得完全缓解,但出现Ⅳ度骨髓抑制;2例经济条件差的患者采用环磷酰胺+多柔比星+顺铂方案化疗,获得完全缓解,药物不良反应轻微。随访复发3例,8例患者存活(3例带瘤生存,5例无瘤生存),1例死亡,失访1例。结论:OMMMT患者年龄大、分期晚,确诊依靠病理检查。治疗原则参照卵巢上皮性癌的治疗方案,首选肿瘤细胞减灭术,紫杉醇+铂类为基础的联合化疗作为一线化疗方案,异环磷酰胺+顺铂作为二线化疗方案。Objective：To summarize the clinical pathologic features of malignant mixed mullerian tumors of the ovary （OMMMT） and to improve the diagnosis and treatment experience. Methods：The medical re- cords of 10 patients was retrospectively reviewed, which included age, symptom, serum CA125 level, FIGO stage, residual tumor size, pathologic findings, chemotherapy regimen and compared the response rate to chemotherapy, side effect and survival. Results：The average age was 60. 1 years, the main symptoms were abdominal distension, pain and mass. CA125 was elevated in all patients. One patient was FIGO stage IIc, eight were stage III, one was stage IV. All patients received cytoreductive surgery, and eight were opti- mal, five patients had no visual residual tumor, only two was suboptimal （ 〉 2 cm）. Pathologic results showed the epithelial components were serous, endometrial and clear cell adenocarcJnoma. Seven had ho- mologous sarcomatous components, two had heterologous sarcomatous components, and one had both. All patients were treated with platinum-based chemotherapy. The overall response rate to paclitaxel and cis-pla- tin/carboplatin was 85.7% （6/7） and the complete response rate was 71.4% （5/7）, only two cases had grade III myelosuppression. One patient using ifosfamide, cis-platin and epirubicin achieved complete re- sponse but with grade IV myelosuppression. Two patients using cyclophosphamide, cis-platin and epirubicin because of economic reasons also got complete response with mild side effect. Three patients relapsed dur-ing follow-up, eight patients survived（three survived with tumor, five survived without tumor） ,only one patient died of the disease, one patient lost follow-up. Conclusions： The OMMMT patients are elder and with ad- vanced stage. Treatment strategy can refer to epithelial ovarian carcinoma, cytoreductive surgery combined with paclitaxel and platinum-based chemotherapy may be the first line therapy, ifosfamide and cis-platin may be considered as,second line choice.

关 键 词：卵巢 苗勒管混合瘤 病理 手术 化疗 

分 类 号：R737.31[医药卫生—肿瘤]