卵巢成熟性畸胎瘤恶变22例临床病理分析  

Malignant transformation in mature teratoma of the ovary:a clinicopathologic study of 22 cases

作　　者：杨旭丹[1] 王雷[1] 王晓卿[1] 傅静[1] 刘裔莎[1] 张潇潇[2] 廖治[2] 徐钢[1] 

机构地区：[1]四川省医学科学院.四川省人民医院病理科,成都610072 [2]四川省医学科学院.四川省人民医院妇产科,成都610072

出　　处：《临床与实验病理学杂志》2015年第1期19-23,28,共6页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨22例卵巢成熟性畸胎瘤恶变的临床病理学特征。方法回顾性分析1 826例卵巢成熟性畸胎瘤,对其中22例伴有体细胞恶变的病例进行临床病理学特征分析并行免疫组化染色。结果 22例成熟性畸胎瘤恶变占同期1 826例卵巢畸胎瘤的1.2%。患者年龄31~79岁,平均56.5岁。临床主要表现为盆腔包块,其中恶变位于左侧卵巢13例,右侧8例,双侧同时累及1例。畸胎瘤大体呈囊性19例,囊实性3例,其中双侧发生的1例左侧为实性、右侧为囊性。畸胎瘤最大径5.0~30.0 cm,平均12.4 cm;恶变成分最大径1.0~10.0 cm,平均3.7 cm。恶变成分为中~低分化鳞状细胞癌14例、类癌4例、腺癌2例、甲状腺乳头状癌2例、肉瘤样癌1例。临床分期：ⅠA期16例,ⅠB期1例,ⅡA期1例,ⅡB期4例。随访6例复发,2例死亡,其余截止随访时均存活。结论卵巢成熟性畸胎瘤中伴有体细胞恶变的发生率低,多见于绝经后女性并表现为盆腔包块,恶变成分组织学上以鳞状细胞癌多见,Ⅰ期患者预后较好。临床与病理医师应重视成熟性畸胎瘤的全面检查及诊断,以防漏诊其中的恶变成分。Purpose To study the clinicopathological characteristics in 22 cases of ovarian mature teratoma with malignant transformation. Methods Clinical and pathologic features were collected and analyzed in 22 out of 1 826 cases of ovarian mature teratoma by retrospective studies,together with immunohistochemical staining. Results In our study,22 cases（ 1. 2%） of ovarian mature teratoma with malignant transformation were identified. The median age was 56. 5（ range,31 ~ 79） years. The main clinical manifestations were pelvic masses,including 13 cases in the left ovary,8 cases in the right,1 case was bilateral. Gross cystic teratoma were saw in19 cases,3 cases of cystic and solid,the bilateral one was solid in the left which the right was cystic. The teratomas size were 5. 0 ~30 cm with average 12. 4 cm in diameter. The malignant components’ maximum diameter was about 1. 0 ~ 10. 0 cm with average 3. 7cm. Microscopicically,there were poorly differentiated squamous cell carcinoma in 14 cases,carcinoid carcinoma in 4 cases,adenocarcinoma in 2 cases,papillary thyroid carcinoma in 2 cases,and the last one was sarcomatoid carcinoma. The FIGO stage distribution was as follows： 16 were stage IA,1 was stage IB,1 was stage IIA,4 were stage IIB. Follow up showed 6 cases recurrened,2 patients died,the rest are survival. Conclusions A low incidence of ovarian mature teratoma in somatic cells with malignant transformation,which are common in postmenopausal women and present with pelvic mass. The main malignant components is squamous cell carcinoma,patients of stage I have better prognosis. Both clinic and pathology should take more attention to the comprehensive examination and diagnosis of teratoma for prevent misdiagnosis.

关 键 词：卵巢肿瘤 成熟性畸胎瘤 恶变 临床病理 

分 类 号：R737.31[医药卫生—肿瘤]