良、恶性卵巢甲状腺肿的临床和病理特征分析  

Clinicopathological analysis of benign and malignant struma ovarii

作　　者：田明[1] 孔秋 候晓晓 苗劲蔚[1] Tian Ming;Kong Qiu;Hou Xiaoxiao;Miao Jinwei(Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing 100006, China;Department of Gynecologic Oncology, Beijing Chaoyang Integrative Medicine Emergency Medical Center, Beijing 100022, China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院妇科肿瘤科,北京100006 [2]北京朝阳中西医结合急诊抢救中心妇科肿瘤科,北京100022

出　　处：《首都医科大学学报》2022年第3期343-349,共7页Journal of Capital Medical University

基　　金：北京市自然科学基金面上项目(7162063);首都医科大学附属北京妇产医院中青年学科骨干培养专项(FCYY202007)。

摘　　要：目的探讨良、恶性卵巢甲状腺肿(struma ovarii,SO)的临床和病理特征,分析诊断与治疗方法。方法收集2009年3月至2021年8月首都医科大学附属北京妇产医院及北京朝阳中西医结合急诊抢救中心经手术病理证实的80例良性SO、13例恶性SO患者的年龄、症状、体征等一般资料,进行超声检查及血清学肿瘤标志物的检测。良、恶性SO患者均行手术治疗,术后常规进行肿物大体及石蜡苏木精-伊红(hematoxylin-eosin,HE)染色镜下病理分析明确诊断,对于恶性患者根据手术病理进行国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期并依据美国国家综合癌症网络(National Comprehensive Cancer Network,NCCN)指南补充治疗。结果绝大多数SO患者无明显临床症状,多发生于单侧卵巢。超声表现不特异,常为形态规则的多房囊实性肿物。13例恶性SO病理均为Ⅰ期卵巢甲状腺肿类癌。15例进行了免疫组化检测的患者中甲状腺转录因子-1(thyroid transcription factor-1,TTF-1)、甲状腺球蛋白(thyroglobulin,TG)均为阳性,Ki67表达水平低。良性SO中仅16例(20%)患者出现了肿瘤标志物的升高,恶性SO中3例(23.08%)患者出现了糖类抗原199(carbohydrate antigen 199,CA199)水平的轻度升高。腹腔镜是良性SO手术的主要入路,41例(51.25%)患者行卵巢囊肿剥除术。经腹是恶性SO手术的主要入路,仅5例(38.46%)患者进行了卵巢肿瘤分期术,4例术后补充化学药物治疗。结论SO发病率低,临床表现、超声、血清肿瘤标志物无特异性,如合并腹水时极易与上皮性卵巢恶性肿瘤相混淆。SO剖面典型表现为多房囊实性,可见胶冻样组织物及陈旧出血灶,质地不糟脆。手术切除是主要的诊断及治疗方法。Objective To investigate the clinicopathology features of benign and malignant struma ovarii(SO)and analysis the diagnosis and treatment.Methods The ages,symptoms,signs and other general data of 80 patients with benign SO and 13 patients with malignant SO confirmed by surgery and pathology were collected from March 2009 to August 2021 in Beijing Obstetrics and Gynecology Hospital,Capital Medical University and Beijing Chaoyang Integrative Medicine Emergency Medical Center.Ultrasound examination and serum tumor marker test were performed.Both benign and malignant SO patients received surgical treatment.The diagnosis was confirmed by routine postoperative pathological analysis of the gross mass and paraffin hematoxylin-eosin(HE)staining.For malignant patients,The International Federation of Gynecology and Obstetrics(FIGO)staging was performed according to surgical pathology and supplementary treatment was performed according to National Comprehensive Cancer Network(NCCN)guidelines.Results The majority of SO patients did not show obvious clinical symptoms,most of which occurred in unilateral ovary.The ultrasound findings were nonspecific and often showed regular multilocular cystic solid masses.All 13 patients with malignant SO were stage I ovarian thyroid carcinoid.Among the 15 patients who underwent immunohistochemical test,thyroid transcription factor-1(TTF-1)and thyroglobulin(TG)were positive,and Ki67 expression level was low.Only 16 patients(20%)in benign SO had elevated tumor markers,while carbohydrate antigen 199(CA199)levels of 3 patients(23.08%)in malignant SO had slightly elevated.Laparoscopy is the main approach for benign SO surgery,and 41 patients(51.25%)underwent ovarian cystectomy.Transabdominal surgery is the main approach for malignant SO surgery,only 5 cases(38.46%)were performed with ovarian tumor staging,and 4 patients received postoperative supplementary chemotherapy.Conclusion The incidence of SO is low.The clinical manifestations,ultrasound and serum tumor markers are not specific.Patients wit

关 键 词：卵巢甲状腺肿 临床病理特征 诊断 

分 类 号：R737.31[医药卫生—肿瘤]